First what is sciatica; sciatica is an inflammation of the sciatic nerve, the longest nerve in your body. The sciatic nerve is formed from the Lumbar 4 (L4) to Sacral 3 (S3) segments of the spinal nerves as they exit the vertebrae at the same levels.
It provides motor innervation and sensation to part of the muscles along the lower lumbar vertebrae and the muscles of your hip and pelvis, to the muscles in your thigh esp. the hamstrings the back of your knee and lower leg and the sole of your foot.
When you have sciatica, you can have pain, weakness, numbness, or tingling in any of the fore mentioned areas. It can start in the low back and extend down the back of your thigh to your calf, foot, or even your toes. It’s usually on only one side of your body.
Causes of sciatica include a herniation or degeneration of a disc at the levels mentioned above, subluxation of the vertebrae associated w the sciatic nerve. https://drvittoriarepetto.wordpress.com/2010/07/17/the-subluxationspinal-joint-dysfunction/ or a narrowing of the spinal canal that puts pressure on the sciatic nerve root which is called spinal stenosis.
As a doctor of chiropractic, I would do a proper orthopedic and neurological examination to determine the level of spinal dysfunction/subluxation.
But before adjusting the vertebrae to remove the subluxation, I would test via muscle testing and palpation the muscles innervated by the involved spinal segments or attached to the spinal segments.
A case in point would be the testing of the psoas muscle as part of the muscle attaches to the anterior of the lumbar vertebrae; a weakness or a hyper tonicity of the muscle can cause rotation of the vertebrae and place tension on the sciatic nerve root. http://en.wikipedia.org/wiki/Psoas_major_muscle
The piriformis muscle is another important muscle that needs to be checked as the sciatic nerve passes under the piriformis; a spasm of this muscle can put pressure on the sciatic. http://en.wikipedia.org/wiki/Piriformis_muscle
Other muscles that may be checked are the hamstrings, the lumbar erector, the quadratus lumborum, the gluteus maximus and the gluteus mediu
I ask, is there a dysfunction in the coordination of muscles working in patterns. Is the above mentioned psoas or piriformis inhibited by the muscles like the gluteus maximus or the quadratus lumborum that are compensating (facilitating) for weak or inhibited muscles, for example. or vice versa. Muscle imbalance can cause misalignment of the vertebrea they attach to.
The muscles that are found to be either weak or hyper tonic are balanced by spindle or golgi tendon work and blood flow and lymphathic drainage to the muscle is increased by working on neuro-vascular and neuro-lymphatic points.
I would also test for problems with the illiolumber ligament and the sacrotuberous ligament which help stabilize the lumbar spine and sacrum respectively.
I also examine the pelvis as the pelvis forms the foundational support of the human skeleton, I look to see if the patient is showing what is known in SOT technique as a Category Three pelvic problem.
Category Three occurs when the low back can no longer tolerate the physical stressors placed on it. This can be a sudden one-off event such as a lift, or it can be a pre-existing weakness that is aggravated. Category Three produces pain in the low back and sciatica. Correction involves using blocks under the pelvis in a specific direction and position. Your weight and breathing helps to gently balance the low back and take the pressure or irritation off the nerve.http://www.soto.net.au/A-patients-guide-to-the-practice-of-SOT
I also check for cranial involvement; there are cranial faults involved in low back and sciatic pain. https://drvittoriarepetto.wordpress.com/2010/05/17/cranial-sacral-therapy-in-applied-kinesiology/
The combination of all these techniques along with nutrition and specific stretches and exercises helps the patient heal faster.
For information on specific techniques, please read:
© 2015-Dr. Vittoria Repetto/ 2016 revised
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