In our previous post, we discussed lumbar facet syndrome and discussed how you, the patient, can learn to differentiate different types of back pain. This post will focus on a condition known as sciatica. Although it sounds like a Russian province, the word simply means any condition that irritates the sciatic nerve in the hips and legs. The way clinicians diagnose sciatica is if a patient has pain originating in the buttock (usually one side only) which travels all the way into the ankle and/or foot and is made worse if the patient pulls the knee to the chest.
The sciatic nerve is made up of the L4, L5, S1, S2 and S3 nerves. These individual nerves converge together to form one single garden hose that exits the pelvis and travels down the leg.
There is one major way of putting pressure on the sciatic nerve and thereby causing the set of buttock and leg symptons known as sciatica. The area of compression occurs directly in the buttocks region (underneath the glute max) where the sciatic nerve has to literally snake its way between the hip rotator muscle group. If the hip rotators get too tight because of too much exercise, too much sitting or due to an injury, the swelling, inflammation and pressure can accumulate on the sciatic nerve to the point where it “can’t breathe” and sends pins & needles or pain down the leg. And because the sciatic nerve is comprised of several nerve roots (i.e.: L4 through S3) the pain and numbness will be spread out over a generally large area.
Sciatica must be differentiated from nerve root compression.
Nerve root compression occurs right at the spine and involves only one single nerve root. For example, if a disc bulge, herniated disc or bone spur is placing pressure on the L4 nerve, the patient can experience sciatica-type pain down the outside of the thigh, the knee cap and then the inside region of the shin (see picture). That is the region of skin innervated by the L4 nerve. The pain is therefore localized to this, barber shop spiral strip of skin. Whereas the sciatic nerve has L4, L5, S1, S2 and S3 skin sensation involved. So a sciatica will involve pain all over the thigh, calf and foot, not just a thin stripe of skin.
Another way to tell if someone has a nerve root compression instead of sciatica is that bending forward makes things worse, whereas laying on your back and bringing your knee to your chest does not increase pain.
The reason is, by bending forward at the waist, you are squeezing the discs and any bulging will be accentuated, therefore placing more pressure on the nerve root. But if the patient is laying down, and brings their knee to their chest, the low back is not bending (and so not pressuring/bulging the disc) so a nerve root compression problem won’t be made worse.
But if the patient has sciatica, laying down and bending the knee to the chest will stretch the buttock region hip rotators and put a squeeze on the sciatic nerve, thereby increasing pain down the leg.
So if you suffer from buttock, hip and leg pain that travels all the way to the foot, you may want to try the above advice to try and differentiate between nerve root compression and sciatica. But please also see a professional in order to get full and proper diagnosis. I simply want the reader to be better equipped when they see a professional. This makes the patient confident and will decrease the likelihood of getting unnecessary treatment or wrong diagnosis.