Sciatica "The Scourge & The Treatments"

When sciatica or other radiating nerve pain presents, can learning to distinguish between nerve pain and different types of pain help individuals recognize when spinal nerve roots are irritated or compressed or more serious problems that require medical attention? 

Spinal Nerve Roots and Dermatomes

Spinal conditions such as herniated discs and stenosis can lead to radiating pain that travels down one arm or leg. Other symptoms include weakness, numbness, and/or shooting or burning electrical sensations. The medical term for pinched nerve symptoms is radiculopathy. (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020) Dermatomes could be contributing to irritation at the spinal cord, where the nerve roots are causing symptoms in the back and limbs.

Anatomy

The spinal cord has 31 segments.

• Each segment has nerve roots on the right and left that supply motor and sensory functions to the limbs.
• The anterior and posterior communicating branches combine to form the spinal nerves that exit the vertebral canal.
• The 31 spine segments result in 31 spinal nerves.
• Each one transmits sensory nerve input from a specific skin region on that side and area of the body.
• These regions are called dermatomes.
• Except for the first cervical spinal nerve, dermatomes exist for each spinal nerve.
• The spinal nerves and their associated dermatomes form a network all over the body.

Dermatomes Purpose

Dermatomes are the body/skin areas with sensory input assigned to individual spinal nerves. Each nerve root has an associated dermatome, and various branches supply each dermatome off that single nerve root. Dermatomes are pathways through which sensational information in the skin transmits signals to and from the central nervous system. Sensations that are physically felt, like pressure and temperature, get transmitted to the central nervous system. When a spinal nerve root becomes compressed or irritated, usually because it comes into contact with another structure, it results in radiculopathy. (National Institutes of Health: National Institute of Neurological Disorders and Stroke. 2020).

Radiculopathy

Radiculopathy describes symptoms caused by a pinched nerve along the spine. Symptoms and sensations depend on where the nerve is pinched and the extent of the compression.

Cervical

• This is a syndrome of pain and/or sensorimotor deficiencies when nerve roots in the neck are compressed.
• It often presents with pain that goes down one arm.
• Individuals may also experience electrical sensations like pins and needles, shocks, and burning sensations, as well as motor symptoms like weakness and numbness.

Lumbar

• This radiculopathy results from compression, inflammation, or injury to a spinal nerve in the lower back.
• Sensations of pain, numbness, tingling, electrical or burning sensations, and motor symptoms like weakness traveling down one leg are common.

Diagnosis

Part of a radiculopathy physical examination is testing the dermatomes for sensation. The practitioner will use specific manual tests to determine the spinal level from which the symptoms originate. Manual exams are often accompanied by diagnostic imaging tests like MRI, which can show abnormalities in the spinal nerve root. A complete physical examination will determine if the spinal nerve root is the source of the symptoms.

Treating Underlying Causes

Many back disorders can be treated with conservative therapies to provide effective pain relief. For a herniated disk, for example, individuals may be recommended to rest and take a nonsteroidal anti-inflammatory medication. Acupuncture, physical therapy, chiropractic, non-surgical traction, or decompression therapies may also be prescribed. For severe pain, individuals may be offered an epidural steroid injection that can provide pain relief by reducing inflammation. (American Academy of Orthopaedic Surgeons: OrthoInfo. 2022) For spinal stenosis, a provider may first focus on physical therapy to improve overall fitness, strengthen the abdominals and back muscles, and preserve motion in the spine. Pain-relieving medications, including NSAIDs and corticosteroid injections, can reduce inflammation and relieve pain. (American College of Rheumatology. 2023) Physical therapists provide various therapies to decrease symptoms, including manual and mechanical decompression and traction. Surgery may be recommended for cases of radiculopathy that don't respond to conservative treatments.

Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. We focus on restoring normal body functions after trauma and soft tissue injuries using Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility, and mobility Fitness Training, and Rehabilitation Systems for all ages. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers to bring El Paso, the top clinical treatments, to our community.

Reclaim Your Mobility: Chiropractic Care For Sciatica Recovery

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

National Institutes of Health: National Institute of Neurological Disorders and Stroke. (2020). Low back pain fact sheet. Retrieved from https://www.ninds.nih.gov/sites/default/files/migrate-documents/low_back_pain_20-ns-5161_march_2020_508c.pdf

American Academy of Orthopaedic Surgeons: OrthoInfo. (2022). Herniated disk in the lower back. https://orthoinfo.aaos.org/en/diseases--conditions/herniated-disk-in-the-lower-back/

American College of Rheumatology. (2023). Spinal stenosis. https://rheumatology.org/patients/spinal-stenosis

The discs that cushion the vertebrae are made up of a tough outer layer and a softer inner layer. When the outer layer is damaged and the inner layer comes out into the spine, it is referred to as disc herniation.

