A shocking 80 % of all Americans will experience low back pain at some point in their life.  Its epidemic status continues to grow and sufferers seek the most cutting edge approaches to not only ensuring relief but also restoring function.  Quite often individuals may also develop associated thigh or lower leg pain termed sciatica.  The clinical term sciatica requires clarification.  Sciatica simply means "pain in the leg".  It does not mean that the sciatic nerve has been "pinched".  In fact, the sciatic nerve is not involved in most cases of thigh or gluteal pain because it does not supply sensation from this area. 

     Sciatica can be caused by irritation or trauma to nerve roots within the spinal canal or to peripheral nerves outside of the canal anywhere from the pelvis to the lower leg.  Space occupying lesions within the spinal canal such as a bone spur, disc herniation, congenitally narrow canal, infection, metastasis, or mass can be the causative agent.  Outside of the canal we find the instigators to be a femur head fracture, incorrectly placed intra-muscular injection, fixation of the sacroiliac joint, and primary bone cancer of the pelvis.   

     The two most common and least diagnosed causes are facet joint syndrome and piriformis contracture.  Facet joints help to guide motion of the spine letting us bend forward and back and side to side. They also relieve some of the weight bearing burden of the rest of the spine.  Quite often they are irritated due to an injury, arthritis, or misalignment.  This irritation produces referred pain into the gluteal region and back of the thigh.

     Piriformis contracture occurs when the piriformis muscle tightens and shortens for a prolonged period of time compressing peripheral nerves that provide sensation from the gluteal region and thigh.  The tightening can occur due to repetitive use such as is seen in runners and tennis players, injury, and misalignment of the pelvis.  The pain pattern is typically represented as severe buttock pain and mild thigh pain.

     A comprehensive neurological and orthopedic examination should be performed checking reflexes, strength, sensation, posture, gait, muscle tone, and evaluating pain production from different positions.  X-rays help to narrow down the diagnosis.  Further imaging studies such as MRI and CT should only be necessary after a lack of improvement from conservative treatment or a progression of symptoms.   

            The treatment of sciatica is aimed at removing the cause and restoring proper function to the area.  Cutting edge maneuvers such as eccentric fast stretching and cross cord inhibition focus on reducing tension in tightened and shortened muscle and joint capsules.  Chiropractic manipulations focus on removing the irritation and restoring proper motion in the facet joints.  Flexion-distraction therapy helps to reposition some of the herniated material and increase the overall health of the disc.  Neurophysiologic rehabilitation of the part of the brain that directly controls the tone of the deep spinal muscles helps to create stability in the spine.  Lastly, a proper nutritional assessment should be made to promote an anti-inflammatory diet.

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