A pinched sciatic nerve is a common expression used by both doctors and laymen alike to explain chronic back and leg pain issues stemming from a suspected compressive neuropathy condition. It is certainly possible for the sciatic to suffer impingement due to a wide range of reasons. However, the most commonly cited example of sciatic nerve compression is a lumbar herniated disc, which makes no sense, being that the sciatic nerve does not even connect directly into the spine.
Actual pinched sciatic nerve issues can be caused by several known reasons. The first is inflammation related to traumatic injury. This event is most often found in patients who experience severe damage to the legs or buttocks from a car accident, significant fall or other form of direct trauma. The inflammatory process can put pressure on the sciatic nerve almost anywhere in the lower body, enacting symptoms often associated with a pinched nerve. Luckily, inflammation is a temporary concern and these neuropathy issues should resolve completely, even without any formal treatment.
The next possible situation involving an actual pinched sciatic nerve is the pain condition known as piriformis syndrome. This occurs when the sciatic nerve is impinged upon by the piriformis muscle. Some patients demonstrate an anatomical abnormality which locates their sciatic nerve directly through the piriformis muscle, rather than beneath it. These patients are statistically more likely to suffer piriformis syndrome than others who do not share this bodily variation, but this is certainly not an absolute rule. It is well known that most cases of piriformis syndrome have less to do with the anatomy or suspected injury, and far more to do with regional oxygen deprivation of the involved musculature, enacting spasms and painful symptoms. In the vast majority of affected patients, the source of this ischemia is surely psychogenic.
The herniated disc explanation for sciatica can be accurate, but not in the way some patients perceive. Due to the watering-down of medical information, and in some cases, the fundamental lack of understanding by diagnosticians, some patients actually feel that their sciatic nerve is being pinched by the herniated disc directly. This could not be further from the truth. The sciatic is made up of nerve roots from the L4, L5, S1, S2 and S3 vertebral levels and the herniated disc may be compressing one or more of these roots, not the sciatic nerve itself. The actual sciatic nerve forms far below the end of the spinal column, making this theory ridiculous and anatomically nonviable. In most cases, it is the L4, L5 or S1 nerve root affected, due to herniations at L4/L5 or L5/S1. However, in my experience, the overwhelming percentage of patients suspected to be suffering from foraminal stenosis or spinal stenosis in the lumbar spine or lumbo-sacral juncture as the source of their pain are grossly misdiagnosed. It is quite rare for pinched nerve roots to occur in the spine and the best way to double check the diagnosis is to compare the expected symptomatic pattern to the actual clinical expression. In almost every case, there will be great discrepancies, making structural nerve compression the least likely source of pain, even when diagnostic imaging suggests otherwise…
Remember that foraminal stenosis and spinal stenosis are normal parts of the aging process for most patients. Spinal degeneration, such as disc disease and herniations, is par for the course. Most of the time, these diagnoses are made in an attempt to explain the occurrence of back pain, although subsequent treatments are almost never successful, especially in the long term. Furthermore, the majority of people with identical anatomical issues have no pain whatsoever… This is the best evidence that the various structural issues most commonly blamed for enacting sciatica are mistakenly diagnosed. No wonder the condition has such a terrible reputation as a long term and treatment-resistant syndrome. After all, if the diagnosis is wrong and treatments are targeting a mistakenly identified causation, then how can patients ever find relief?
