Sciatica? Herniated Disk? Similar Symptoms, Different Causes

SCIATICA? HERNIATED DISK?

Some important facts to consider:

•       Back pain and radiculopathy(pain caused by a nerve or a nerve route compression that travels to the buttock or the leg) are symptoms not causes

•       Proper diagnosis and treatment depend on  the understanding of spinal and pelvic mechanics

•       69% of MRIs for Sciatica are negative for spinal causes

•       Bulging discs rarely are symptomatic

•       MRI and x-ray testing do not evaluate the most important factors: the patient’s function and spinal and pelvic movement

•       Muscle relaxers are not the most ideal form of medication for pain.  Spinal muscle spasms are a protective mechanism

•       Bed rest and medication have been shown in studies to be detrimental to the patients’ recovery

•       Studies show that if not properly treated and rehabilitated the patients are much more likely to re-injure and then more severely

Below are some common causes and risks for the herniated disk.

•         Approximately 1 in 32 people experience a herniated disc during lifetime
•         Most common in the patients between ages 30 to 50
•         Less prevalent after age 55 due to disc desiccation (drying up of the disk material)
•         Most common causes are micro-traumas over a lifetime that put the person at risk for an injury from lifting, coughing, or sneezing.

Sciatica is more prevalent in women ages 30 and older. Its causes are typically related to poor pelvic and spinal mechanics. One of the frequent causes is the entrapment of the sciatic nerve by the piriformis muscle (this muscle is located deep in the buttock and serves to rotate the hip).

Symptoms caused by a herniated disk most often include:

•          increased pain in the morning with difficulty bending forward;
•       radiating pain with location that is dependent on the spine level with the herniated disk (see picture below);
•         specific back pain (right vs. left);
•         tenderness to pressure at the level of herniation;
•         increased, but centralized pain with bending backwards;
•         pain that is partially relieved with sitting, but getting worse if sitting is prolonged.
•         it is very common for the patients to have weak hip muscles.

Sciatica symptoms not caused by a herniated disk include: 

• increased pain with standing and prolonged walking;
• radiating pain down the back of the leg; 
• mild (or absent) back pain (typically from altered walking pattern); 
• tenderness to pressure in the buttock and back of the upper thigh (especially, if sciatica is caused by the piriformis syndrome or by the sacroiliac joint inflammation);
• increased pain with putting weight on the affected side; 
• poor balance or inability to stand on the affected leg; 
• weak hip abductors (muscles that bring the leg away from the body).

TO BE CONTINUED...

Next week I will post Part 2: Evaluation and Treatment. You will find the answers to the questions "what's better: pain in the center of the back or pain in the leg" and "how much pain should one expect with physical therapy" among others. And... there will be a surprise! Meanwhile, stay healthy and protect your back!

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center