Sciatic Nerve Pain
Lumbar disk syndrome includes diseases resulting from disk disorder, either herniation or degenerative change (spondylosis). Massive disk protrusion may rarely lead to paralysis in the lower extremity, a condition termed cauda equina syndrome. Gradual narrowing of the spinal canal (lumbar stenosis), usually from spondylosis, may also cause lower extremity symptoms.
PHYSICAL FINDINGS & CLINICAL
- Overlapping clinical syndromes that may result:
- Mild herniation without nerve root compression
- Herniation with nerve root compression
- Cauda equina syndrome
- Chronic degenerative disease with or without leg symptoms
- Spinal stenosis
- Low back pain, often worsened by activity or coughing and sneezing
- Local lumbar or lumbosacral tenderness
- Paresthesias, usually unilateral
- Restricted low back motion
- Increased pain on bending toward affected side
- Weakness and reflex changes (L4—knee jerk and quadriceps, L5—extensor hallucis longus, S1—ankle jerk and toe walking)
- Sensory examination usually not helpful
- Lumbar stenosis that possibly produces symptoms (pseudoclaudication), which are often misinterpreted as being vascular. Pseudoclaudication usually recovers quickly with sitting or spine flexion. Vascular disease is unaffected by spine position and is typically associated with atrophic skin changes and diminished pulses.)
- Positive straight leg raising test if nerve root compression is present
- Soft tissue strain or sprain
- Degenerative arthritis of hip
- Insufficiency fracture of hip or pelvis
In most cases the diagnosis can be established on a clinical basis alone.
- Imaging is not warranted for most patients with acute low back pain.
- Plain roentgenograms may be indicated within the first few weeks for persistent pain; they are usually normal in soft disk herniation, but with chronic degenerative disk disease loss of height of the disk space and osteophyte formation can occur.
- MRI may be indicated in patients whose symptoms do not resolve or when other spinal pathology may be suspected.
- Electrodiagnostic studies may confirm the diagnosis or rule out peripheral nerve disorders.
PHYSIOTHERAPY TREATMENT OPTIONS
- Short course (3 to 5 days) of limited physical activity for acute disk herniation with leg pain
- Physical therapy for modalities plus a careful gradual exercise program. Physical therapists generally use the McKenzie method for the treatment of low back pain.
- Lumbosacral corset brace during rehabilitation process in conjunction with exercise program is beneficial only in some cases.
- Percutaneous electrical nerve stimulation may be beneficial in selected patients with chronic back pain.
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