Back Injuries and Sciatica

It’s almost that time… You know what I’m talking about, when that white, frozen powder starts to fall from the sky and stick to our yards, doorsteps, driveways, and decks. It’s also that time when my office will start to see low back injuries from improper shoveling mechanics. Many times, this pain will be accompanied by pain down the back of the leg, or “sciatica.” Common snow shoveling technique is literally the “perfect storm” to injure a lumbar disc—bending, twisting, and carrying a weight out away from the body. Although studies vary due to different definitions of what actually constitutes “sciatica,” as many as 43% of adults will experience it in their lifetime.[i]

I’m sure you’ve all heard it before, but bend from the knees while shoveling, not from the waist. Try to keep the load close to your body, and use leverage when emptying the shovel. Suck your stomach in to activate your core stability muscles and protect your spine. While twisting to throw snow behind you is not advisable, sometimes it is a necessary evil. To properly throw snow behind you, swing your hips as well, and be sure to never twist just your upper body.

How Does This Relate to Sciatica?

Despite general public understanding of sciatica, it is not a diagnosis or even a standalone condition. Sciatica, like any nerve pain into a limb, is a symptom of an underlying cause. Nerve pain generally occurs only when the nerve is irritated or impinged; therefore, that irritating factor is the true diagnosis, not the sciatica itself, and the issue will never be resolved until the cause is corrected.

Sciatica generally is caused by a few main factors:
· Disc Injury (Snow shoveling!)
· Degenerative Disc Disease (essentially spinal arthritis from long-standing dysfunction)
· Muscle Spasm
· Irritation of the nerve root from spinal subluxation

Arguably the most common cause of sciatica is a disc injury. The intervertebral discs are basically composed of thick, fibrous bands wrapped around a pulpy, gel-like center. They work as shock absorbers while allowing for a stable range of motion. Normally, with a proper forward curve of the low back, this pulpy material is pushed forward into the strongest part of the fibrous bands and is nicely contained. Since our lumbar discs are weakest towards our backs and our sides (posterolateral), the bending, and rotating while carrying a load posture is the most common cause of disc injury, especially when the normal frontward wedging of the discs is compromised by improper spinal curves. This unfortunately aims the material straight towards the exiting nerve roots, yielding sciatica. In order to treat the issue, you must thus restore proper curvature to the low back and perform therapies to decrease the disc bulging and take pressure off of the nerve.

Degenerative disc disease causes sciatica by continually narrowing the foramen (hole) that the nerve exits the spine through. Prior disc injuries will eventually become calcified leading to bone spurs. Since spinal discs contain no blood vessels, movement is imperative in maintaining their health. Lack of motion (subluxation) prevents the normal pumping action of nutrients in and waste products out of the disc. Long-term subluxation will eventually cause the disc to dry out and the cells that maintain it to die. The resultant disc narrowing and attempts by the body to stabilize it (bone spurs) can encroach upon the nerves. In order to treat this cause of sciatica, motion must be restored to the subluxated segments. Flexion-distraction therapy is essential as it provides a distractive force to the narrowed discs, creating a negative pressure to rehydrate the disc.

Muscle spasm can cause sciatica as the sciatic nerve itself runs directly under the piriformis muscle deep within your posterior that stabilizes and externally rotates the hip. In some individuals, it actually pierces and runs directly through this muscle. Straining this muscle, over exerting it (a golf swing, for example), or compressing it (a typical toilet seat) can cause pain, tingling, and numbness into the back of the leg. In order to treat this cause, you must stretch the muscle, strengthen the opposite muscle group, and maintain pelvic balance so that this stabilizing muscle does not spasm again.

Spinal subluxation is a very common cause of sciatica. Most typically, this is when sciatica symptoms persist despite no verifiable nerve impingement on an MRI. The nerve is always accompanied by an artery, a vein, and a lymphatic duct in the spinal foramen from which it exits. This is called the neurovascular bundle. Misalignment of the vertebra can compromise the blood flow to and from the nerve, causing irritation that can produce the symptoms we all call sciatica. Correcting this cause and restoring motion to these segments can greatly improve the condition.

If you or a loved one is having radiating pain down the leg, or have been diagnosed with sciatica, the cause must be ascertained and corrected in order to get lasting relief.

As always, eat healthy, exercise, and stay subluxation free!

Daniel J. Myerowitz D.C., Dipl. Ac (AACA)
Myerowitz Chiropractic & Acupuncture Clinic
291 Main Rd
Holden, ME 04429
207-989-0000

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