Sciatica: Chiropractor Viewpoint

The gentleman appears to be experiencing pain from nerve root compression at L5-S1. A MRI performed in August of 2000 confirms a disc herniation at the L5-S1 and at L4-L5. Specific information is not given regarding nerve root compression/central or lateral recess stenosis. A comprehensive conservative treatment history is needed before any treatment by a doctor of chiropractic, one that provides insight into the types of physical therapy procedures, osteopathic manipulative techniques, home exercises and ergonomic recommendations.

There are objective findings consistent with sacroiliac joint dysfunction and degenerative joint (facet) disease. The SI and facet joints produce various patterns of pain and may be contributing to the gentleman symptoms. The lateral calf pain seems consistent with nerve root compression at L5-S1.

Based on the objective findings I would recommend the following program of chiropractic care. This is a 2-3 week chiropractic treatment program only. The cardiac rehabilitation is of utmost importance and if the conservative chiropractic program fails I recommend surgery. The patient would then be able to return to cardiac rehab without limitations.

Chiropractic Treatment Program

1. The treatment program designed by the chiropractor will begin with right SI and or facet injections followed immediately by chiropractic treatment.

2. High velocity chiropractic manipulation to improve facet generated pain and restore vertebral motion. Specific SI manipulations to improve SI dysfunction and eliminate this as a pain generator.

3. A chiropractic technique called flexion distraction manipulation to improve disc elasticity, facet mobility, erector spinae and nerve root flexibility.

4. A comprehensive home rehabilitation program will supplement the chiropractic care, including ergonomic recommendations will be provided to enhance healing and eliminate external exacerbating factors.

5. In house physical therapy utilizing flexion and or extension based protocols along with a lumbar stability program will be utilized immediately following each chiropractic treatment.

A 2-3 week trial of this conservative chiropractic program is recommended. If there is no improvement in the patient’s symptoms following the chiropractic treatment, I would recommend a surgical approach to treat the sciatica.

• Article written By:
• Rodney K. Lefler, DC, CSCS

May 1, 2001

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