What is Sciatica?
Technically speaking, sciatica is a symptom not a diagnosis It is a non-specific term commonly used to describe symptoms of pain radiating downward from the buttock over the posterior or lateral side of the lower limb. It is usually assumed to be caused by compression of a nerve but this is not necessarily so.
A common neurolgical cause of this pain is entrapment of the sciatic and/or posterior femoral cutaneous nerves. But the pain may be caused by trigger points in the soft tissue. This latter case is easily overlooked and requires manual palpation of the musculature associated with the hip if the pain is not to be misdiagnosed.
Background
It is often assumed that there is sciatic nerve root entrapment, resulting in the compression of the nerve. Pain and symptoms being transmitted or referred from the low back to one of the buttocks and down the back of the leg along the pathway of the sciatic nerve. Hence the term sciatica.
The exact cause of sciatica is not fully understood but is commonly thought to involve a slipped or herniated disk. This means one of the disks, which lie between each of the vertebra in the lower back (lumbar area), has cracked and allowed some of the inner disk material to protrude out, putting pressure on the adjacent nerve root, which in this case is the sciatic nerve. The term 'lumbago' is often banded about as well which is a general term for low back pain. However, some people have been found to have a slipped disk but have no pain.
Sciatica Symptoms
Symptoms can vary from extreme pain in the low back radiating into one buttock and down the leg. Pain often increases on exertion or bending forward. Alternatively, there may only be a mild sensation in the leg or buttock. There may be numbness in the area, weakness in the leg and diminution of the reflexes. Pain may be triggered by coughing or straining and can be so severe that the lower back becomes locked in sideways bending position (scoliosis) caused by a strong contraction.
Alternatively, it may only come on when sitting or standing in a certain position. Clinical experience indicates that these certain positions are usually associated with continually holding a poor posture either at home or at work. For example, protruding the head forward peering at a computer all day or regularly lifting a baby out of the back of the car. But some or all of these symptoms are also associated with other conditions which is probably why the name is often misused as a catchall word for any pain affecting the buttocks or other parts of the leg. In this case the pain is triggered by a local trapping (trigger point) or straining of the nerve along its pathway.
Piraformis Syndrome Symptoms
May be a mixture of seemingly unrelated symptoms. Pain and paresthsias (pins and needles) may be apparent in one or more of these areas: the low back, groin, perineum, buttock, hip, back of the thigh, leg and foot or the SI joint. Swelling can occur in the painful leg and sexual dysfunction can occur. The condition can be aggravated by sitting, getting up, or standing. Conversely, activity can worsen the symptoms. It can also cause the buttock muscles to atrophy. Numbness of the foot and loss of position sense (proprioception) can lead to an unstable walk.
Activation
Piraformis syndrome can be activated in numerous seemingly different ways. For example, long drives in the car result in the accelerator foot being flexed for long periods, resulting in the tightening of the piraformis muscle. Lifting or lowering of a heavy weight, catching oneself from falling, twisting sideways while bending or lifting a weight such as a baby out of the back of the car. Direct trauma such as hitting the muscle itself or impact caused by a car accident particularly when the impact is from the side. Morton's foot (second toe is longer than the big toe) can initiate the syndrome after a long walk. This is because the condition tends to cause medial rotation and adduction (inward movement) of the thigh, which puts a strain on the piraformis.
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