Dr. Ryan Burke of Precision Chiropractic & Massage in Ann Arbor Michigan explains that often patients believe their back pain is sciatica, but it's not.

What is Sciatica?

Sciatica is one of those conditions that are often misunderstood. I'll have individuals that come in and they say, "Doc I’ve got sciatica." And I’ll say "What’s going on?" And they’ll say, "I have pain down the front of my leg, or pain down the side of my leg." Those things are not sciatica. They are different types of conditions with different routes of treatments.

What sciatic pain or sciatica truly is, it starts with pain in the lumbar region, typically in the low back: the L3, L4, or L5 area. And then patients will complain typically of pain that is traveling down their buttock, the back of their thigh, and the back of their calf, and all the way into their feet at times. This can come with associated lack of sensations, numbness and tingling, weakness in the leg, and a condition called foot drop, where the patient can’t even pick up their foot, and they’ll just drag it on the ground. And sometimes even changes to your reflexes.

So any physician you work with, be it a chiropractor, physical therapist, or an internal medicine doctor, should be assessing muscle strain, reflexes and sensation in the legs to see how to advance this sciatic case, and that’s something that we do in my office as well.

Why is Sciatica So Common?

Why is this so common? A lot of people ask me that. And the reason is that the sciatic nerve is a huge nerve, it comes out of the pelvic area right here and it’s very easy to get pressure on the nerve. And the reason it’s easy is because it’s very wide and the wider a nerve is, the associated structures in that area put pressure on it.

And the thing I deal with in my day-to-day practice is a structural correction of the spine. What does that mean? It’s kind of wordy, it means basically achieving proper alignment of these spinal bones, vertebrae, and this pelvic structure. What we see often times is that there will be small movements in the pelvis. The pelvis will rotate up and down. And that’s why sometimes people will say they have a short leg. When you have a short leg, it's because the pelvis has shifted in one direction or the other. And the vertebrae will move left or right, even up and down a bit. And when these bones move, what happens is that they put pressure on the nerve. When you have pressure on a nerve you get pain, you get back sensation and a slew of other things.

How to Relieve Sciatic Pain

What we do here is to get the spine in as perfect alignment as we possibly can. We do it gently with a handheld instrument which allows us to precisely move the bone in a specific direction and it is very comfortable for the patient. We don't do any popping, cracking, or snapping of the spine. When we get the alignment corrected, what we see is really a huge decrease in patients, in terms of pain and sciatica symptoms down the leg. We see sensation increasingly return back to normal and obviously people start to be able to do the activities that they were not able to do because of their sciatic pain.

Some of the other things that we recommend here, and that you would see with a physical therapist or some other healthcare professionals as well, are appropriate strengthening and stretching of the muscles in that area of the spine. What happens is that certain muscles get weak or certain muscles get too tight, and because of misalignment of the spine and pressure on nerves, specifically the sciatic nerve. So we give individuals recommendations or we will even give them instructions on how they can strengthen their core, maybe their glutes, and how they can stretch certain muscles too, like their quads or their hamstrings.

Piriformis Syndrome Can Cause Sciatic Pain

And one other thing that we see, somewhat commonly and that is a bit overlooked in the healthcare community, is what’s known as piriformis syndrome. What piriformis syndrome is, there's a muscle that runs right in your glute area, right in the buttock area. And it runs diagonally right here and some people are somewhat familiar with it because it gets tight sometimes. And what happens, the sciatic nerve runs right below this piriformis muscle. What happens is the muscle gets tight, it gets contracted and shortened. And when you shorten something it tends to get a little bit wider. So your sciatic nerve runs right underneath the piriformis muscle. The muscle contracts, it gets tight, it puts pressure on the nerve and then all of a sudden you get these sciatic symptoms going all the way down your leg. We see that day-to-day or week-to-week in my office. And we correct the alignment of the structure like I’ve mentioned earlier, but also we give some specific stretches to get that piriformis muscle loosened up. Our massage therapist may work on it because we have a couple of great professionals in this office that do work such as that. And also I’ll give patients some recommendations for how they can stretch at home. And in a subsequent video, I’m going to be walking you through a real simple piriformis stretch that you can do at home that can help to alleviate some of these sciatic symptoms.

Transcript of Sciatica Stretches & Pain Relief for Piriformis Syndrome

Hi, my name is Doctor Ryan Burke, owner of Precision Chiropractic and Massage Center in Ann Arbor, Michigan. Today is part 2 of our sciatic video. Here we are going to be showing you a quick stretch of the piriformis muscle which can trigger sciatic pain in individuals.

Today we have Andrea here with me. Andrea is one of my patients, and she is going to be displaying the stretch for you. We’ve been working with Andrea, giving her care and you are in your 3rd trimester now. How many weeks pregnant are you?

Andrea: 29 weeks.

We're working with a lot of pregnant women and they tend to have challenges in their spine and a lot of sciatic complaints we see, it's more common in the pregnant women than in the general population. Have you had any sciatic pain since you have been pregnant?

Andrea: No

Have you had any low back pain since you have been pregnant?

Andrea: No.

And that’s one of the great things, Andrea is in great shape, she’s in chiropractic care and we’ve given her some home care stretches and some exercises she can do which is a great fit for helping her to have a completely healthy pregnancy. So we're going to have her lay her back here for just a moment or so.

How to do the Stretch for Sciatica

Right there. Good. And what she is going to be doing for this piriformis stretch, she's going to be taking her right leg, her right knee and she is tractioning it or pulling it to her left shoulder. That’s the key. You’ve taken the right knee and you are tractioning it to the left shoulder or pulling it to the left shoulder. Can you point to where you feel stretched?

Andrea: Right here.

That’s perfect. That’s exactly where we should be feeling it. Relax that right leg and hold this for about 5 seconds. We always do both sides. She’s now going to take her left knee and she’s going to traction it into her right shoulder. And she’s going to feel in that same area right there. And even at 29 weeks pregnant, she still can do this easily.

With some individuals, we have been modifying. We have been having them seated on the floor, with their back up against the wall or some support. But this is perfectly fine for her. We have to repeat it about 3 times, but just for the purpose of showing you. Give you a hand up if you like. We just had her do it once.

So as simple as that. That’s a great tool to help stretch that piriformis muscle.

Once again my name is Dr. Ryan Burke, Precision Chiropractic and Massage. It was great speaking with you today. Thanks.