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Sciatica

Posted Nov 06 2008 9:44pm 1 Comment

“Thou cold sciatica, cripple our senators, that their limbs may halt as lamely as their manners.”– William Shakespeare 1564.

As you can see from the Shakespearian quote above, sciatica has been torturing mankind for hundreds if not thousands of years. In fact, there has even been biblical mention of this disease!

Sciatica is a term which refers to a burning, stinging, and/or numbing pain that is felt in the buttock, thigh, leg, and/or foot; it may or may not be associated with low back pain.

Eliminating the medical mumbo-jumbo, sciatica is caused by a pinching and/or irritation of one of the three lowest lumbar nerve roots that make up the giant sciatic nerve. Any pinching and/or irritation of these delicate nerve roots may cause lower back pain but may also ignite the entire sciatica nerve into a pain state!

Not all lower extremity pain is classified as ‘true sciatica’: Sciatic pain may be classified as radicular pain (true sciatica) - pain radiating from the low back, past the knee, and into the feet and toes of the affected lumbar nerve root; or as non-radicular pain - pain radiating in the lower limb in a non-specific pattern. Bogduk (a famous researcher on sciatic and back pain) defines radicular pain as a burning and/or numbing pain that presents in a band-like specific pattern below the knee.

THE CAUSES OF SCIATICA:

Disc Herniation, The Conundrum, Discogenic, Chemical Radiculopathy, and Autoimmune Attack.

Now that we know what sciatica is, it’s time to try and explain why it occurs–a task easier said than done!

As I see it, there are three possible “causes” of acute sciatica–excluding the more exotic forms: (1) disc herniation induced sciatica; that is, the rear section of the disc herniates into the closest sciatica nerve root, which in turn physically compresses and irritates that nerve root into a painful state; (2) a grade 5 tear in the disc (annular rings) induced sciatica; that is, the disc rips open and allows biochemical substances (cytokines) to leak out and soak the nearest sciatica nerve root(s), which in turn inflames the sciatic nerve root into a painful state; and (3) discogenic sciatica; that is, the patient may experience a “referred” pain (that often is in a specific pattern) down the lower limb from severe irritation of the tiny sensory nerve fibers (sinuvertebral nerve) that livewithinthe outer 1/3 of the disc. This is NOT an irritation of the actual sciatic nerve but simply the patient’s perception of sciatic nerve irritation–like the left arm pain felt by someone suffering a heart attack.

In a general sense, disc herniation and/or stenosis are by far the most frequent causes of compressive sciatica, there are, however, other more exotic causes of sciatica; such as, Spondylolisthesis,Piriformis Syndrome, Obturator Syndrome, Far-Out Syndrome, Synovial Cysts, Hypertrophied Epidural Vessels, Gas-containing Ganglion cysts, and Tumors. These rare causes are beyond the scope of this paper.

Treatment

The American Academy of Orthopedic Surgeons andAlfNachemson– who is the number one spine researcher in the world - recommends the following conditions be met before decompressive surgery is offered:

#1

Functional incapacitating pain in the leg, extending below the knee with a nerve root distribution.

#2

Nerve root tension signs (positive straight leg raising test) with or without neurologic abnormalities, fitting the radiculopathy.

#3

Failure of clinical improvement after 4-8 weeks of conservative treatment,

#4

Confirming imaging study: abnormal myelogram, computed tomogram (CT), or magnetic resonance imaging (MRI) correlated to the physical signs and distribution of the pain.

 

The only ABSOLUTE indication for surgical intervention, however, is if the patient develops a loss of bowl or bladder control (cauda equina syndrome); if the patient develops severe progressive loss of muscle control in the lower limbs, such as foot-drop; or if the patients has severe debilitating pain.

 

If you would like to know all of the treatments available for Sciatica pain, Dr Scot Gray, D.C. will be presenting the 7 Treatment options available at his Neck & Back Pain Discovery Day on Saturday, March 22 nd from 10 AM to 11:30 AM.   The seminar will take place at The Ohio Neck & Back Pain Relief Centers (across from the Southland Mall, next to Kroger).   The seminar is almost full right now (limit of 20 seats).   If you would like to reserve a seat, call the 24-hour, toll free phone number 1-800-350-3464 or go www.BackBrothers.com.

Comments (1)
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I have a burning pain in my left hip/buttocks.  I have no pain anywhere else.  It is excruciating when I am sitting for a while and stand up.  I was limping around for a while with a sprined ankle, and then this started.  Any Idea what this could be? 
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