Sciatica care in Clarksville

Sciatica is pain from an irritated or compressed sciatic nerve, the nerve that runs from your lower back to your feet. It usually shows up in your bottom and the back of one leg, and it can come with tingling, numbness or weakness. The name tells you where it hurts. It doesn't tell you what's irritating the nerve, and several different problems can. That's why our Clarksville chiropractors look for the cause first and talk about treatment second. This page covers where sciatica is felt, why it can be worse at night, how long it tends to last, what happens at a visit with us, and the signs that mean the ER.

When is sciatica an emergency?

Go to an emergency room now for any of these. Please don't wait to see us first:

• Loss of bladder or bowel control, or new difficulty passing urine
• A change in the sensation of passing urine, such as not feeling the flow, or losing the sense of when the bowel is full
• Numbness in the saddle area: the inner thighs, buttocks, or around the genitals
• New sexual dysfunction, including new numbness in the genitals
• New or worsening weakness in both legs
• Severe back pain with fever, or an unexplained fever with new back pain. Either alone is enough

Most of these can be signs of cauda equina syndrome, an emergency involving the nerves at the bottom of the spinal canal, and back pain that comes with a fever also needs urgent medical assessment. The NHS's emergency list also includes sciatica on both sides, and finding it hard to start peeing or noticing when you need to poo. Cauda equina syndrome is an immediate ER referral from our office. So is a blood clot in the leg:

• A calf or leg that is swollen, warm, red or tender, especially in one leg only
• Sudden shortness of breath or chest pain, which can mean a clot has moved to the lungs. Call 911

The NHS lists throbbing pain in one leg, usually in the calf or thigh, swelling, and red, blue or darkened skin as signs of deep vein thrombosis, and says to get emergency care if those come with shortness of breath or chest pain.

Some other signs need prompt medical care too. MedlinePlus lists reasons to contact a provider right away, including weakness or numbness in the buttocks, thigh, leg or pelvis, back pain after a severe blow or fall, and an unexplained fever with back pain. It lists unintentional weight loss as another reason to get in touch.

Why do you feel sciatica in your buttock and leg?

The sciatic nerve starts in the lower back and runs through the buttock and down the back of the leg, so pressure on it near the spine can be felt a long way from the spine. MedlinePlus describes sharp pain in one part of the leg or hip with numbness in other parts, sometimes reaching the back of the calf or the sole of the foot, and a leg that may feel weak. Cleveland Clinic says sciatica symptoms can affect the lower back, butt and legs.

A sore buttock isn't always sciatica, though. MedlinePlus lists piriformis syndrome, a pain disorder involving a narrow muscle in the buttocks, among the common causes of sciatica, and not every leg or buttock pain involves the nerve at all. Our guides to hip pain and arm and leg pain cover other possible sources, and we look at your back and leg symptoms together.

How the pain behaves helps us sort out which it is. MedlinePlus says sciatica pain may get worse after standing or sitting, at night, or when sneezing, coughing or laughing.

Why can sciatica hurt more at night?

Night is one of the times MedlinePlus lists when sciatica pain may get worse. Lying down takes most of the pressure off the discs compared with standing, as one measurement study found, but a sleeping position is still a posture you hold for hours, and our guide to sleep and your spine walks through what each one does. Face up with the legs straight, the curve of the low back deepens, and a pillow under the knees lets the hips and knees bend a few degrees. Side-lying, the top leg tends to fall forward across the bottom one and turn the pelvis with it, and a pillow between the knees holds that leg roughly in line with the hip.

That's a description of load, not a fix. A pillow or a new position isn't a treatment for whatever is irritating the nerve, which is why the exam comes first. Pain that's worse lying down, or that wakes you at night, is also on MedlinePlus's list of reasons to contact a provider right away, so at the first visit we ask about your nights along with sitting, walking and what makes the pain better or worse.

What causes sciatica?

