“Sciatica” refers to nerve irritation that travels from the back to the buttock and leg/foot. Basically the nerve is being compressed by either a herniated disc or is pinched in a tight hole (stenosis). Most commonly, the outside coating of the nerve is compressed which sends shooting electricity, tingling, and numbness pain. On occasion weakness can accompany the pain with inability to move an extremity or a foot drop/drag. That means that the nerve compression is severe, not only affecting the outside of the nerve, but the inside as well. Fortunately most cases do not involve strength loss and heal conservatively with a variety of treatment options that meets the patient’s philosophy and needs.
Sciatica can also result when there is no disc herniation in the spine; however, the nerve is pinched as it travels through a buttock muscle called the piriformis. This muscle has two heads and occasionally the sciatic nerve gets trapped in between which causes buttock pain with sitting that can radiate down the leg. Often patients will have a negative back MRI yet continue to experience “sciatica.” There are specific treatment options for “piriformis syndrome” that differ from standard herniated disc protocol which can make all the difference. Patients with this condition frequently see many physicians until they are properly diagnosed and treated.
In addition to a comprehensive history and physical exam, nerve injury can be confirmed with MRI or Electrodiagnostic study.
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