{"id":396,"date":"2021-05-07T09:34:28","date_gmt":"2021-05-07T09:34:28","guid":{"rendered":"https:\/\/thebackpainpodcast.com\/?p=396"},"modified":"2021-05-07T09:34:30","modified_gmt":"2021-05-07T09:34:30","slug":"i-have-sciatica-what-else-could-it-be","status":"publish","type":"post","link":"https:\/\/thebackpainpodcast.com\/index.php\/2021\/05\/07\/i-have-sciatica-what-else-could-it-be\/","title":{"rendered":"I have Sciatica – What else could it be? – Part 1"},"content":{"rendered":"\n

Differential Diagnosis of Radicular Pain <\/strong>by Luke Murray<\/h3>\n\n\n\n
Luke Murray – Specialist MSK Physiotherapist – Originally posted on Physio Network here https:\/\/www.physio-network.com\/blog\/diagnosing-radicular-pain\/<\/h5>\n\n\n\n

Radicular pain (such as sciatica) is a common problem that presents to musculoskeletal physiotherapists and general practitioners. In a recent primary care study in the UK including 609 patients, 60% of people presenting with a combination of back and leg pain were diagnosed with sciatica (1). Due to the high prevalence of sciatica and associated pain and functional limitations, it is vital clinicians can identify radicular pain accurately and differentiate it from other pathologies. Part 1 of this two-part series will aim to help you understand what radicular pain is, how it presents, and outline conditions that can masquerade as radicular pain that could be considered in your differential diagnoses. But first, let\u2019s delve into some definitions, causes and presentations.<\/p>\n\n\n\n

Definition and Presentation<\/strong><\/h4>\n\n\n\n

Radicular pain is caused by inflammation and\/or compression of the lumbosacral nerve roots (L4-S1) and results in a gain in nerve function (2). This refers to an abnormal excitability of the nerve, presenting with paraesthesia, pain, hyperalgesia, allodynia, hyperreflexia, and\/or muscle spasms. Pain often presents in the buttock, travelling down the leg and below the knee.<\/p>\n\n\n\n

\"image\"\/<\/a><\/figure>\n\n\n\n

This differs from lumbar radiculopathy, which is also a nerve root problem, but results in a loss of nerve function. This means there is reduced impulse conduction which may present as hypoesthesia, anaesthesia, weak\/absent reflexes, muscle weakness and\/or reduced sensation. Unfortunately for practitioners, patients don\u2019t always fit into these categories and it\u2019s therefore not uncommon for patients to present with features of both conditions, such as a painful radiculopathy (3). It\u2019s also important to remember that true radicular pain is an extremely distressing and painful condition, with some patients reporting a loss of their sense of self (4).<\/p>\n\n\n\n

In general, sciatica is poorly defined in the research. Whether you are a physiotherapist fresh out of university or have been practicing for many years, you\u2019ll likely have known or heard of someone complain of sciatica. But, how do we know it is definitely sciatica? How do we know the problem isn\u2019t from the sacroiliac joint, the hip or (god forbid) the dreaded piriformis muscle?! Let\u2019s look into some risk factors and causes of radicular pain to help identify the patients that might have a true nerve root pathology.<\/p>\n\n\n\n

Risk Factors<\/strong><\/h4>\n\n\n\n

To accurately identify someone with radicular pain, it is important to understand the risk factors and causes of the problem. This was very nicely laid out by Tom Jesson in the Physio Network Masterclass on Radicular Pain<\/a>. If you want a thorough explanation of the history, pathophysiology and management of radicular pain, be sure to check it out. Tom classified risk factors and causes into two groups as documented below.<\/p>\n\n\n\n

Distal (The Kindling):<\/p>\n\n\n\n

  1. Smoking<\/li>
  2. Obesity<\/li>
  3. Manual work<\/li>
  4. Work bending down<\/li>
  5. Driving a lot<\/li>
  6. Moderate walking<\/li>
  7. Mental stress<\/li>
  8. Poor job satisfaction<\/li><\/ol>\n\n\n\n

    Proximal (The Fire):<\/p>\n\n\n\n

    1. Disc lesion<\/li>
    2. Spinal\/Recess stenosis<\/li>
    3. Spondylolisthesis<\/li><\/ol>\n\n\n\n

      While this is not an exhaustive list, these are important to consider as part of a comprehensive assessment including your subjective and physical exam.<\/p>\n\n\n\n

      How is Sciatica Diagnosed?<\/strong><\/h4>\n\n\n\n

      A diagnosis of sciatica is based on clinical presentation, involving the patient\u2019s subjective symptoms and the findings of the physical examination. There is no specific test for sciatica, but a combination of positive findings on examination increase the likelihood (6). Imaging is rarely required to make a diagnosis unless a more sinister pathology is suspected or if the patient has not responded to conservative management as expected (2). However, if the patient presents to your clinic with imaging already completed, then by all means check to see if your exam aligns with the imaging findings. The key signs and symptoms of sciatica include:<\/p>\n\n\n\n