The NHS lists a slipped disc, which is the most common cause and is more likely as you get older, spinal stenosis (narrowing where the nerves pass through the spine), spondylolisthesis (when a bone in the spine slips out of position) and a back injury. Our disc injury guide explains the gap between a scan finding and a treatment decision.

New back or leg pain during pregnancy is worth talking over with your OB or midwife before choosing treatment.

How long does sciatica last?

The NHS says sciatica usually gets better in a few weeks to a few months but can last longer, and that it can come back. That's one reason the length of a plan comes from your exam and not from a set number of visits.

What a sciatica visit with us looks like

At the first visit for pain running down one leg, one of our chiropractors starts with your history: how long you've had the symptoms, exactly where they are, whether you've had them before, what makes them better or worse, and whether they began with an activity or with no clear cause. We go through your paperwork for anything that would make treatment a bad idea.

Then come the tests. X-rays are one we may order when they're clinically appropriate, and we'll tell you what we're looking for and whether the result would change the plan. NICE, which writes the clinical guidelines for England's NHS, advises against routine imaging for low back pain, with or without sciatica, outside specialist care. That's a UK guideline for one setting, and it's a fair reason to ask what any image is for.

The hands-on exam includes orthopedic tests, a straight leg raise, muscle strength, reflexes, sensation, palpation and the range of motion of your back. Then we explain what we think is going on, and we tell you if anything we find needs another doctor.

Sciatica treatment options at our office, and their limits

For leg pain or sciatica-type symptoms, what we may recommend after the exam includes:

• Adjustments for joints that aren't moving well
• Spinal decompression, a table-based traction therapy. You lie face up on our decompression table with two straps around your waist and chest while a gentle stretch is applied to the low back.
• Class IV laser therapy
• Dry needling, which our chiropractors perform (see our dry needling page)
• Rehab exercises for weakness or movement problems

We go over what we found before recommending anything, and the plan is built around your condition and goals. StemWave, which we use for some other problems, is usually not part of care for leg pain.

The NICE guideline includes manual therapy (hands-on treatment) for low back pain, with or without sciatica, only as part of a plan with exercise, and it supports keeping up your normal activities as far as you're able. It also recommends against traction for low back pain, with or without sciatica. Research on manipulation specifically for sciatica has limitations, so we won't promise you a painless adjustment, a disc moving back into place, or a set number of visits that works for everyone.

Spinal decompression is a form of mechanical traction, so the NICE recommendation against traction above applies to it, and our spinal decompression page goes through the studies. A disc finding alone doesn't tell us it will help, and how much it helps, if at all, varies from person to person. We go through that and the other routes below before you decide. Even if you've had sciatica for years, the length of the plan comes from what the exam finds.

Risks, alternatives and what we don't do

The NIH's fact sheet on spinal manipulation notes that hands-on care can leave you sore or stiff for a short while, and that serious neurological complications have also been reported. Traction studies have reported more pain and worsening nerve symptoms in some people. Reporting was incomplete, so there's no exact figure for the risk with our protocol. Your own risk depends on your health and the technique. Our page on the benefits, risks and alternatives to chiropractic care covers these, and they're worth talking through before treatment starts. New or worsening weakness is a reason to contact a provider right away.

Chiropractic isn't the only route. Physical therapy can guide an activity and exercise plan. A medical evaluation can sort out if medicines, a specialist or another treatment should be part of your care. Which way you go depends on what the exam finds and what you'd prefer.

We don't prescribe medication. Questions about pain medicine belong with your doctor or a pharmacist, and the NHS suggests asking a pharmacist about painkillers for sciatica.

If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider. If you're not sure whether your leg pain is sciatica or something in the hip, that's exactly what a first visit is for.

How soon can you be seen?

Call us and we'll give you the soonest opening we have. New patients can also read about the new patient special and what a first visit involves.

You can meet the chiropractors who see patients here before you come in.