Dr. Jose Carreras
DHR Health Orthopedic Institute
By definition, sciatica is pain down the right or left leg. Most people associate sciatica with a herniated disc, but there are actually many conditions that can cause pain to travel down the leg and lead to back pain, as well.
I’ll start with a herniated or displaced disc. This can be caused by trauma or another reason, when the disc ruptures and causes the jelly-like substance to leak out and irritate the nerves, causing a lot of pain, numbness, and/or weakness. Depending on the site of the injury, it will affect the nerves, and symptoms will appear. Symptoms may be made worse by sneezing, coughing, and/or laughing and after standing or sitting for a long time. A careful physical examination and a discussion about the patient’s medical history are the first steps toward diagnosis.
Now I am going to explain some other conditions sciatica mimics. Facilitation pain is when there is an inflammatory reaction or condition next to the nerve in the spine that causes pain resembling sciatica. This could come from facet joints, which are the small joints throughout the back. Upon examination, a specialist is able to differentiate facilitation pain by creating movement of the spine yet not finding numbness or weakness in the lower extremity.
Hip bursitis can cause pain in the back down to the lower extremities, and this can also be found upon examination of the patient. This pain can also reach the knee or go down to the ankle and radiate to the back.
Piriformis syndrome is caused by the piriformis muscle, when the nerve passes through the muscle, causing pain to travel down the leg.
Tarsal tunnel syndrome is pain that originates from the inside of the ankle and radiates to the hip and back. This, too, can be discovered during a physical examination. It is similar to carpal tunnel syndrome in that it sometimes causes pain in the shoulder and on the side of the neck. Morton’s neuroma can have symptoms similar to tarsal tunnel and cause pain in the leg.
The last one is spinal stenosis, which can cause discomfort in the leg. However, this condition is mainly related to arthritis of the spine in the lower back that causes a narrowing–either central in the canal or lateral–or that exits through the nerves. The symptom of this condition is a thickening in the area of the lower extremity (either the right or left leg or both), aggravated by walking. Symptoms usually appear when you stand for a long time or when you walk. This should not be confused with vascular problems, which prevent the patient from walking long distances due to lack of oxygen.
It should be noted that children can have a herniated disc, but the symptoms are totally different from those of adults. Most children complain that they can’t run or play the games they used to. In a small percentage of adults and children, although a herniated disc is seen during a physical examination, the condition does not appear upon further examination.
Therefore, if you have pain that runs down your leg and includes back pain, you should get a referral from your family doctor so you can be seen by a specialist. When a patient visits a specialist for sciatica, it is an opportunity for the doctor to start looking for the source of the pain.
For more information about our services at the DHR Health Orthopedic Institute, please call (956) 362-6980.
