The Sciatic Nerve

The sciatic nerve is often implicated as being a causative component of many back and leg pain syndromes.  In fact, the structure has graced the orthopedic and neurology communities by lending its name to the actual condition known as sciatica.  By accepted medical definition, sciatica is caused by a pinched nerve in the back, creating symptoms in the lumbar spine, buttocks, legs and/or feet.  However, the structural theory used to explain most sciatic nerve complaints is shaky at best and misdiagnosed in the vast majority of patients.

Medical science describes true sciatica as stemming from physical compression of a spinal nerve root, as it leaves the neuroforaminal openings between each vertebral bone.  This condition is often referred to as radiculopathy, a radicular pain condition or a compressive neuropathy.  Medical science also defines a condition known as pseudo-sciatica as back and leg pain symptoms not caused by a spinal source.  The 2 most commonly diagnosed varieties of pseudo-sciatica include piriformis syndrome and sacroiliac joint pain.

The diagnostic basis for determining a condition of true sciatica rests on the fact that the affected nerve root is being pinched off by some structure in the spine.  This structure may be a herniated disc, a ruptured and extruded disc or an osteoarthritic bone spur (also called an osteophyte).  These conditions are identified as the source of pain in countless patients, even though anatomical evidence proves most of these abnormalities to be completely innocent and asymptomatic.  It is well known that in order for a nerve root to be affected, virtually the entire foraminal space would need to be closed off.  This almost never actually occurs.  Usually, the suspected symptomatic culprit either does not touch the nerve at all or merely makes contact, but provides no compression.  It is further known that continued compression of a nerve root will cause that neurological structure to completely cease function.  The result is true and objective numbness, not the pain, tingling, weakness and subjective numbness often encountered by sciatica sufferers.

Pseudo-sciatica is a diagnosis on the rise, although these pain syndromes are even more logically suspect.  Sacroiliac joint pain can be diagnosed as sacroiliitis or sacroiliac joint dysfunction, but rarely actually exists.  The SI joint is one of the strongest in the body and rarely becomes injured or degenerated to the point of explaining pain above and below the theorized source of symptoms.   Piriformis syndrome is a completely unproven diagnosis, usually speculated to exist after an injury to the powerful piriformis muscle, which exists deep in the buttocks.  Although this diagnosis has never been medically validated, it continues to be a popular scapegoat on which to blame otherwise idiopathic sciatica and back pain.

Sciatica patients are further subjected to insult on top of injury when they are told by their care provider that something in the spine is compressing or pinching their sciatic nerve.  This is anatomically impossible, since the sciatic does not even join directly into the spinal column.  Instead, this largest of all bodily nerves is made up of branches stemming from the L4, L5, S1, S2 and S3 spinal nerve roots.  Suspicion of a spinal cause is common in these poor souls even when the actual symptoms do not correspond to the diagnosis rendered.  For example, there is pain in the lower back, buttock and leg attributed to a herniated disc.  However, the patient suffers from far too wide ranging symptoms than could be explained by the single herniation, since the affected nerve root does not even remotely serve the neurological needs of areas which exhibit pain.  This fact is grossly overlooked in the vast majority of diagnosed patients and helps to explain why treatments for sciatica are so universally unsuccessful.

Sciatica is a fascinating condition, since it is well known to be treatment-resistant and chronic.  Medicine will gladly acknowledge these attributes as descriptive of almost all sciatic nerve pain.  However, what medical providers will not acknowledge is just how clueless they are in dealing with the condition and how it is criminally misdiagnosed in most sufferers, leading to years worth of wasteful symptomatic treatment and even unnecessary and negligent surgical interventions...