When is Sciatica, not Sciatica? By Dr. Steven Zodkoy

Sciatica is a specific diagnosis indicating pressure on the L4 and L5 nerve roots in the lower back that refers pain down the leg. Sciatica is caused by disc issues, spinal arthritis or joint fixation in the lower back. Too often physicians and patients use Sciatica as a generalized term for leg radiculopathy pain which leads to inadequate care and years of pain. There are several other conditions that mimic Sciatica, but will not respond to the care used to treat Sciatica.

Piriformis Syndrome is the most common mimic of Sciatica. The Piriformis muscle starts on the anterior side of the low back and runs forward, inferior and lateral to the edge of the femur “hip bone’. This muscle is responsible for rotating your hip/leg out, like when you sit in a yoga position. The sciatic nerve runs adjacent to the Piriformis muscle which is why their symptoms often mimic each other. If this muscle goes into spasm a person may feel; back pain, hip pain, buttock pain, leg radiculopathy and have difficulty moving their back and leg. These are the same symptoms indicated in Sciatica, so how do you know the difference?

A chiropractor is specifically trained to do an examination to distinguish between Sciatica and Piriformis Syndrome. The simplest test is to palpate the spine at the L4 /L5 which is where Sciatica starts and compare it to palpation of the sciatic notch regions (the belly of the buttocks) where the Piriformis muscle is. The area which causes more pain is usually the primary issue. It is possible to have both conditions. The treatment for Piriformis Syndrome is focused on relaxing the muscle which include chiropractic adjustments to the pelvis, , trigger point therapy and other physical modalities. The most effective treatment is Litecure Laser Therapy which can quickly penetrate deep into the muscle to relieve the spasm and reduce inflammation.

Iliotibial Band (ITB) Syndrome is also often misdiagnosed as Sciatica and is usually the reason for long standing leg pain. ITB refers to a muscle that runs from above your hip to just below your knee on the outside of your leg, this is similar to the pathway that the Sciatic nerve follows. It is important to note that pain behind the leg is usually Sciatica but pain on the outside of the leg is usually ITB syndrome. ITB syndrome is caused by the irritation and weakness of the Tensor Fascia Lata (TFL) muscle and sometimes the entrapment of the common peroneal nerve behind the knee. The common peroneal nerve is an extension of the sciatic nerve, so it possible to have both conditions. ITB syndrome is often caused by physical activity or shoes that cause your ankles to supinate (roll in). A chiropractic exam of the TFL muscle, sciatic notch and L4/L5 region will help differentiate your diagnosis and determine the best treatment approach.

Correcting ITB syndrome requires finding the underlying cause which may include a person’s abnormal, gait, shoes, spinal or leg fixations or muscle weakness. I use Applied Kinesiology to evaluate my patient’s gait and shoes, kinesiology tape to stabilize and strengthen the muscle and the Litecure Laser to reduce inflammation in the muscle. This approach allows me to treat the underlying cause and treat the pain at the same time to relieve pain and restore normal function.

The final mimicking condition that needs to be evaluated when a person says they have Sciatic is an impinged Common Peroneal Nerve, this can occur with or without ITB Syndrome. The Sciatic nerve turns into the Common Peroneal nerve at the knee level. Impingement of the Common Peroneal nerve at the knee is a common cause of radiating nerve pain above and below the knee which is why it mimics sciatica. This condition requires treatment to the knee area and will not respond to traditional Sciatica care to the low back and pelvic regions.

Your chiropractor can diagnose Common Peroneal Nerve impingement by palpating behind lateral part of the knee, acute pain is an indicator that is a major issue in your leg pain. ITB syndrome and Common Peroneal nerve impingement often show up together because the Tensor Fascia Lata muscle is major stabilizer of the Fibula bone which is adjacent to the Common Peroneal Nerve.

The treatment for this condition includes Applied Kinesiology to evaluate my patient’s gait and shoes, mobilization of the Fibula, kinesiology tape to stabilize the Fibula and the Litecure Laser to reduce inflammation.

Sciatica is now used as a general term for all forms of radicular leg pain. It is important that your healthcare provider does a full exam to determine the underlying causes for pain and why it first occurred. It is common to have more than one issue causing Sciatica and healing will only occur if all underlying issues are addressed. If you haven’t received the relief you deserve from your sciatic pain, maybe it isn’t sciatica!

Dr. Steven Zodkoy has been in clinical practice for 30 years at Monmouth Advanced Medicine in Freehold NJ. He specializes in diagnosing and treating difficult health issues. He can be reached at 732–308–0099 or szodkoy@hotmail.com