Can’t Shake Your Sciatica? You May Have Been Misdiagnosed!

Sciatica is a common lower back condition caused by compression of the sciatic nerve, which is formed by five sets of nerve roots that exit the lumbar spine. Sciatica is often caused by a herniated disc or bone spur in the low back that places pressure on the nerve, irritating it and causing pain. Sciatica usually responds well to chiropractic treatment, physical therapy and appropriate rest. But when low back, buttock and leg pain is persistent despite the best care, your low back pain may have a different origin.

It turns out that the majority of “sciatica” patients may have been misdiagnosed. It is important to remember that the low back and pelvic region is complex, with multiple structures interacting, and many neural bodies sending messages to and from the brain. With that in mind, and given that the symptoms are nearly identical, it should not come as a surprise that cluneal nerve entrapment (CNE) is often misdiagnosed as sciatica.

Many patients complaining of low back pain experience tightness near the top of the buttocks, at the thoracolumbar junction, where the thoracic and lumbar vertebrae meet. The cluneal nerves originate between the tenth thoracic vertebra and the second lumbar vertebra (T10-L2) and each nerve forms three branches. Cluneal nerves are sensory, or “feeling” nerves that pass under or through the long posterior sacroiliac ligament. They can become entrapped near the posterior illiac crest, causing pain syptoms similar to sciatica.

Symptoms shared by sciatica and CNE include:

• Unilateral low back pain
• Pain in the buttock
• Referred pain radiating into the posterior thigh, calf, and foot

Sadly, many medical practitioners are unaware of CNE syndrome, leading to frequent misdiagnoses. As a result, treatment approaches, including surgery, fail to resolve the symptoms, leaving the patient in worse condition, and with considerably less money.

Despite similarities in symptoms, CNE has characteristics that are distinct from sciatica. Practitioners who are aware of the syndrome can readily arrive at a differential diagnosis with a simple clinical exam.

A patient with CNE will experience pain over the posterior ilium and upper buttocks region. When palpated by the clinician, pain is felt that reproduces the patient’s symptoms, particularly when symptoms occur far away from the iliac crest.

The clinician may feel a thickening of tissue, or trigger point, along the rim of the posterior iliac crest, and it may be tender. When tapping on the tender spot or thickened tissue, the patient may feel a shock-like sensation.

A nerve block injection near the iliac crest trigger point will relieve symptoms of CNE.

CNE syndrome often responds well to spinal manipulation adjustments and soft tissue mobilization techniques. Treatment sometimes includes nerve block injections and, in severe cases, surgery. Accurate diagnosis is key to successful treatment of CNE syndrome.