Another catchall phrase, like sciatica is “stenosis”. This word by definition means the “closing in of a hole.” This interpretation alone can’t offer you back pain, but sometimes the effects of the stenosis may. To understand how stenosis can cause pain in the back or legs we need to know which holes are being closed.
Your spine has a central hole, or more correctly called the central canal, which runs the entire length of your spine; from the base of your skull to the top of your buttocks. Inside most of this hole is your spinal cord. Located on the sides of your spinal cord are 32 pairs of (left and right) “lateral recess” ; which is where the nerves branch off the cord. As the nerve moves out from the lateral recess it pierces through another hole called the foramen (foramen literally means hole in latin).
We all have a central canal running the length of our spine and on the sides are lateral recess which move into the foramen. By definition these are all holes. Your spinal cord is located inside the central canal, the spinal nerves branch off the spinal cord and pass through your lateral recesses then out the foramen. Anything that causes a closing in of these holes can be called “stenosis”.
There are several types of stenosis. A slipped disc could move into a place that closes off a hole and be called stenosis. A ligament could become scarred or calcify and create stenosis. The vertebrae could develop arthritis which may causes stenosis. A vertebrae may shift creating what is called a spondylolisthesis which could causes stenosis. The point, stenosis isn’t a diagnosis, it is more like a symptom of an underlying cause.
Some types of stenosis may be easy to correct, where others may be much more difficult. Saying you have “stenosis” doesn’t fully answer the “why” or the “how” it may be treated. MRI reports now explain the cause of the stenosis, which allows the doctor to know a correct course of treatment. Only with a complete and precise diagnosis can true treatment options and risks vs. benefits be honestly discussed.
Don’t let anyone tell you your diagnosis is stenosis, there is an underlying cause. By knowing this cause treatment can be rendered that may fix or offer relief for your “stenosis”.
~Dr. Michael Guadagnino, Chiropractic Physician
Often times people who are suffering with either back pain, pain in the leg or a combination of both will call the office and say they have “sciatica”. This has become a catchall phrase but does not really tell the doctor what is actually wrong with their back or leg.
Our lower spine has nerves that branch off and head down the legs. Some of these nerves go to the thigh, others into the groin region while others make their way all the way down to the leg to the foot. This bundle of nerves is called the sciatic nerve. Anything that irritates or insults these nerves can be called “sciatica”.
Knowing the pattern of the pain, or where the pain travels to (the ankle, the knee or the top of the foot etc.) allows the doctor to understand where to begin the examination. If the nerves are irritated into the upper leg region, this would lead the doctor to begin the examination at the upper lumbar spine area. If the pain goes down the leg into the back of the ankle, this would be an indication to check the lower lumbar region. Like wise for any number of pain patterns.
The sciatic nerve may also be irritated from a muscle in the buttocks. Often times this occurs with weight lifters, blue-collar workers and other people who use their hips and body doing strenuous activities. The sciatic nerve may also be impinged in the lower leg, at the knees or anywhere else along its course down the body. Finally the nerve may be affected in the lower back as well as in the leg, creating what is commonly called a “double crush syndrome” meaning the nerve is injured in more than one area.
When a patient conveys this information verbally the doctor may begin to focus in and locate the causes of the “sciatica“, which as mentioned above could be many. Some of the causes of sciatica may be an injured disc (slipped, bulging, herniated), arthritis, taught lumbar musculature, sacroilliac joint issues, lumbar facet syndrome…..as well as a few others.
The point being made is that sciatica is a blanket name for anything affecting the sciatic nerve. Reasons for these symptoms must be identified as the cause has many layers and many diagnoses. There is no single “treatment for sciatica” rather sciatica is a red flag to any practitioner that something is assaulting the nerve, a clear and concise diagnosis needs to be made and treatment that falls within the parameters of the diagnosis will get the patient out of pain and back to pre-injury status!
~Dr. Michael Guadagnino