SCIATICA SERIES PART 4: My Approach to A Sciatica Examination

As a chiropractor in Crofton, I work with patients everyday who have sciatica. My job is to help them feel and function better.

I’m always looking for the root cause, trying to get as close to the source of their problem as possible.

But what is their “problem”? Mainly I think their problem is inflammation. Among other things, inflammation causes pain, muscle weakness and muscle tightness.

In fact I think that maybe the biggest thing that so-called “natural treatments” like chiropractic, soft tissue therapy, acupressure, cold laser therapy, exercise and electrical stimulation have in common is that they effectively reduce inflammation.

And those happen to be the treatments we use in our office to treat sciatica.

Treatment Steps For Sciatica in Crofton MD

When the patient comes in to Grande Family Chiropractic on day one, we take a full history of the problem, past and present. We check for existing MRIs, x-rays, or lab tests that may have been taken by other doctors.

Then we take vitals, and perform a physical exam that includes orthopedic and neurologic tests. This is done mainly to identify any issues that have to be referred to a medical doctor for further investigation.

Once those parts of the exam are done, I start zeroing in on figuring out the nitty-gritty of the patient’s particular complaint.

I start by looking for tenderness. If I find there is tenderness when I press on the patient’s lower spinal column, then a little red flag goes up in my head.

That’s when I start wondering if maybe a worn-out spinal disc, or something else is inflaming one of the nerves that projects out of the spine and runs down the back of a thigh. This situation is often the main reason for the sciatica pain.

I continue palpating (pressing on the body is called “palpation”) the spine and the surrounding muscles, as well as the buttock (gluteal muscles and external hip rotator muscles including the piriformis) muscles, looking for tenderness. Tenderness = inflammation.

If most of the tenderness is in the buttock muscles, not in the spine, then it’s looking more like a case of classic sciatica. But then again, there can also be an equal amount of back pain and buttock pain in sciatica cases.

At this point in the exam I don’t concern myself too much with figuring out if there is a disc bulge or a disc herniation.

A lot of times the lower spinal muscles are just sore because they are working overtime to make up for weakness in one or more of the gluteal or core muscles, but that’s really a story for another day.

I’ll usually consider any further disc work-up later in the exam, and I might order x-rays or an MRI to start down that line of investigation if I think disc damage is a possibility. But not always.

Getting back to the exam, I then test the strength of the gluteal muscles and the back muscles and the core muscles. If any of these are less than full strength, then the weakness could cause a spinal alignment imbalance that could be a further source of inflammation. Weakness = inflammation.

Once I have a firm idea of what’s going on, I type my formal diagnosis into my software, and then I create a treatment plan. Treatment at Grande Family Chiropractic in Crofton starts as soon as possible, usually right after the examination, sometimes on the next visit.

The short-term goal of my treatment is to make the weak muscles strong, and the tight muscles loose. Doing that takes the edge off the pain immediately or within a few hours in most cases, and gives the patient hope that recovery is possible.

Long-term, I consider my job to also heal the damage caused by the inflammation. This allows me to help get the patient as healthy as I can.

That’s one of the main values I see myself adding to somebody’s health. What they do with it is up to them. Sometimes, just the surprise and hope that comes from their improvement inspires patients to keep moving forward past their sciatica, into what becomes a life-long personal journey to health.

Call Grande Family Chiropractic in Crofton today to schedule an appointment.