By
Dr. R. Greg Lusk, DC
Over the years I have listened to
many patients tell me that they have "sciatica". Either they think they do based on what they
found after a Google search, another healthcare professional has told them that
they do, or a well-intentioned friend or family member has made the suggestion. Sciatica is a term often used broadly to
refer to pain or other symptoms, such as tingling or numbness, in one or both
legs. However, it is often used
incorrectly to describe pain from another nerve and in and of itself offers
very little value in understanding the source of one's symptoms. It's similar to being told that you have
tendonitis. Tendons attach muscles to
bones, and because we have many muscles we also have many tendons. Saying that you have an inflamed tendon
("itis" = inflammation) doesn't inform someone where certain
treatments (e.g. laser/ultrasound/soft tissue therapies) should be applied or
what actions/exercises should be avoided, or done, to assist with recovery. The same holds true for sciatica, but
understanding the source is crucial to successfully managing the condition.
The sciatic nerve is like the trunk
of a tree. There are various roots that
come together to form the "trunk" and then the trunk offers up many
branches. This nerve is the longest and
widest in the entire body and forms deep in the pelvis as 5 nerve roots (L4&5,S1,2,3)
come together. It exits the back of the
pelvis through deep buttock muscles and then runs down the back of the leg where
it distributes its various branches. It
is responsible for sensation of the skin on the back of the thigh, the outside
front and back of the calf, and most of the foot. It does not supply the inside, front, or
outside parts of the thigh, or the inside of the shin and foot. Therefore, if that is where your symptoms
are, you do not have "sciatica".
Furthermore, the sciatic nerve is the power source for the muscles on
the back of the thigh (i.e. hamstrings) and all muscles of the shin and foot.
If you do have symptoms in the
correct area(s) the question still remains - "Where is the source of
irritation?" Frequently, where you
feel symptoms (i.e. the leg) is not where the problem is and often pain
relieving efforts are directed at the smoke but not the fire. Often a nerve root in the back is the site of
irritation and this is more properly named a radiculopathy. This could be due to spinal disc degeneration
and resulting arthritic changes (a.k.a. stenosis), a disc bulge/herniation, or
slippage/excessive movement between vertebrae (spondylo-listhesis). Sorry for the tongue-twisting mouthful! In each case, the management of symptoms
could involve aspects that are quite different.
For instance, disc bulges often respond best to exercises where you bend
backward whereas relief from stenosis symptoms usually occurs by bending
forward. This illustrates why
"sciatica" as a diagnosis doesn't really cut it while something like
"L4/5 Disc Bulge with a right L5 Radiculopathy" is much more
informative. Furthermore, this doesn't
even consider the fact that muscles and joints, namely the sacro-iliac (SI)
joint or hip joint, other soft tissues (e.g. bursae), or irritation to the
sciatic nerve and its branches along its path, can refer symptoms into the leg
as well.
Differentiating the cause of your
"sciatica" is empowering as it clarifies what activities you should
refrain from or participate in, providing you with a sense of control over your
symptoms.
This
article is for general information purposes only and is not to be taken as
professional medical advice.
No comments:
Post a Comment