What is sciatica?

Sciatica is pain in the distribution of the sciatic nerve. In other words, sciatica is pain where the nerve runs or travels. The sciatic nerve is made up of 5 nerve roots that arise from your spinal cord, travel down your spinal canal, and exit from the little holes between the vertebrae, specifically between your L4, L5, and sacral bones. The L4, L5, S1, S2, and S3 nerve roots exit their respective holes and then merge in your buttocks to form your body’s biggest nerve. This large nerve then travels down the back of your buttock, back of your thigh, and entire lower leg and foot. So, technically, any pain in these areas can be sciatica. But there are other, less frequent causes of pain in these areas, and sometimes pain can be felt in your buttock and thigh, and may not be sciatica. Sometimes it is not possible to be certain of the origin of pain in these regions, and doctors may differ in their guess as to whether it is sciatica or not.

Some chiropractors, physical therapists, and doctors will guess as to other causes of pain in these areas, such as piriformis syndrome. But sciatica is very common and varies considerably in its presentation, and evolves variously in its presentation, so I almost always assume it is sciatica until proven otherwise, or unless I have reason to think it may be something else. When it comes to diagnoses, it’s best to have a hierarchy of guesses, and always be suspicious that you can be wrong. Always lurking, improbably, but potentially catastrophically, is cancer or infections.

Anyway, back to sciatica. Since sciatica is a pain that starts in your buttock, and is often not felt in your low back, you may think the problem is in your buttock, which probably accounts for the popularity of a piriformis diagnosis. But pain is a very misleading phenomenon. Doctors have to learn all the various counter-intuitive presentations of all kinds of pain. Different organs/viscera result in pain in different, and misleading places. Most people are familiar with the presentation of heart disease with pain in the chest, left neck, left face and left arm. This is an example of referred pain from an organ or viscus. Similarly, sciatica, a pain in your buttock, thigh and leg is not typically caused by any problem in your buttock, thigh or leg. Rather, it is almost always casued by a herniated or bulging disc in your low back, which pinches one of the above-mentioned nerve roots, usually L4, L5 or S1, causing pain to be felt where that nerves travels, hence, pain in your buttock, thign and leg.

Most doctors do not like to treat sciatica, because it can be very painful, and difficult to treat effectively and quickly. I’ve been in practice since 1987, and I spent my first 18 years in an orthopedic, physical medicine and physical therapy clinic. We did not treat sciatica very effectively, so lots of patients were sent to pain management for epidural steroid injections, L-ESI’s. Steroid injections can be a fine, eventual option. But they are not the appropriate, best, first choice of treatment. And neither is conventional physical therapy and exercises. The fastest, safest and most effective treatment is spinal decompression, which is a more sophisticated form of traction.

I have now been using spinal decompression treatment since 2006. It is, BY FAR, the most effective treatment I have ever used in my 35 years of practice, treating more than 40,000 patients. If I can help you, call me at 404-558-4015. I’m Dr. Craig Castanet, D.C.