Sciatica

Sciatica refers to a condition that is characterized by sharp shooting pains such as burning, stinging or numbing that begins in the buttocks and travels down the leg to the foot which may or may not be associated with lower back pain. The most common cause of lower back pain is a compressive neuropathy from a disc herniation impinging one or more of the bottom three nerve roots of the lower back(L4,L5,S1) that make up the largest and longest nerve in the body, the sciatic nerve. The pain is usually one sided, but can occur bilaterally. True sciatica is a radicular pain that travels and displays a dermatomal pain pattern. Dermatomes are a clinical map that indicates the distribution of nerve fibers to the skin and how we perceive pain and sensory information. In short and in very simplified terms, the S1 distribution which is the most common impinged nerve root by the L5 disc, presents as pain and or numbness of the back of the thigh through the back and part of the side of the lower leg as well as the side of the foot. The L5 distribution occurs at the most lateral aspect of the lower leg and the L4 on the inside of the lower leg. These clinical symptoms help doctors diagnose the level of impingement or herniation preliminarily before a MRI is ordered to confirm the lesion. Weakness as well as loss of reflexes may also be present of certain nerve root levels which correspond to the dermatomal pain distribution and generally classifies a more serious impingement.

There of course can be other causes of sciatica which I will mention, but is beyond the scope of this discussion. Other causes such as Synovial Cysts, Piriformis Syndrome, Obturator Syndrome, Far Out Syndrome, Tumors, Hypertrophied Epidural Blood Vessels, Spondylolisthesis and Gas Filled Synovial Cysts are certainly more rare in occurrence, but should be differentiated by a trained and licensed health care professional.