By Dr. Amin Javid, Beverly Hills Spine & Rehabilitation
First, know this: Sciatica is SYMPTOM, not a diagnosis. Sciatica refers to the numbness and tingling sensation you feel going down the buttock region often all the way down the back of the legs to the toes. The actual diagnosis is called Compressive Neuropathy, and under this umbrella falls many neuropathies; these are the usual suspects: Carpal Tunnel, Tarsal Tunnel and the notorious, often misdiagnosed, Sciatica.
While we’re on the subject, here are a few facts you probably didn’t know about sciatica:
1) True, sciatica (often referred to as root sciatica) the kind that is caused by a herniated disc in your low back will almost ALWAYS cause symptoms from the low-back all the way to your TOES, thats right, the numbness and tingling will not stop at your butt or behind the knee! In fact, if you feel numbness and tingling that stops somewhere in the vicinity of the back of the knees, its very likely that your facet (the little joints of the spine) is the root of your problem and not a disc herniation as many often think.
2) The sciatic nerve is the largest nerve in the body and spans the width of two of your fingers side-by-side
3) Many, if not most cases of sciatica are treatable without surgery.
4). Common underlying conditions differ based on age. For adults under 60, the most common causes of sciatica are a lumbar herniated disc, degenerative disc disease, and isthmic spondylolisthesis. For adults over 60, degenerative changes in the spine like lumbar spinal stenosis and degenerative spondylolisthesis are the typical culprits. Pregnancy, scar tissue, muscle strains, and bone fractures can also give rise to sciatica-like symptoms.
5) Location matters. Five nerve roots from your lower back join together to form the large sciatic nerve. Symptoms are typically dictated by which of these 5 nerve roots is pinched or irritated. For example, numbness in the feet is common when the nerve root near the L5 vertebra is pinched.
The 5 Most Common Causes of Sciatica
The following five lower back problems are the most common causes of sciatica:
Lumbar herniated disc
A herniated disc occurs when the jelly-like inner material of the disc leaks out, or herniates, through the fibrous outer layer and irritates or pinches the nerve root. You have likely eard this refered to as, “slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve”, Sciatica is the most common symptom of a lumbar herniated disc.
This condition occurs when a small stress fracture causes one vertebral body to slip forward on another vertebra; for example, if the L4 vertebra slips forward over the L5 vertebra. With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.
Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60. This could occur as a result of: facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain. Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.
This is often times overlooked and misdiagnosed. The sciatic nerve can get irritated as it runs under or in some cases even THROUGH the piriformis muscle that is located in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. Although this is not a true lumbar radiculopathy, which is the clinical definition of sciatic, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.
Treating the problem is easy, but only if you reach the correct diagnosis. Contact us at Beverly Hills Spine & Rehabilitation so we can help YOU get rid of your pain like we have for hundreds of others just like you. Stay tuned to our blog for more helpful tips.