Bulging Disc, Sciatica, or SI Joint Pain?

Back pain is complicated and is caused by many different underlying issues – often occurring at the same time. Sciatica, bulging discs and SI joint dysfunction all cause back pain. Taking a pain medication might take away the pain, but it doesn’t solve the underlying problem – which will continue to fester in the background and ultimately return much worse.

Distinguishing the true source of a patient’s pain – sciatica, a bulging disc or SI joint dysfunction, is the first step in determining the proper course of treatment.

Most people are familiar with sciatica and correlate it to any pain going down the leg. Sciatica is a fairly vague term that simply means nerve pain or nerve irritation and it can be caused by a disc problem, SI joint problem or even a tight muscle in the buttocks or hips.

Sacroiliac pain is usually sharp and excruciating – making it difficult to put weight on the leg of the affected side. The pain is typically located very low in the back, near the buttocks. It can also cause pain that shoots down the leg.

Bulging discs can cause pain, but usually not excruciating pain that prevents weight-bearing on a leg. The pain may also radiate into the leg, but it’s usually a deep achy type pain (like a toothache).

The sacroiliac joints are a very common source of pain that often gets missed when an MRI shows bulging discs in the lumbar spine. It’s common to see a bulging disc and diagnose that as the source of the pain.  

Sometimes a cortisone shot is given and it doesn’t help. The reality of the situation is that most people over the age of 40 have some degree of disc bulge or degeneration – and most of these people don’t have pain. There is no correlation between pain and bulging discs. 

Thus, something else is needed to differentiate between disc pain and other causes. That’s where a chiropractic examination comes in. The purpose of a chiropractic examination is to pinpoint the true source of the back pain. Sometimes an MRI is not as meaningful as a thorough chiropractic exam.

When I perform an exam, the goal is to find out what is really going on underneath. Sciatica? Bulging disc? Sacroiliac joint dysfunction? Most often, there is a component of all three going on. Restricted spinal joints, muscle spasms, and core muscle weakness all put stress on your body that results in pain at your “weak spot.”

For example, the sacroiliac joint needs to be able to move freely when you walk, run, or sit. This is a complicated joint and it can often become stuck or shifted into an awkward position. When this happens, pain ensues. 

The sciatic nerve runs through this region along with a bunch of other smaller nerves. These nerves can get pinched when the sacroiliac joint is not working properly – another source of intense, excruciating pain that makes it difficult to put weight on the affected leg.

Once the true cause of the pain is identified, gentle chiropractic care is applied to release the stuck spinal joints and relief is usually fairly immediate. A few more treatments are typically needed to fully resolve the issue and then home exercises are given to strengthen and stabilize the entire lumbopelvic region (core exercises). This prevents the problem from happening again. 

My ultimate goal is to help my patients build stronger, healthier bodies once their pain has resolved.