Sciatica

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By George S. Pellegrino, LMT, CMTPT, RMTI

and Victoria L. Magown, CMTPT, LMT, RMTI

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The term “sciatica” has been around for a long time. In fact, it was first used in the year 1450 when it appeared in the Oxford English Dictionary. Today, it is commonly used to describe low back and buttock pain often accompanied by pain radiating down the thigh.

About 40% of the population will experience sciatica at some time during their lives. Sciatica and other low back pain symptoms disable 5.4 million Americans a year. It has cost America at least $16 billion a year in lost productivity, and patients more than $16 million in out-of-pocket healthcare expenditures. Although the term “sciatica” is often used as though it were a diagnosis, it is really a set of symptoms with one or more underlying causes that may or may not involve the sciatic nerve. Before an appropriate treatment can begin, the underlying cause (or causes) must be identified.

True Sciatica occurs with compression and/or irritation of one of five low back nerve roots that give rise to the sciatic nerve. They are lumbar nerves L4, L5 and sacral nerves S1, S2 and S3. This is usually the result of a disk herniation, narrowing of the spinal canal, or misalignment of the lower lumbar vertebrae at L4-L5.

Compression of the entire sciatic nerve by the piriformis (and other muscles) can also produce sciatica symptoms. When this happens, it is appropriately referred to as “Piriformis Syndrome” (Illustration A).

Both True Sciatica and Piriformis Syndrome are often accompanied by numbness and other sensory disturbances in the area involved with the sciatic nerve. This is because both conditions produce pressure on part or all of the nerve.

Another source of these same symptoms can be the result of Myofascial Trigger Points (MTrPs) in a muscle that has little to do with the sciatic nerve or its nerve roots. Gluteus minimus MTrPs will produce pain in the hip, buttock, and thigh all the way to the ankle (Illustration B). When this occurs, it is appropriately referred to as “Pseudo-sciatica.” Myofascial Trigger Points are hypersensitive, self-sustained contraction knots in muscle accompanied by a shortening in the length of the muscle called a taut band. When these knots are stimulated by movement or pressure, pain is referred through pathways in the nervous system in predictable patterns, usually away from the MTrPs.

The pain of the gluteus minimus Trigger Points is indistinguishable from the pain caused by True Sciatica and Piriformis Syndrome. It is this similarity of pain that causes all of the confusion. It is this confusion that often leads to unnecessary and often ineffective treatment that may include medication or back surgery.

According to a study conducted by James Weinstein, DO, and published in the Journal of the American Medical Association in 2006, people with herniated disks in the lumbar spine usually recover whether or not they have surgery.

The study, a large trial, found that surgery appeared to relieve pain more quickly but that most people recovered eventually. No adverse health effects were reported by delaying surgery and many sufferers benefited from non-surgical alternatives.

At MyoRehab, the results of an in-depth evaluation combined with medical findings are employed to identify the underlying causes of these often confounding symptoms. This insures the application of the most effective, non-surgical, drug free treatment protocol.

Because the treatment protocols used at MyoRehab are specific, in the case of True Sciatica, therapists certified by the American Society of Laser Therapy in the use of Low Level Laser Therapy (LLLT) treat the cause, not the symptoms. The MicroLight 830 “cold laser” is one of the most powerful among the tools applied. The 830 nanometer wavelength of the MicroLight laser has the deepest reach (5 cm) into the body of any “cold laser” and is FDA approved (Illustration C).

In the case of Piriformis Syndrome and Pseudo-sciatica, manual techniques are applied by Manual Trigger Point Therapists certified by the American Institute for Myofascial Studies, LLC. The therapists at Myo- Rehab are highly skilled at employing the most advanced techniques available. Whatever the underlying cause, during each hour-long visit, behaviors that perpetuate sciatica symptoms are also identified and modified. A very specific exercise program is customized to fit the physical abilities and practical realities of each patient.

Are you among the 40% of the population suffering needlessly?

Give us a call at 505-872-3100 and set up a consultation appointment.