Many patients with Back pain also suffer from sciatica. Sciatica is usually described as a pain that arises in the back or the gluteal area and radiates down the side of the leg into the little toes or down to the back of the calf. There are variations of severity, the most being neuropathic pain; and associated symptoms such as muscle spasm, weakness, numbness and tingling. The classic cause of sciatica is compression or chemical irritation of the spinal nerves (dorsal nerve roots)  that make up the sciatic nerve. This is due to degenerative changes in the Lumbo-sacral spine such as disc prolapse, osteophytes from facet joints, spondylolisthesis and spinal stenosis. Often the sciatic nerve is compressed where it comes out at the pelvis at the greater sciatic notch together with the piriformis muscle. Commonly therapies are focused at stretching the piriformis muscle for this reason. Another cause of sciatica are myofascial trigger points in the Gluteus minimus muscle. this muscle is deep to the gluteus medius and gluteus maximus muscles and may develope trigger points from compressive forces in the maximus and medius muscle which in turn develop trigger points from Hip Rib impingement, tight iliotibial band or according to Janet and Travell commonly comes from sitting on a wallet in the back pocket. I have also noticed that people who wear a stiff tight belt may also activate the gluteal trigger points. The nerves from the gluteal muscle also go through the greater sciatic notch together with the piriformis muscle and the sciatic nerve so trigger points in the piriformis muscle will cause trigger points in the gluteal muscles also. In my opinion, Hip Rib Impingement causes swelling or inflammation of the sacroiliac joint (sacroilitis) which in turn compresses the piriformis muscle causing myofascial trigger points in the muscle which then tightens and compresses the sciatic and gluteal nerve as they go through the tight space of the greater sciatic notch similar to carpel tunnel syndrome.

What do you think?

This is the last blog for this year and wishing every one a merry Christmas from www.drchrischinbackpain.com.au