Sciatica – A word from Dr. Matta

Sciatica is one of those diagnoses that I honestly don’t know how I feel about.  For those of you who are unfamiliar with Sciatica…where do I start?  I could copy and paste a definition from Wikipedia and put my doctor stamp on it.  Without looking (seriously, I haven’t looked), I’m sure it would say something that involved low back pain that shoots down the leg associated with a pinching of the sciatic nerve.    And Wikipedia would not be wrong with that.  Or would they?

The problem with Sciatica is that there really is no uniform definition for Sciatica.  Some consider Sciatica more of an umbrella term that refers to pain that shoots down the back of the leg.  Some say Sciatica describes the pinching of the sciatic nerve as it courses through the piriformis muscle.  Others say Sciatica is really just referred to as pain from one of the gluteal muscles.  Still others say that Sciatica is really a problem with the ligaments at the base of your sacrum.  Who’s right?…Everybody, I suppose.  And nobody.

The other nice thing is that in addition to doctors, anyone that has been told they have Sciatica seems to be an expert on someone else’s back pain.  I’ve had several patients who list Sciatica in their medical history and when I inquired, they told me that they were never actually diagnosed with Sciatica from a healthcare practitioner but when they told their symptoms to a friend, their friend swore up and down they had exactly the same symptoms and that they definitely had Sciatica.

How is Sciatica diagnosed?

I honestly really wish I could tell you.  Once again, if there is no clear definition of Sciatica or what the source is, then I can’t really say how one can diagnose it.  For the most part, Sciatica is usually diagnosed “clinically” which means that if someone describes shooting pain down the back of their leg, maybe with some pins and needles in their foot, we can probably make the diagnosis just with historical information.  If we do suspect it, we might confirm our suspicion with the Straight Leg Test.  This is a very difficult test.  With this test, you lie on your back and keep your leg…straight…and if you have pain when we raise your leg, the test is positive.  Beyond that, there’s really no other diagnostic tools.

How about an Xray?  Can you diagnose Sciatica with an Xray? 

Nope

How about an MRI?  If I get an MRI, can you diagnose Sciatica?

Nope

EMG?

Nope

CT Scan?

Nope

Thermography?

Nope

Medical Mediums (apparently there are mediums that diagnose)?

I have no idea; my wife just told me about this and I didn’t know they existed ‘til 30 seconds ago.  But probably…No. The thing is, since there isn’t a uniform definition of Sciatica, there really is no way to say with certainty something is or isn’t Sciatica.

Sciatica Treatment

This also varies.  Some believe that since the sciatic nerve is pinched, it gets inflamed, and we should treat it with corticosteroids (commonly known as…steroids), like prednisone.  Now, I will say that, for some reason, this often works.  Why?  I believe that if a nerve is disrupted, the covering of the nerve called the myelin sheath does actually get inflamed and, perhaps, steroids decrease that inflammation and swelling.  The problem is, this does not always work or continue to work.  That’s probably because if we haven’t determined the root cause of the problem, then even if we decrease the inflammation for the short term, we haven’t really dealt with the problem. 

Home Exercises and Stretching

Performing stretches and exercise of the sciatic area, seem to be the treatments that have the most benefit for the long term.  This is most likely because we are either taking pressure off the nerve by strengthening a weak muscle which was previously pinching on the nerve itself.

Regenerative Injections

Okay, so you’re probably wondering what I recommend for Sciatica treatment.  My approach begins with addressing the root cause, which is often coming from a combination of nerve entrapment of the sciatic nerve around the gluteal muscles , some dysfunction of the sacroiliac joint, and perhaps the nerves from the spine that eventually become the sciatic nerve.

Using regenerative injection therapies, we can begin to take pressure off of the nerve and provide some repair and from the repeated damage occurred to the nerve.  These injection therapies must be performed using ultrasound guidance which allows identification of the nerve and visualization of the needle which allows precise administration of the product to the nerve.  In addition, with ultrasound I can perform nerve hydrodissection which uses a volume of the fluid I’m injecting to free up the nerve from its entrapment.

My favorite regenerative injection technique is PRP.  After taking a volume of your blood, we can run it through a centrifuge which separates the components including red blood cells and then everything else which includes your platelets.  We then discard the red blood cells, which are inflammatory to other parts of your body, and we’re left with your plasma including platelets, hence the term PRP.  Platelets, when activated contain growth factors which then communicate with local stem cells which initiates a repair process to the area where the PRP is injected.  From the blood draw, I can use a more highly concentrated solution of PRP for the sacroiliac joint to provide a stronger healing response, while around nerves I like to use a less concentrated solution of PRP which will not be as inflammatory and more gentle for the nerves.

I have found this approach to be very effective and have had much success treating sciatica by addressing the root cause and then providing treatment that is aimed at repair of all the structures involved.

To benefit from a comprehensive and regenerative approach to treating sciatica at Meeting Point Health, give us a call at 215.298.9928 (Option 1).  You can also schedule a consultation by completing our online contact form at https://www.meetingpointhealth.com/contact-us/.