This is the first in a three-part piece looking at sciatica, the pain affecting the back, hip and outer side of the leg, which is caused by compression of a spinal nerve root in the lower back.Don’t forget to “Ask Your Chiropractor” every week where your questions may be published and answered in subsequent articles. Address questions to: Dr Chris Davis, the Spinal Mechanic at movethebone@gmail.com; or, Dr Michael Harvey, director, at dr.michael_harvey@yahoo.com

EVER had that deep, aching back pain that could be felt all the way down to your legs and feet? You wake up with it, or it shows up with a simple sneeze or when you bend over to tie your shoelaces.

This problem, called sciatica, affects up to 40 per cent of people during their lifetime, and costs the global economy billions of dollars yearly. Sciatica is pain affecting the back, hip and outer side of the leg, caused by compression of a spinal nerve root in the lower back, often owing to degeneration of an intervertebral disc. Only headaches are a more common neurologic ailment. Incidentally, headaches are not from a deficiency of, or the body’s inability to produce pain pills; and in 15 years of practice in chiropractic care, I have witnessed countless number of people being completely relieved of headaches, quickly and sometimes instantly and permanently – whether they are tension headaches or migraines.

In most cases of low back pain, the leg pain and most severe symptoms are resolved in eight weeks or even faster and more permanently with chiropractic care, which also can prevent the condition from recurring. However, we are not a patient society. Many of the people who experience sciatica symptoms go on to have back surgery that may or may not solve the problem. Realistically, most times it does not.

Despite changes in technology and impressive titanium screws, plates and cages, the overall results of surgery have not significantly improved over the last few decades. In fact, the adverse effects from surgery have remained and even increased in the majority of cases. The over-prescription of surgery is a huge problem worldwide. And, patients are rarely informed of all of the very serious and very real possible, as well as probable complications, that commonly arise from surgery, including permanent nerve damage, paralysis and even death. Also, they do not advertise that you are 50 to 80 per cent more likely to have a second and even a third surgery as a result of undergoing surgery in the first place, and this is regardless of whether the surgery is successful or not. Patients are also not warned about the iatrogenic sclerosis that is inevitable with any surgery.  Scar tissue has less tensile strength and more pain receptors than healthy tissue, so even if the initial problem is decreased, you will most like experience chronic tenderness, pain and exacerbations indefinitely, as a result of major surgery.

MRI scans of the back

The introduction of magnetic resonance imaging (MRI) scans in the 1980s resulted in elegant pictures of the lumbar spine and graphic demonstrations of the deterioration that happens to our spines as we age. It is one thing to look in the mirror each morning and see the wrinkles that slowly form at the edges of your eyes and mouth, but it is another thing to have your doctor suddenly show you a picture of your spine with its bony growths, deteriorated disks and endangered nerve roots after years of degeneration and repetitive stress injuries or traumas.  

When throbbing back and leg pain attack your brain’s pain centres, it is easy to say, “I will do anything to get rid of this pain. Where is the surgeon?” But, a recent study in the New England Journal of Medicine looks at whether an MRI scan can predict whether you need surgery or whether you are better off taking your time and following an extended course of conservative treatment. Having an MRI of your lumbar spine performed may be quick and painless, but it can lead almost directly to unnecessary surgeries, complications, poor outcomes, and chronic pain — for life. The 15-20 per cent of people who have recurrent episodes of sciatica will have even more MRI scans and repeatedly face the decision of whether or not to have surgery. Eventually, many succumb.