Sciatica....or.....Pseudosciatica?

Patients often complain of sciatica, an electric-like pain that courses down one or both legs.  Often times they come into my office with a pre-diagnosis of sciatica given to them by another healthcare provider.  True sciatica is most often caused by a lumbar disc pathology such as a herniation, by boney osteocyte growth such as a spur into the IVF where a nerve exits from the spinal cord through the skeletal spine, and can occr from a stenosis or narrowing of the spinal canal.  Pain typical runs the full course of the nerve being affected, in the case of sciatica, often the lumbar nerves L4-5 and the first sacral nerve.  It is distinguished from a lumbar facet imbrication (a jammed posterior joint) by the fact that nerve irritation from a lumbar imbrication usually doesn't follow the path of the nerve all the way to the foot, but rather often ends before it reaches the knee.

Often, however, sciatica is the wrong diagnosis and the patient should be examined for pseudosciatica or a pain similar to the pain of sciatica but not caused by a disc or skeletal pathology.  Rather, the more common pseudosciatica is caused by over tonicity or spasm of the piriformis muscle, a muscle in the gluteal complex running from the sacrum, across the sciatic notch of the pelvis, and inserting on the femur (long bone of the upper leg).  When the piriformis muscle is tonic, or spastic, it compresses the branches of the sciatic nerve (L4-S1 nerves) causes irritation to the nerve bundle and similar pain to true sciatica.

If you do experience sciatic pain, this differential diagnosis should be made by your health care provider.  Treatment for the pseudosciatica can be as simple as employing myofascial release techniques, electrotherapies to fatigue the muscle, and simple stretches to elongate the muscle whereas true sciatica may involve more extensive treatment and quite possibly surgical intervention if conservative approaches fail to bring relief.