Sciatica

By: Allison Brooks

What is Sciatica?
Injury to or compression of the sciatic nerve. Low back pain that travels down through the buttock and possibly into the leg.

Sciatic Nerve Background

Largest nerve of the body. Usually a combination of nerves roots that include: L4, L5, S1, S2, S3. Leaves pelvis through the greater sciatic foramen and passes through gluteal region, which then enters into the posterior compartment of thigh. Sciatic Nerve then divides into common fibular and the tibial nerve.

Mechanism of Injury
Herniated or slipped disc.
The nucleus pulposus or jelly-like center of a disc can protrude and cause pressure on the nerve root.

Piriformis syndrome.
Inflammation of the piriformis muscle. Pinching of the sciatic nerve.

Injections to buttock. Trauma to the buttock.

Mechanism of Injury Continued

Posterior dislocations or fractures to the hip joint. Aging
narrowing of the nerve
canal that contains the spinal cord

Some rare causes of sciatic pain are: diabetes,

pelvic infections, and various infectious causes of arthritis.

Signs and Symptoms

Described as shooting or tingling pain and sometimes numbness. Prolonged sitting or standing can worsen pain. Usually only occurs on 1 side of the leg. Weakness of muscles in the posterior thigh could be due to spasm, trauma, and inflammation. Weakness of the muscles can also show an abnormality in the patients gait.

Palpation of Sciatic nerve

Patient flexes hip, press firmly between the ischial tuberosity and the great trochanter The nerve is barely palpable but if injured it will become point tender.

Special Tests
Straight Leg Raising Test- must determine between sciatic nerve
or tight hamstrings (positive sign for both is pain)
To stretch the sciatic nerve elevate leg to where pain is and then dorsiflex the foot. If pain is reproduced with this motion, ask patient to locate the pain, depending on the type of pain, examiner will be able to make a differential diagnosis.

Well Leg Straight Leg Raising Test

Lifting uninjured leg produces pain.

Sitting Root Test

Patient sits with neck flexed and their knees extended, while hips are flexed at 90o. (pain is the positive sign)

Further Testing to confirm sciatica would be:

Spinal X-ray MRI CT Scan

Management Options
Rest Ice or Ice massage NSAIDS Moist Heat Stretching ***Long term nerve damage can occur if not treated promptly.

Surgical Treatment
Diskectomy- removal of a portion of the herniated disc that is irritating the nerve root. This surgery helps alleviate pressure and inflammation, if conservative management options such as the ones we just discussed do not relieve pain.

Exercises
Focus on exercises that strengthen and stretch the abdominal and back muscles for core stabilization. Decreases muscle imbalance, which can result in decreasing spasm and pain.

Work Cited
eMedicineHealth: Emergency Care and Consumer Health. Sciatica. Available at: http://www.emedicinehealth.com/sciatica/article_em.htm. Accessed March 15, 2007. Hoppenfeld, Stanley. Physical Examination of the Spine and Extremities. Upper Saddle River, NJ: Prentice Hall; 1976. MayoClinic: Diseases and Conditions. Sciatica. Available at: http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=1. Accessed March 15, 2007. Magee, David J. Orthopedic Physical Assessment. 4th ed. Edmonton, Alberta, Canada: Saunders Elsevier; 2006. MedlinePlus. Sciatica. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000686.htm. Accessed March 15, 2007. Spine-Health: Spine Topics. What you need to know about Sciatica. Available at: http://www.spinehealth.com/topics/cd/d_sciatica/sc01.html. Accessed March 15, 2007.