Herniated Discs and Sciatica Don’t Mix
By Dr. Mitchell Yass – Stop the Pain, I Want My Life Back
I recently saw a slideshow presented on WebMD supposedly explaining sciatica including the symptoms and potential causes. I was in complete agreement that the typical symptoms of sciatica are pain or an altered sensation from the gluteal region down the side or back of the leg to the foot. I was also in agreement with their position that sciatica represents irritation of the sciatic nerve. What absolute infuriates me is when they go on to say that the most common cause of sciatica is a herniated disc. I will make a blanket that will shock most; a herniated disc can never and will never create sciatica. How can I be so sure that this is the case when most of the medical community continues to promote this idea? I will give you the evidence and let you make your own decision.
Sciatica is believed by most to be irritation of the sciatic nerve. What most people do not know is where the sciatic nerve begins and ends. It begins in the gluteal region or buttock region and ends at the back of the knee. That’s right! The sciatic nerve does not begin at the spine. So if you accept the idea that sciatica is irritation of the sciatic nerve than no structural abnormality at the spine could create the symptoms.
What do come out of the spine are nerve roots. At every level of the spine, a nerve root comes out. These nerve roots eventually joint to form nerves. In the case of the sciatic nerve, there are seven nerve roots that form the nerve. The nerve roots are susceptible to be impinged at the spine secondary to a herniated disc or stenosis. If a nerve root is impinged, it creates a symptom only in the area of the skin that the nerve root innervates. This is called the dermatome. So if L4 were impinged, there could only be an altered sensation at the inner shin. If L5 were impinged, it would only create an altered sensation at the outer shin. If S1 were impinged, it would only create a symptom at the heel and calf region. Since sciatica creates symptoms from the gluteal region to the foot, it would be obvious that symptoms of sciatica span much larger areas than the areas created by a nerve root impingement. Therefore, sciatic symptoms could never result from a nerve root impingement secondary to a herniated disc or stenosis. Now the powers that be will tell you that if a nerve root that forms a nerve is impinged, it will create the same symptom as if the nerve were impinged. Hopefully, this description of where nerve roots create symptoms versus sciatic symptoms should prove that claim false.
Here is another paradox regarding nerve roots and nerves that the medical establishment needs to explain. If someone suffers form carpal tunnel syndrome, the explanation of the symptoms is that the median nerve is being impinged at the wrist and that treatment should consist of surgery at the wrist. But the median nerve root is comprised of nerve roots from the cervical spine. So if you follow the logic regarding the sciatic nerve that a nerve root impingement is creating the symptoms and surgery should be performed at the spine to resolve the symptoms, why is it in the case of the median nerve, surgery at the wrist is recommended and not surgery at the cervical spine where the nerve roots of the median nerve originate? Do you see the lack of consistency of thought here?
Finally, let’s look at the finding of a herniated disc as a diagnosis for any symptom. There is so much evidence that herniated discs and stenosis exist completely independent of pain. The American College of Physicians just recommended that MRIs no longer be used to identify the cause of back pain because in 85% of cases of people coming to primary care their pain could not be attributed to a spinal abnormality such as a herniated disc or stenosis.
The reality is that in almost every case of sciatica I have treated, the cause was found to be the piriformis muscle which lies in the gluteal region impinging on the sciatic nerve. The piriformis muscle strains and thickens allowing it to impinge on the sciatic nerve because the muscles that work in conjunction with it namely the glute med, glute max and hamstrings strain first causing the piriformis to compensate and strain. This finding was actually confirmed by Dr. Aaron Filler through his invention, the MRN, magnetic resonance neurography which is an enhanced MRI.
Before you consider spine surgery or an epidural nerve block to resolve your sciatic symptoms, I strongly suggest you evaluate this information and make a more informed decision about how to proceed to address your sciatic symptoms. Logic has a way of making decisions a lot easier.
Mitchell Yass, DPT is the "Miracle Man" among Long Island physical therapists and now Boca Raton, Florida. With more than 18 years in practice, he has helped thousands of patients avoid surgery, eliminate chronic pain and lose weight. Patients travel from multiple states and even from abroad to seek out his unique brand of physical therapy, which makes use of targeted strength training and an intricate knowledge of how to determine the true cause of pain.