Low back pain (LBP) can be localized and contained to only the low back area or, it can radiate pain down the leg. This distinction is important as the former, LBP only, is often less complicated and carries a more favorable prognosis for complete recovery. In fact, a large part of our history and examination is focused at this differentiation. This weeks’s Health Update is going to look at the different types of leg pain that can occur with different LBP conditions.
We’ve all heard of the word “sciatica” and it (usually) is loosely used to describe everything from LBP arising from the joints in the back, the sacroiliac joint, from the muscles of the low back as well as a pinched nerve from a ruptured disk. Strictly speaking, the term “sciatica” should ONLY be used when the sciatic nerve is pinched. The sciatic nerve is made up of five smaller nerves (L4, 5, S1, 2, 3) that arise from the spine and join together to form one large nerve (about the size of our pinky) called the sciatic nerve – like five small rivers merging into one BIG river. Sciatica occurs when any one of the small nerves (L4-S3) or, when the sciatic nerve itself, gets compressed or irritated. This can be, and often is caused from a lumbar disk herniation (the “ruptured disk”), a mis-positioned vertebra (such as a forward slip of the vertebra called “spondylolisthesis”), pressure from an arthritic spur off the spine where the nerve exits (“spinal stenosis”), or, from a tumor near or around the nerve. A term called “pseudosciatica” (a non-disk cause) includes a pinch from the piriformis muscle where the nerve passes through the pelvis (in the “cheek” or, the buttocks), which has been commonly referred to as “wallet sciatica” as sitting on the wallet in the back pocket is often the cause. When this occurs, the term “peripheral neuropathy” is the most accurate term to use. Other “pseudosciatic” causes include referred pain from the facet joints which is described by the patient as a “deep ache” inside the leg, or from a metabolic condition where the nerve is affected such as diabetes and other conditions. Here again, the term, “neuropathy” is the better label when diabetes, hypothyroid, lead poisoning, alcohol toxicity and/or others is the culprit. Direct trauma like a bruise to the buttocks from falling or hitting the nerve during an injection into the buttocks can also trigger “sciatica.”
The symptoms of sciatica include low back pain, buttocks pain, back of the thigh, calf and/or foot pain and/or numbness-tingling. If the nerve is compressed hard enough, muscle weakness can occur making it hard to stand up on the tip toes creating a limp when walking. In the clinic, we will raise the straight leg and if pinched, sharp pain can occur with as little as 20-30° due to the nerve being stretched as the leg is raised. If pain occurs anywhere between 30 and 70° of elevation of either the same side leg and/or the opposite leg, this constitutes a positive test for sciatica (better termed, “nerve root tension”). When a disk is herniated into the nerve, bending the spine backwards can move the disk away and off the nerve resulting in relief, which is very diagnostic of a herniated disk. Having a patient walk on their toes and then heels and watching for foot drop as well as testing the reflexes, the sensation with a sharp object, and testing the reflexes at the knee and Achilles tendon can give us clues if there is nerve damage. The GOOD NEWS is that chiropractic methods can resolve this problem FREQUENTLY, thus avoiding unnecessary surgery! So, check with us FIRST, before electing for surgery!!!
We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
To schedule an appointment for sciatica treatment in San Francisco please call 415-392-2225. Mention this blog post for a complimentary consultation.