Often the symptoms of a herniated disc include back pain, as the inner layer of the disc puts pressure on nerves in the spine. A herniated disc can impact the sciatic nerve, leading to sciatica.

If you know that your sciatica was caused by a herniated disc then try these exercises and stretches to help reduce back and leg pain.

Exercises that help relieve sciatica from a herniated disc

If your spine specialist or chiropractor informed you that a herniated disc is what caused the pain also known as lumbar radiculopathy they may recommend  three sciatica exercises:

• Prone on elbows into Press-up
• Upper back extension
• Opposite arm and leg extension

These stretches can help provide relief when the root cause of sciatica from herniated or bulging disc.

Prone Elbows/Press-Up

This exercise is to ease sciatica from herniated disc pain and pressure in the lumbar spine/low back.

How to:

• Lay on stomach
• Slowly push up until rested on forearms
• Beginners hold for 30 seconds
• Once strength is gained and you feel comfortable then hold for 3 to 5 minutes
• Gently lower to the floor
• Repeat 10 times
• Once comfortable holding for 5 minutes then perform an extended arms version, which is like push-ups raising your arms to the point where your elbows lock

Upper Back Extension

This exercise is to strengthen and stabilize the low back muscles.

How to:

• Lay on your stomach with a small pillow or rolled towel under your hips
• Rest your arms at your sides
• Slowly lift your upper body up off the floor, contracting your low back muscles as you rise
• Hold the lifted position for 3 seconds
• Slowly lower your body to the ground
• Repeat 10 times

Throughout this exercise, keep movements fluid and controlled.

Opposite Arm and Leg Extension

This exercise is to stabilize your spine and strengthen your low back, hamstring and gluteus muscles.

How to:

• Lay on your stomach with a small pillow or rolled towel under your abdomen
• Extend both arms in front of you
• Contract your abdominal muscles as you slowly lift both your right arm and left leg
• Hold for 3 seconds. Lower your leg and arm down
• Repeat with your left arm and right leg
• Hold for 3 seconds
• Repeat the exercise 5 to 10 times on each side

As you alternate the lifts, make sure to keep abdominal muscles contracted to get the full benefit.

How do these exercises relieve sciatica from a herniated disc

These exercises and stretches are designed to move the pain from the leg and into the low back.

This is centralization/localization.

This is a good thing, as the goal is to get the pain centralized and back at the source.

When the leg pain goes away, it means the pressure on the sciatic nerve and related nerves has been removed.

If sciatic pain stretches down to the foot, you will feel these exercises, meaning that the pain and electrical sensations will move through the ankle and knee. Which means you're doing it correctly.

This does not mean that the pain is immediately going to centralize to the low back, it does take time because you are trying to stretch and straighten out this long nerve.

But you will notice sciatica pain does not go as far down the leg.

Therefore these exercises need to be done consistently and be made a part of your routine. 

What to know before exercising

Before starting these stretches, consider three recommendations:

Get a doctor’s approval

A spine specialist should clear you to perform these stretches and exercises before you start.

While these exercises are safe, get a doctor’s permission before starting physical activity.

Know the cause so your exercise program helps and not makes the condition worse

Sciatica from herniated disc means a different type of exercise than sciatica caused by piriformis syndrome.

Knowing this information will help you choose an exercise plan that provides maximum relief.

Don’t push too hard

Don't aggravate sciatica, listen to your body and go slow.

Experience any pain or symptoms:

• Weakness
• Tingling
• Numbness

Contact a spine specialist immediately!

Sciatic nerve pain caused by a herniated or bulging disc is a common problem.

But incorporating these exercises and stretches can provide sustained relief.

The sciatic nerve is a large nerve that travels from the lower back down both of the legs and into the feet. When pressure is placed on the nerve, such as from a herniated disc, it can lead to the symptoms commonly referred to as sciatica.

The sciatic nerve can be impacted by a number of different things, including injury and degenerative diseases.

Difference Custom *FOOT ORTHOTICS* Make to Control Posture & Mobility | El Paso, TX (2019)

Custom foot orthotics can help control foot motion and posture. Healthcare professionals prescribe custom foot orthotics to help patients focus on the control of their foot posture and mobility. Research studies have determined that utilizing custom foot orthotics for posture and mobility control can help correct excessive foot pronation and supination to prevent a variety of foot health issues. The following video describes how custom foot orthotics can help control foot posture and mobility to improve health and wellness.

