Low Back Pain with Sciatica

I wanted to share a recent success story of a 37 year old who was experiencing lower back pain with sciatica. He presented to the office with 9/10 lower back pain with sensations traveling into his right buttocks. He related that while bending over to stretch he immediately experienced the pain. This is something he does frequently to stretch but had never had this happen before.

Lower back pain is the number one reason for doctor visits and it’s second only to upper respiratory infections (aka the common cold) during the height of that season.  It’s estimated that nearly 80-90% of people will suffer from low back pain at some point in their life. When it comes to symptoms many suffers only experience low back pain. For some it’s on one side, some its both and others even experience low back pain with sciatica.  Let’s briefly define sciatica.

True sciatica is caused by irritation on the sciatic nerve which originates from the L4/L5/S1 spinal levels. The wires from these three levels converge to make a very big nerve called the sciatic nerve. Pressure from a swollen disc can irritate the nerve resulting in pain that travels down the posterior or back and occasionally the lateral or outside part of the buttock, thigh, leg and even into the big toe.  Attention: Pain down the front of the leg is NOT SCIATICA

After seven years in practice I can tell you that no two cases are alike. I’ve met a lot of people over the years that received bad advice from well intentioned friends and family. Talk to your doctor and be careful.  Don’t waste time waiting for it to go away. Get care quickly.

Thankfully for Brett he called and was seen within two days of the onset of his pain. Interestingly he was an atypical case and that’s why I thought I’d share it with you. He exhibited no muscle weakness and his range of motion was limited in his ball and socket joints on both sides (35 degrees of lateral/external rotation). He had fixation on the right SI joint (sacro-iliac) with tenderness to palpation (touch). Because of his symptoms and an observed leg length difference I ordered an x-ray. Here is a picture:

short leg

You can see that he has a significant leg length inequality (LLI) of 23mm aka short leg. I should mention that nearly 25% of adults have an anotomical leg lenght difference. It typically happens during adolsence. If you’ve ever sprained your ankle you’ll know what I’m talking about. While you injured your lower extremity you probably walked funny to compensate. You may even had to use crutches. The resultant weight shift while favoring the uninjured side remains as a pattern of movement well after the injury heals and the pain goes away. Google “pain alters motor control” or “PR Janda” or read some of Gray Cook’s material. When you’re weight-bearing is not distributed evenly 50/50 it will stunt the growth of the long bone (femur). Google Hueter Volkmann for more on this prinicple.

I should mention that we take our films in the standing weight-bearing position and we have research supporting the radiographic mensuration (line-markings) you see on the film. Both the positioning and the line-markings are reproducible and have inter and intra-examiner reliability. That means it can be repeated or reproduced.

Now for the really cool part: I adjusted Brett a total of three times the first week and perscribed a lift based on the measurements we found on his initial x-ray. I should mention that we do not do this very often and this by no means is the appropriate treatment for all cases of lower back pain with sciatica. This is just an example of one success case observed with one patient who got precise care he needed based on his condition and presentation. Ok, with that out of the way here is a follow-up x-ray after 3 visits. You can see the marked reduction in the leg length difference and even more important the leveling of his hips.

Foot Lift
Brett was pain free in 3 visits and left on vacation for two weeks. I saw him upon his return and he was still pain free. I performed an adjustment to his right SI joint and told him to follow-up in 3 weeks.  When he returned in three weeks he had not had any pain during that time. I released him from active care and invited him to come in periodically for preventative wellness or maintenance check-ups or as needed. Now that he has a level pelvis and more even weight-bearing he has been able to maintain this improvement and it’s been six months since his initial visit.

This information is provided for educational purposes only and is not intended to diagnose or treat your condition. I recommend consulting with your physician or our office if you have low back pain with sciatica so we can determine if and what care is appropriate for your unique needs.