“I feel a shooting pain down my leg” is a common description from those with Sciatica.
Because of the location and path of the sciatic nerve, people may press on the nerve in the lower back or buttocks in an attempt to relieve the pain, like the woman in the photo. Physical therapy, carefully managed medication, and advanced solutions like epidural steroid injections and radiofrequency ablation are used to control and resolve sciatica pain.
A herniated disc in the lumbar spine is a common cause of sciatica.
Sciatica is Nerve Inflammation and Can Reflect Nerve Damage
Nerve inflammation, like sciatica, can be associated with nerve damage.
A herniated disc in the lumbar spine can cause compression of the nerve causing considerable pain.
Sciatica can be disabling until treated.
Independent Medical Examination in a Medicolegal Matter
An IME of a person who reports sciatic-like pain is valuable for the Expert Witness.
This allows the expert to diagnose the condition, and put symptoms into perspective for a jury.
Dr. Singla is a Certified Independent Medical Examiner in addition to her medical and forensic practices.
What is sciatica?
Sciatica is inflammation of the large nerve in the lower (lumbar) spine. The sciatic nerve exits the bottom of the spinal canal, goes through the piriformis muscle, branches into each of the hamstrings, then down to the calves and feet.
Symptoms of sciatica include pain or numbness in the buttock and thigh that might radiate down the leg and into the foot. There may also be weakness in the leg or foot, and walking and standing may be particularly painful.
Although this type of pain is typical of sciatica, the pain might instead be caused by pseudosciatica, which causes similar symptoms.
What causes sciatica?
The nerve irritation or pinching of the sciatic nerve that triggers sciatica can develop for many reasons, including:
- Lumbar disc herniation
- Osteoarthritis in the spinal canal
- Spinal stenosis (narrowing of the spinal canal)
- Spondylolisthesis (step-off deformity)
Pseudosciatica may be due to conditions like trochanteric bursitis, piriformis syndrome, or a type of neuropathy (pain originating in the nerves).
Dr. Singla can make a preliminary diagnosis of the cause of sciatica symptoms by performing a careful IME, observing the movements that worsen or relieve the pain (like the photo above) and a careful review of medical records available.
X-rays or other diagnostic imaging tests may be needed to rule out problems like fractured vertebrae or tumors.
An MRI is one of the best methods of identifying the cause of sciatica, as it shows detailed images of even the smallest structural changes that are causing nerve compression.
What are the treatment options for sciatica?
Non-surgical treatments for sciatica include medications such as anti-inflammatories and oral steroids to reduce inflammation. Muscle relaxants could also be helpful, and antiseizure medicines can help reduce nerve excitability.
Physical therapy is generally highly beneficial in treating sciatica. It helps correct muscle imbalances, improves the range of motion through the spine, and strengthens core muscles. Dr. Singla works with skilled physical therapists to create the right treatment plan.
What if sciatica isn’t improving?
Most individuals with sciatica find that conservative treatments such as medication and physical therapy resolve their symptoms satisfactorily. However, if there is no significant improvement using noninvasive therapies, there are other cutting-edge options available.
Examples of other treatments include regenerative medicine injections and lumbar epidural steroid injections into the lower back. Dr. Singla uses fluoroscopic guidance to deliver these medications to the seat of the inflammation. Radiofrequency ablation and spinal cord stimulation might also be options for the most persistent cases.
Whether shooting leg pain is due to sciatica or pseudosciatica, Dr. Singla can recommend the right treatment to relieve symptoms.