Sciatica: It's not what you think

Pain or numbness in the lower back, buttock, or running down the leg. Sometimes, there may be numbness, muscular weakness, pins and needles or tingling and difficulty moving or controlling the leg. Any of this sound familiar? This isn’t sciatica. Believe it or not, the sciatic nerve only gives sensations below the knee. What you’re feeling is likely radiculopathy coming from the lumbar spine.

The sciatic nerve is a large nerve about the diameter of a dime which runs down the back of the leg, branching to supply most of the muscles of the posterior leg, but only creates sensation below the knee. Sciatica is a collection of symptoms associated with irritation or compression of the sciatic nerve and it’s extremely commonplace. There are a number of potential causes of sciatica. I’ll outline some of them.

The most frequent cause of sciatica is intervertebral disc herniation. In such a case, a herniated or bulging disc presses on one of the five nerve roots which form the sciatic nerve. Activities featuring heavy impact or repeated impacts will exacerbate such cases. Often, depending on severity, these herniations can heal themselves.

Spinal stenosis is a condition where the spinal canal narrows and compresses parts of the spinal cord; and in some cases the roots of the sciatic nerve. The narrowing can come from a number of sources, such as bone spurs or disc herniations. Poor posture is a frequent contributing factor.

Above were conditions which cause true sciatica. There is also what is known as pseudo-sciatica. With pseudo-sciatica, the piriformis muscle of the hip compresses or surrounds the sciatic nerve creating symptoms. The symptoms can be the same or similar to true sciatica, but the cause is generally much more easily resolved.

Again, what most people think is sciatica is actually radiculopathy. This also is most frequently caused by lumbar disc heraniation and sometimes stenosis. Referred pain from surrounding muscles can also give radiculopathy-like symptoms. Trigger points in muscles such as the gluteals, quadratus lumborum, psoas (hip flexor) and deep hip rotators can causes similar pain referral patterns.

Compression, degeneration or irritation of the facet joints of the low back (joints along the spine) can cause pain referral patterns in the low back and upper legs.

Last, but not least, is constipation. Yes… constipation. Pressure from the bowel can press on the nerve roots.

Most of the conditions I’ve listed above can be treated non-surgically. Through improved posture, correction of muscle imbalances and, in the case of bulging or herniated discs, spinal decompression (whether via traction tables or decompression equipment such as the DRX-9000), as well as such interventions such as weight-loss, physical therapy and acupuncture, symptoms can be reduced or eliminated all together. In the case of disc herniation, as many as 90% of cases heal without intervention, though there are often residual imbalances that require correction.

There are also numerous surgeries designed to eliminate the underlying causes of sciatica and radiculopathy. Just be aware that numerous studies show that after two years, surgical and non-surgical treatments offer about the same results. Food for thought.

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