Sciatica

“Sciatica” is classically described as a severe, potentially debilitating pain that begins at the lower back and travels or radiates downward through the buttocks and often into one leg. This pain is often aggravated by straightening and stretching of the painful leg and the patient can be comfortable only in an exaggerated flexed postion.

Pain distributed by branches of the sciatic nerve is, by definition, neuropathic or neurogenic—meaning it is caused by degenerated intervertebral disc nerve root compression in the lumbar region. Such nerve root compression can lead to severe complications of significant pain and muscle weakness (e.g., foot drop) or, even, muscular paralysis of the foot or leg. The pain and paralysis of sciatica can also be accompanied by an abnormal tingling or pins-and-needles sensation or, eventually, even frank numbness or sensory loss—also beginning in the toes and feet.

Diagnosis

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CAUTION:  Beware that such pain radiating down the leg can just as often be non-neurogenic, projecting from a sprain injury of the iliolumbar and sacroiliac ligaments. Injured low back ligaments can send a similar type of dull achy or, even, sharp ligament pain down into the buttock, hip, thigh, or further down the leg to the foot—mimicking true sciatica. It is possible that such ligament injury is the actual cause of your pain—even when radiological evidence demonstrates chronic disc disease.

Therefore, it is critical that a combined functional musculoskeletal and neurological physical exam be performed and that expert radiological interpretation is provided to ensure an accurate differential diagnosis.

Treatment

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Osteopathic Manual Therapy (OMT), alone, may readily resolve lumbar vertebral and sacroiliac joint misalignment, which may be the cause of the, so-called (false), “sciatic” pain.

If the lumbar vertebral and sacroiliac joint misalignment repeatedly reoccurs following OMT treatment, then there is undoubtedly a significant lumbo-sacroiliac ligament sprain with sustained joint instability. Such an injury is readily treated by Prolotherapy.

Platelet-Rich Plasma (PRP) Therapy would be more appropriate if there is significant ligament or tendon tearing.
In the situation of severe non-neurogenic, ligament-generated sciatic-like pain, a properly fitted and properly worn Sacroiliac Belt can provide the therapeutic window of time necessary to perform a successful medical treatment of the lumbo-sacroiliac sprain injury. In such a situation, an SI Belt can provide the window of time to satisfactorily complete the Prolotherapy, stabilize the SI joints, and level the sacral base and pelvis—making the patient pain-free.

In the case of critically severe, crippling pain where there is clearly a lumbo-sacroilac joint misalignment and dysfunction co-existent with nerve root compression, we have a setup for a “Perfect Storm”—the collision of two competely separate but equally devastating clinical conditions creating a combined clinical disaster.  In such a case, we recommend appropriate neurological tests and consultations.

In lieu of immediate surgery, a properly fitted and properly worn Sacroiliac Belt can be “life saving” in the case of such a clinical “Perfect Storm”. The belt can provide the window of time necessary to effect a successful medical (nonsurgical)evaluation and decompression of both sacroiliac and disc conditions.  This course of action can allow thge patient to avoid surgery or, at least, provide preparatory time for the required surgery to be nonemergent in nature.

Gary B. Clark, MD, MPA | 1790 30th Street, Suite 230, Boulder, CO | (303) 444-5131