Sciatica is treated by numerous specialties: PCPs, Chiropractors, Physical Therapists, Physical Medicine Practitioners, Pain Management Doctors, Orthopedic Spine Surgeons, Neurosurgeons, and Massage Therapists to name a few.

For the purpose of this article, we are going to discuss how conservative care can be helpful and when it’s time to escalate management to more invasive options.

Conservative treatment options for sciatic low back pain include a vast array of options like Chiropractic, Physical Therapy, massage, and acupuncture. The reason it’s called conservative treatment is because these interventions are minimally invasive and do not come with significant risk. Other interventions include home exercises, lifestyle modifications, muscle therapy, adjustments, non-narcotic medications, and the use of passive therapies.

Sciatica pain is often used as a “catch-all” diagnosis early on in treatment. Sciatica is a broad diagnosis describing low back pain with radiation into the leg. It’s called sciatica because of the sciatic nerve itself. The sciatic nerve originates from five nerves in the low back/spine. They merge together to travel past the knee and then disperse into numerous named nerves which terminate in the lower leg and foot.

Chiropractors at Smart Pain Solutions consider ourselves primary treaters of spine pain. When a new patient presents for assessment of “sciatic” pain at our Bridgeton or Clayton office, the first thing we do is discuss the patient’s symptoms and perform an exam.

Sometimes x-rays are taken and prior records ordered to help narrow down the diagnosis options. Once we feel enough information has been collected, we offer our patient recommendations. For most cases this is going to include a conservative approach including in-office treatment, and self-management strategies to be done by the patient away from the office.

An example of a typical approach would look like something like this;

“Ok, Mr. Jones after evaluating your low back pain with referral symptoms to the calf, I suspect your sciatic nerve is involved. This can occur from a variety of different reasons. I have narrowed it down to inflammation near or the direct “pinch,” of one of the nerves in your lower back causing the pain to travel down your leg. The x-rays we took today helped identify your L5 disc as the working culprit but in order to confirm we would need an MRI. Since you are not experiencing any loss of muscle strength and your reflexes are intact, a conservative approach is warranted per your insurance. I am going to recommend a few visits over the next two weeks to decrease your pain and help get your joints moving better. I am also going to prescribe and demonstrate some core strengthening exercises for you to do at home between visits. These are equally as important as in-office treatment. Based on my experience treating this condition, I have high confidence you will see some benefits. However if you are still limited in your daily activities, we may discuss other options. How does that sound? Do you have any questions?”

The truth is conservative providers such as Chiropractors and Physical Therapists have great success treating sciatica and low back pain. But when what we have to offer is not enough, or a patient is demonstrating signs such as muscle wasting and weakness, we must have referral options for our patients.

This is where a physician like Dr. Swastik Sinha comes in. He is a John Hopkins trained orthopedic spine surgeon who specializes in surgical and non-surgical solutions for spine pain. Dr. Sinha was kind enough to participate in this discussion and answer a few frequently asked questions about low back and sciatic pain.

When should a patient give conservative treatment a try and when should a credible provider pivot and make recommendations to pain management or a spine surgeon?

“As long as a patient is seeing weekly gains and is not experiencing any loss of function such as leg weakness or difficulty walking, they should continue with options like chiropractic and physical therapy care. Of course, a patient’s health history and imaging findings can change this.”

When a patient is not succeeding with conservative treatment for their low back pain what are some of your initial recommendations?

“First of all it is always better when the patient has a current MRI of the problem area. When we have a current spinal MRI we can identify the true pain generator. Targeted steroid injections based on MRI findings and the patient’s reporting are one of the best ways to mediate disc inflammation and disc bulges which lead to low back pain and sciatica.” 

Once a person starts getting injections for their back pain, should they expect to always need injections to stay pain free?

“When the patient’s pain is caused by inflammation, steroid injections are very effective at reducing the patient’s symptoms. It doesn’t necessarily mean they will need to undergo regular pain management. However, there are times when the patient’s pain is caused by an underlying permanent condition. At this time it is important to have a discussion between the patient and their surgeon about future treatment options including injections, or minimally invasive spine surgery so that the patient can return to normal everyday activities with the least amount of restrictions.” 

Dr. Swastik Sinha, MD

Our patients have seen great success with Dr. Sinha’s recommendations. For those seeking an evaluation for unresolved neck or low back pain, he practices at Axis Spine and Orthopedics in O’Fallon, Illinois. He will be opening his Midtown St. Louis clinic and surgery center later this year. His focus is on cervical disc replacement surgery and other minimally invasive interventions for neck and low back pain. Dr. Sinha takes great pride in getting patients back to their daily lives with the least invasive treatment available and minimal recovery time.

Dr. Robert “Bo” Andel, DC

Dr. Robert “Bo” Andel, have been practicing for 14 years. Providing cost effective and practical solutions for patient’s neck pain, low back pain, and headaches. I hold two Bachelor’s Degrees. A Master’s of Sports Science & Rehabilitation, and a Doctorate of Chiropractic Medicine. Smart Pain Solutions providers treat low back pain at two locations in St. Louis, MO. Smart Pain Solutions is in-network with most insurance companies and also treats patients for work comp and auto-accident injuries.

Thank you to Dr. Sinha for participating in our discussion for treatment of sciatic pain. Please reach out if you have any questions about your specific condition.