SCIATIC NERVE PAIN

Sciatica is a real pain in the butt, literally. Studies suggest that almost 50% of the population will experience sciatica pain during their lives. In fact, sciatica causes more problems than back pain. Symptoms are usually located in the buttocks, back of the thighs and below the knee. Often it presents unilaterally, but it can affect both legs. The sciatic nerve is composed of branches primarily from the L4, L5, and S1 lumbar nerve roots, and usually involves the L4 and L5 spinal discs but not always. There are generally 2 main types of sciatica, axial and appendicular. In either case, it is nerve pain and can be burning, shooting, numbing, tingling or sharp. It can range from a slight disturbance to severe, causing hospitalization.
-Axial is considered true sciatica, where site of entrapment is in the lumbar spine usually caused by a herniated, or bulging disc or bony compression from arthritis. Low back pain is usually present as is posterior thigh and buttock pain. There is usually no pain past the knee.
-Appendicular is also known as pseudo sciatica, it composes less tan 90% of sciatica pain we see clinically. The entrapment site is distal to the spine and caused by a soft tissue mechanism. There is usually no low back pain but pain does exists in the posterior thighs and buttocks. Pain below the knee is sometimes present with appendicular sciatica.

DIAGNOSING SCIATICA

The straight leg raise (SLR) is the most useful test for sciatica pain. It is also known as Lasegue's sign, after Charles Lasegue (1816-1883). In 1864 Lasègue described the signs of developing low back pain while straightening the knee when the leg has already been lifted between 30-70 degrees. In order to make this test more specific, the ankle can be dorsiflexion and the cervical spine flexed. The test can also be preformed in the sitting position. 9 out of 10 people who test positive with the SLR will accurately indicate axial sciatica. Regardless if the SLR indicates axial sciatica you will also want to test for appendicular sciatica, often they are both present.

Bowstring Test

The Bowstring test is a variation of the SLR where the examiner flexes patient’s hip with knee slightly flexed. Next pressure is applied on the hamstrings muscles & then the popliteal fossa (back of the knee). Pain from this pressure indicates entrapment that is not associated with the spine. Another test for appendicular sciatica is the Piriformis test. This is a very popular diagnosis, and the most common cause of appendicular sciatica (70%). The test involves bringing the knee to your chest and then across the midline of your body.

Piriformis Test

OTHER CAUSES OF SCIATICA

-Other causes of appendicular sciatica include prolonged sitting from direct pressure on the sciatica nerve from wallets or hard chairs
-Driving (sitting to long) can cause axial and appendicular sciatica.
-Repetitive movements, exercise can over develop the Piriformis muscles and cause sciatica.
-Pregnancy can cause tissue changes to the Piriformis muscles.
-Direct injury to the Sciatica nerve, tumors, infections or scarring can all cause Sciatic pain.

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*DISCLAIMER: Dr. Stephen Stokes received his Doctor of Chiropractic degree from Logan College of Chiropractic in 2001. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. The material provided on this site is for strictly informational purposes only. It is not meant to replace or substitute for the recommendations or advice of your physician or medical provider. The products are not intended to diagnose, treat, cure or prevent disease. The information contained in this site should not be used for diagnosing or treating a health problem or disease. If you believe you have a medical condition or problem contact your health care provider. The statements contained in this website have not been evaluated by the Food and Drug Administration. Not every patient has results like those seen in our Video Testimonials. Both verbal information and written records about our patients cannot be shared with another party without the written consent of the patient or the patient’s legal guardian or personal representative. It is our official office policy not to release any information about a patient without a signed release of information except in certain emergency situations or exceptions in which client information can be disclosed to others without written consent. Dr. Stephen Stokes BSc, DC, FIAMA offers no charge consultations as a community service with the goal of reaching out to as many people as possible in order to educate them on the alternative treatments available for pain. If the patient and any other person responsible for payment decides to purchase services or products as the result of this no charge offer, they have the right to refuse to pay, cancel payment or be reimbursed for payment within 72 hours of responding to this advertisement for a no charge consultation.