Chiropractor Dr. Alexander Jimenez of Injury Medical and Chiropractic Clinic focuses on long-haul truck drivers and non-invasive spinal treatments. Truck drivers are at a much higher risk of developing degenerative spinal disorders from the stress that constant driving and repetitive lifting can place on the spinal muscles of the lower back.

Driving a huge truck for eight to ten hours every day/night means the person sits in a stationary position for a long time. The muscles, joints, and ligaments tend to become stiff, and proper blood circulation is affected over time. Ailments can last for weeks, even up to several years if drivers don’t take time to focus on their health and find the right treatment.

Teams are in a truck that never stops. Even sleeping in the bunk, these drivers are subject to constant vibration and bouncing as the truck moves. Roads that are poorly maintained can cause impact trauma to both the driver and the person in the bunk. Various factors can cause musculoskeletal pain like:

1. Awkward sitting posture/s
2. Constant body vibration
3. Extended sitting
4. Lifting and loading
5. Repetitive motions
6. Strained muscles, nerves, discs, and joints
7. Improper mechanics
8. No exercise
9. Improper Diet

Having limited mobility can lead to structural problems like pain in the back, hip, knee, shoulder, arms, and legs. This is compounded by the fact that prescription medications are the norm for these issues and can be dangerous. 

Long Haul

These individuals are taught proper lifting techniques but with time forget to follow them during the rush to make the delivery/s on time. Driving for extended periods regularly places added strain on the back. This is due in part because these individuals can't use their feet to support the lower part of their bodies while working the pedals of the truck.

The continuous instability, vibrations, and positional changes that come with long haul driving can cause tension in the spine and surrounding muscles in the area. Research has shown that vibration of the body while driving increases the load on the lower back and driving on roads that are not maintained can exacerbate the condition.

The continuous bouncing can lead to spinal disc compression, which in turn causes degeneration pain in the spine and nerves. This continuous strenuous routine can lead to herniated/bulging discs, which can cause pain and lead to the development of other spinal conditions like sciatica. Improper alignment of the spine can lead to dysfunction and pain in one or several areas of the body. Other conditions that could develop include:

• Facet joint syndrome - the cartilage wears away making the spinal joints stiff and swollen. This syndrome can lead to reduced mobility.
• Vertebrae rubbing together
• Spinal compression from sitting in a single position for a long time places pressure on the spinal column. As the spinal column compresses, it causes tightness in the lower and upper back muscles.
• Sciatica is a combination of symptoms and pain that travel from the lower back to the knee and even into the foot. Usually, caused by a herniated disc that compresses the sciatic nerve, it can cause shooting electrical pain down the leg. Drivers with sciatica can also have tight gluteal muscles that place pressure on the nerve.
• Neck pain from tight and tender muscles can affect the middle back and cervical/neck area of the spine causing soreness.
• Tension headaches begin with the muscles at the base of the skull. When these muscles are tight, they can pinch the nerves, beginning a headache.
• Shoulder pain can be caused by overuse when loading, along with rotator cuff injuries and bicep tendonitis. An inflamed bicep can cause inflammation and pain in the shoulder. 

Preventable and Treatable

Prevention and proper treatment are key. Here are a few simple ways to improve the drive:

• Better seating to reduce vibration
• Correct sitting posture
• Chiropractic/physical therapy
• Exercise
• Proper diet
• Ice therapy
• Proper sleep support

Proper Seat

The seats that are standard in a truck do not offer proper support for a driver's back, shoulders, neck, and legs. A seat pad for extra comfort or a memory foam seat with a massage base can relax the muscles. For quick lumbar support roll up a pillow, towel or t-shirt and place it behind the lower back.

An ergonomic truck seat helps fight the discomfort and awkward positions, that result in positive posture. A proper seat will force the back into its healthy arch. Driving with less strain helps:

• Boost circulation
• Distribute the body weight evenly
• Helps drivers operate longer
• Reduces the vibrations running through the body

These long haul drivers can choose to bypass invasive procedures that can take months to heal. This is because of the inability to drive means they don't earn a check. And being taken out of a driving job for any period can cause financial difficulties.

Chiropractic provides long haul truck drivers with a non-invasive, drug-free way to treat injuries, manage conditions, and relieve pain. Regular chiropractic can help correct postural habits that expose the body to injury or move the body and the spine out of alignment. It can identify emerging issues before they become a severe condition.

Larger truck stops offer drivers access to medical and chiropractic services allowing them to get treatment when they need it. Long haul drivers can be out for weeks and may not be able to get their regular adjustments. But it is still a good idea to have a regular chiropractor at home so you can stay healthy and on the road.

18 Wheeler Accident Chiropractic Treatment

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*