No Va Va Voom? Henry's back problem Explained

1. Henry's Problem >
2. Sciatica and Radiculopathies explained >
3. WJ Mixter: The Disc and Sciatica >
4. Recent research on Sciatica
5. Treatment for Sciatica >

Recent research on Sciatica

Since the 1934 publication by Mixter and Barr, the disc prolapse model has been regarded as the sole cause of pain. However more recent clinical observations showed that this may not be the case. For example, Sciatica is not present in some subjects with obvious disc herniation on MRI. In addition, the severity of Sciatica symptoms is often not related to the size of the disc herniation. These findings would suggest that other mechanisms apart from mechanical compression may be responsible for the symptoms. Increasing evidence from clinical and animal studies would suggest that inflammation of areas of the nerve root may be involved.

The combination of mechanical and inflammatory factors that contribute to Sciatica mean that exact diagnosis of the origin of the problem is not always straightforward. MRI scans of the back can show whether a disc prolapse is present, together with the size and direction of the prolapse. However, as mentioned above, the size of a disc prolapse is not necessarily related to the level of pain reported clinically by the patient. Indeed, patients with obvious prolapse on MRI can have no pain, and those with no obvious prolapse can have severe symptoms of pain and/or muscle weakness.

For this reason, further diagnostic tests provide valuable information for the medical team. For over 50 years, abnormalities on ‘needle electromyographic' (Needle EMG) examination have been used to define nerve root injuries. Needle EMG records the intrinsic electrical activity of skeletal muscle fibers. A fine guage needle is inserted into muscles in what is an uncomfortable but tolerable examination. Needle EMG feedback can produce findings that suggest a nerve root injury.

Alternatively, Nerve Conduction Studies (NCS) use a non-invasive stimulator to apply a brief electrical impulse to a peripheral nerve, with the response being recorded by electrodes. The velocity of the nerve transmission can be accurately measured, with healthy nerves transmitting the electrical impulse faster than diseased ones.

Research has shown that 70 to 80% of low back radiculopathies involve the L5 or S1 roots, whilst approximately 10% affect the L2, L3, or L4 roots. Most of these lumbosacral radiculopathies are due to disc disease. Because of the distribution of the Sciatic nerve, the hamstrings on the outer side – long and short head of the Biceps Femoris muscle – may be more commonly involved with S1 rather than L5 radiculopathies, while the opposite may be true for the hamstrings on the inner side – Semitendinosus and Semimembranosus. Symptoms vary from a mild cramping or tightening sensation that can be interpreted as the pre-cursor to a strain, up to constant shooting pain in the buttock, hamstring and down to the foot.

Treatment for Sciatica >

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