Sciatica?
True sciatica is pain, numbness, or tingling down the L5/S1 nerve root pattern. This is described by the medical term radiculopathy. This can be caused by several different conditions. When a nerve is compressed it follows what is known as a dermatomal pain pattern. Basically, this means that wherever this nerve root runs throughout your leg you will feel the symptoms. So, for the L5 / S1 nerve root, you'll typically feel this starting in the gluteal / buttock area, then, when symptoms worsen they could travel into the back of your hamstring, sometimes into the calf, and the furthest the symptoms will go is into the big toe. Sciatica is such a staple term because the most common radiculopathy is from the L5 / S1 nerve root.
Now for the conditions that can cause pain in this distribution. As you could imagine this nerve root starting in your back and going all the way to your toe travels through lots of different anatomy. The first and most common area for this nerve root to get compressed is directly where it starts in the low back. When the nerve root exits the spine it travels through what is known as an intervertebral foramen. Depending on your age and method of injury the intervertebral foramen can be encroached in several different ways.
The first being a disc herniation or disc bulge. Between the 24 movable vertebrae within your back, there is a cushion or shock-absorbing disc between each level. You can imagine these discs to be sort of like a jelly donut and when you compress the disc in certain ways the jelly or nucleus pulposus can herniate out and start pushing on the nerve root. Sometimes the discs can be compressed and just bulge without a herniation. These disc bulges can become large enough where they can also compress the nerve root. Lastly, these discs can undergo degenerative changes just like all the other joints in your body. When the discs begin to degenerate they lose their hydration which makes them lose some of the disc height. When you start to lose the disc height this stresses the bone in the area and some bony arthritis begins to form. This bony arthritis in the area can also push on the nerve roots producing the sciatica type pain.
After the nerve roots get through the intervertebral foramen opening, there are some areas down the line where it can also be compressed. Although, this is far less common than the nerve root getting compressed within the low back area; so I'll just discuss one of these. Some people can suffer from piriformis syndrome. The piriformis is a deep gluteal muscle that attaches from the sacrum and runs to your hip. Sometimes people can have an anatomical anomaly where the sciatic nerve actually pierces through the piriformis muscle. When the piriformis muscle becomes tight this can impinge on the nerve root that is passing through or going directly beneath the piriformis. These people typically will experience the same symptoms as described above.
Lumbar radiculopathy or sciatica is not a widely accepted diagnosis for a problem it's more so a symptom. Through a good clinical examination and history, we can tease out what is causing your sciatic type pain and treat you accordingly. We have several techniques that work very well for all conditions described in this post.
