Sciatica

Symptoms

Sciatica symptoms are characterized by a sharp pain that shoots down a lower limb through the buttock, into the upper thigh, and radiates into the skin of the calf, and the foot. Sciatica patients may also experience tingling or burning sensation as well as numbness of the skin in the affected areas – sciatic nerve pain.

Causes

  • Herniated or protruding disk
  • Spinal stenosis
  • Spondylolesthesis
  • Piriformis syndrome
  • Pseudosciatica

    (pain is mimicing sciatica, but there is no sciaticnerve involvment) this is often caused by sacroilliac joint irritation. This is also called pseudoradicular.

Differential Diagnosis

Sciatica caused by nerve compression or inflamation from within the spinal canal must be differentiated from pseudosciatica or piriformis syndrome.

This differential diagnosis is based on the combination of clinical examination and MRI results. However, overreliance on the MRI results can lead to treating the wrong cause.

Piriformis syndrome

Diagnosis

Diagnosis is based on patient history and clinical examination as well as MRI (magnetic resonanse imaging) results

Treatment methods

Most of the time sciatica responds well to coservative care.

Depending on origin of the sciatica or pathoanatomy, different physical therapy aproaches maybe used. Neurodynamic approaches are equally effective for all types of true sciatica, as it allows for better gliding and sliding of the nerve within the interface (interface is the tissue which restricts the ability of the nerve to glide) However, it should be supplemented with the treatment of the interface itself. Depending on where the sciatic nerve is affected, the treatment approach will be chosen based on pathoanatomy, biomechanics and loss of control in specific regions. We believe that the best treatment for sciatica is usually a comination of different approaches based on the clinical findings and the location and how the sciatic nerve is being compressed.

At NYDNR we are very successful with treatment of all types of sciatica because we use a detailed examination with regards to structural pathology and base our treatment accordingly to each individual patient. Please see our detailed power point presentations on our specific approaches below.

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Sciatica


Sciatica is a medical term used to describe a condition characterized by the sharp pain that shoots down a lower limb through the buttock, into the upper thigh, and radiates into the skin of the calf, and the foot. Sciatica patients may also experience tingling or burning sensation as well as numbness of the skin in the affected areas – sciatica nerve pain.

Sciatic nerver from spoine to the leg; other nerves shown

Sciatic Nerve

The symptoms are usually confined to one side of the body.

Sciatica symptoms are regarded as the consequence of the physical damage to the Sciatic nerve at the points where it emerges from the spine or other confined anatomical places where it could get compressed. The Sciatic nerve, one of the largest neural formations in the human body, innervates most of the lower limb’s skin and musculature providing feeling and movement in the back of the thigh, the ankle and the foot. It is formed by three nerve roots that leave the spine in the Lumbar and Sacral sections (L-4, L-5 and S-1) and merge within the pelvic cavity. From there the nerve proceeds down through the sciatic foramens of the pelvic bone into the hip. It descends along the thigh and spreads out below the knee through the skin and musculature of the calf and into the foot. Pinching, irritation or inflammation of any of the three roots at any of the origination points will result in radicular pain or radiculopathy along the nerve’s path.

It must be noted that there are several other conditions that resemble and are frequently confused with Sciatica nerve pain. The true radicular sciatic pain radiates below the knee into the dermatome (the skin surface area) that is known to be supplied by the Sciatic nerve. This radiation identifies Sciatica proper helping to differentiate it from other conditions of similar simptomatology.

Pinching or irritation of the roots of the Sciatic nerve triggers most often Sciatica by a herniated or bulging disc causing radiculopathy (the true sciatica).

Second most common cause of the sciatic-like pain is the Piriformis syndrome – the compression and irritation of the main body of the Sciatic nerve in the pelvic cavity by the Piriformis muscle. Although not a true Sciatica, this form of the condition is quite common especially among physically active women. This condition is also common as a secondary effect in patients, which have L4-L5 radicular syndrome.

In general Sciatica can be divided into 3 types:

  • Sciatica caused by the spinal pathology affecting Sciatic Nerve roots (radiculopathy)

    Spinal nerves are squished by vertebrae leading to sciatica

    The spinal canal and intervertebral foraminae in the lumbar spine (lower back) are bony tunnels through which run the spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves, the consequence of which may be pressure on these structures.

  • Herniated/bulging disc
  • Ligament flava hyperthrophy
  • Spondilolisthesis

Sciatica caused by extra spinal factors – compression or irritation of the main body of the Sciatic nerve in the Pelvic Cavity beyond the roots’ conversion point:

  • Piriformis syndrome
  • Ischial tunnel syndrome
  • Obturator syndrome.

Sciatica-like conditions – not directly elated to the Sciatic Nerve although producing symptoms that resemble Sciatica:

  • Sacroilliac joint dysfunction
  • Post herniation sciatica
  • Thalamic stroke
  • Intermittent claudication
  • Peroneal palsy.

Uncommon causes:

  • Mononeuropathy Monoplex
  • Autoimmune disease
  • Infectious disease
  • Tumors
  • Ganglion cyst
  • Synovial cyst

Differential diagnosis of Sciatica must be initially based on history, clinical picture and the location of the symptoms. Imaging or electro-diagnostic neurological testing should supplement diagnostic process to help to isolate a specific form of the condition and determine an appropriate treatment.

Sciatica Pain Diagnosis

Dr.Kalika uses diagnostic ultrasonography to visualize disc nerve conflicts inside the spine as well as outside the spine in the hip and pelvis area. Nerve conduction and Electromyography studies can be helpful in diagnosis of sciatic nerve pain and can be performed in our office. But most importantly in treating sciatica is clinical experience with all possible presentations of sciatic nerve pain.

Sciatica Pain Treatment

Sciatica pain treatment begins with the diagnosis. Structures compressing sciatic nerve must be identified through clinical examination and by diagnostic testing. The conservative treatment approach must be undertaken before any invasive intervention is considered. The conservative treatment must not focus only on identified structural factors but include the dysfunction that led to the structural damage in the first place. When dealing with Sciatica nerve pain it is important to keep in mind that the response to the sciatica treatment often varies from one patient to another. The individualized approach therefore is recommended for sciatica pain treatment to be successful.

PREVENTING SCIATICA AND SCIATIC NERVE PAIN

  • Create ergonomic work station
  • Always warm up before exercising
  • When stretching your hip and leg muscles pay attention to symmetry. Do not stretch hard
  • Always maintain dynamic core and hip fluidity by using Pilates, Yoga or working with your chiro or physio
  • Learn how to relax your pelvic floor muscles