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Referred pain - Sciatica
The sciatic nerves are the largest in the human body. They run from the base of the lumbar spine, on either side, through the buttocks and down the back of the legs; they extend all the way to the feet. If the nerve-root becomes compressed, pain is often experienced, not only in the lumbar spine, but also radiating into the buttocks, hamstrings, and (occasionally) lower legs. The condition is referred to as sciatica, and it is very common.
Why does this happen?
The sciatic nerve can become compressed for a number of reasons. For example, the following, underlying conditions (if present in the lumbar spine), can all lead to sciatica:
The list is by no means fully inclusive.
The nerve itself has five roots on either side of the spine: these are labelled according to the hole from which they exit the spinal column, namely L4 and L5 (lumbar) and S1, S2, and S3 (sacral). The five roots come together to form the sciatic nerve, just below, and to the side, of S4 (shown here).
Because the nerve is so big, and has so many roots, sciatic nerve root compression is reasonably common (only one of ten possible roots needs to be compressed for sciatica to develop).
Despite the fact that the nerve root is compressed, the pain can be felt anywhere along the entire nerve, from the lower back, through to the buttocks, hamstrings, knees, and lower legs. This is due to a condition known as referred pain (or radiculopathy), where the brain finds it difficult to localise the pain.
How is it diagnosed?
The symptoms of the condition are relatively unique: whilst the level of pain can vary, from mild to severe, it usually affects one side of the body only (not both), and the pain often radiates through the buttock and/or leg. One or more of the following symptoms may be present:
Pain in the lower back.
A constant pain in one side of the buttocks.
Pain in the buttocks and/or leg that is worse when sitting.
A shooting pain that makes it difficult to stand up.
Burning or tingling (Pins and needles) down the leg.
A numb feeling in the leg.
Difficulty moving the leg or foot (in severe cases, the foot may drop).
As a result, sciatica is fairly easy to diagnose. However, determining which (or how many) of the five nerve roots is compressed is more difficult. It requires a thorough understanding, both of anatomy and referred pain; following on from this, the underlying cause must be identified. In this respect, sciatica is quite a vague term; only a trained individual will be able to give a full and accurate diagnosis.
If your symptoms are severe you should generally consult an expert (for example, by visiting our Spine Clinic). You may have a Slipped disc, or Cauda Equina Syndrome (amongst other conditions), both of which require prompt attention.
What are the consequences for back pain?
The general symptoms are mentioned above. However, depending on the nature of the underlying problem, you may experience other symptoms. At this stage, we recommend that you either consult your doctor, or visit our Spine Clinic.
What are the risk factors?
Because there are so many underlying causes, the risk factors for sciatica are many and varied. However, up to 98% of all back pain is directly caused (or substantially aggravated) by compression of the spine; as a result, compression (which itself is caused by bad Posture, injury, ageing, hereditary conditions and/or excess weight) is a primary risk factor in cases of sciatica.
Can it be treated?
Yes. It follows, that if 98% of all back pain is either directly, or indirectly, caused by compression of the spine, then decompression will solve many of the underlying conditions (at the very least, it will make them asymptomatic, that is, the underlying condition might still be present, but it is improved to the extent that symptoms are removed).
The type of treatment is obviously very important. Some provide temporary relief, others prove ineffectual, and some are actually detrimental to the individual’s health. We believe that Orthopaedic Medicine is the most appropriate form of treatment; the Backrack™ will replicate most of the methods used by a practitioner, but, for more serious conditions, you may wish to visit our Spine Clinic in London.
For more details on the range of treatments available, please visit our section on Treatment.