The sciatic nerve is derived from the anterior ramus of the spinal nerve at the 4th and 5th lumbar and 1st, 2nd, and 3rd sacral segments. From the above 5 anterior branches pass through the psoas major, synthesize the sacral plexus, and descend along this muscle. Most of the nerves of the sacral plexus merge into the sciatic nerve. Descending along the posterior wall of the pelvic cavity to the inferior orifice of the piriformis muscle through the pelvic cavity into the buttocks. In the posterior gluteal muscles down to the lower middle thigh divided into tibial nerve and common peroneal nerve. Thus, the general sources of sciatica are first classified into root, plexus, and dry sciatica. At the same time, sciatica presents three different types of sciatica due to the location and direct involvement of the sciatica nerve. Just because of this, the manifestations of sciatica are various, different and very complex, such as going into the trance, can not point out the real cause of the disease, bring great difficulty to the treatment.
Root sciatica (also known as superior sciatica)
Common causes include lumbar disc herniation, lumbar spinal canal stenosis, and soft tissue compression and inflammation at the nerve root outlet. It is manifested as numbness, pain, acid distension and coldness of the affected nerve root. Lumbar 4, 5 intervertebral disc herniation compresses lumbar 5 nerve root, often show for lumbar, buttock hind ache, ham hind side and crus anterolateral to sufficient back inside, the pain of thumb, hemp, acid, bilge, cold. And lumbar 5 ~ sacral 1 intervertebral disc herniation compresses sacral 1 nerve root, often show for lumbar, the ache of buttock hind, numbness, thigh hind side, crus posterolateral, sufficient backside arrives the ache that toe, sufficient heel, plantar, hemp, acid, bilge, cold.
Plexus sciatica (also known as midcourse sciatica)
It is caused by compression or stimulation of the sacral plexus in the pelvic cavity. Expression is leg ministry of leg of leg of waist buttock, much place, much section, whole lower limbs before, hind, outboard reachs sufficient back inside, outboard, sufficient heel, plantar numbness aches, acid bilges, be afraid of cold to wait.
Dry sciatica (also known as inferior sciatica)
Common causes are:
1. Lumbar disc herniation;
2. Compression and injury of nerve roots (spinal canal stenosis, slippage, rheumatoid, tuberculosis, osteoporosis, etc.);
4. Congenital malformation.
1. Paravertebral tenderness, percussion pain and motor pain. The posterior branch of the nerve root is affected by compression of the nerve root.
2. Neck bending test (+). As a result of the action of pulling the dura and root sleeve.
When lumbar 4, 5 disc herniation, lumbar 5 nerve root compression, pain performance for hip, thigh back, leg anterolateral, foot back medial pain, numbness, and lumbar 5, sacral 1 disc herniation, sacral 1 nerve root involved, mainly in the lateral side of the same side of the leg and foot back lateral and plantar numbness symptoms. In the three vicious cycles of cervical spondylosis, the vicious cycle between the degeneration of the cervical disc and the secondary changes of the perivertebral tissue is also applicable to the explanation of lumbar protrusion patients. When there is lumbar disc degeneration, compression of the anterior branch of the nerve root is affected at the same time, the posterior branch is also affected, and the latter branch innervates the muscles, ligaments and other soft tissues around the vertebra, causing pain and discomfort of these soft tissues and other symptoms. On the contrary, the soft tissues around the vertebra, especially the muscles, ligaments and other soft tissues are damaged by strain, will also stimulate the posterior branch of the spinal nerve, reflex cause sciatica symptoms.
Radiation sciatica acute pain route clear route continuous
Reflex sciatica blunt pain route blurring route interrupted
In most cases, the degeneration of the disc is the internal cause, and the perivertebral soft tissue injury caused by wind, cold, wet and strain is the external cause.
1) sometimes internal factors play a leading role, and external factors are not obvious. Some patients have no obvious symptoms of lower back tapping pain, but only symptoms of lower limbs;
2) in other cases, external factors play a leading role, with obvious pain and discomfort in the back, accompanied by lower limb symptoms;
3) in some patients, the external causes are obvious, the pain and discomfort in the back have been existing for a long time, while the internal causes have not changed much, so only the back pain without lower limb symptoms.
Different stages of performance
In clinic, we found that there are a lot of waist suddenly sickness patients are first on the basis of a trauma and waist pain, lower limb symptoms gradually after a few years later, these changes are also a variety of symptoms appear, seemingly random, actually, there are rules, is the same disease, namely lumbocrural pain in different stages of the performance.
The explanation for this phenomenon is:
1. Young patients with acute trauma
In young people, as a result of acute trauma, acute onset leads to disc annulus rupture, nucleus pulposus herniation within a short period of time, and compression of nerve root, the following two conditions may occur:
A) when is given priority to with pain, numbness of mild, that at this point is given priority to with oppressed nerve root surrounding adipose tissue, adipose tissue in the aseptic inflammation and stimulate the nerve root, led to severe pain, and nerve root of conformity is not serious, release the nerve root by rest, physical therapy, needle knife mouth, mouth and so on, release the inflammatory tissue around nerve root, accompanied by a week of vertebral muscle ligament damage, taps pain obviously, stimulate the release or when it is necessary to add line needle knife with a moderate amount of sacral therapy, can be quickly recovered.
B) in the case of acute onset, numbness and muscular atrophy are the main causes, or numbness in the saddle area and incontinence of urine and feces occur, the curative effect of conservative treatment will decline, and surgical treatment is the main choice.
2.Senile lumbago pain
Senile lumbocrural pain, often a waist pain first, after a few years or even decades to develop symptoms of lower extremity, this kind of situation is usually due to vertebral weeks after the soft tissues such as muscle, ligament strain, the pain, the pain causes muscle spasm, pain and the spasm, between the two is a vicious circle, constantly aggravate each other symptoms. Intervertebral disc under normal circumstances under physiological load, and slowly the physiology degeneration, and the additional load caused by tense muscles, long-term role in intervertebral disc fiber ring, the annulus degeneration acceleration, after several years of strain, finally began to damaged, like worn out skin of basketball, the tank from the weak, herniated, oppression to the nerve root, so he had a lower limb symptoms of sciatica (symptoms). Sciatic nerve in patients with symptoms is very complex, various performance and chalking, both symptoms, waist and buttock leg symptoms, both radioactive neuralgia, and reflective, referred neuralgia, simple treatment of a certain cause often cannot obtain completely heal, and to make a treatment for multiple causes one by one.
1. Chronic pelvic inflammatory disease and appendicitis.
Pelvic injuries, iliopsoas and piriformis injuries or inflammation, and sacroiliac arthritis
1, dry pain, that is, at the same time with multiple nerve stem involvement symptoms
A. sciatic nerve radiates pain to the lower extremities
B. femoral n: radiating pain to the front of the thigh
C, superior buttock n: radiating pain to the sacral area
Lower buttocks n: radiating pain to the buttocks
Obturator foramen n: alternating or simultaneous radiating pain to the knee
F. Pudendal nerve: radiating pain to the perineum
G. Posterior femoral cutaneous nerve: radiating pain to the back of the thigh
Among them, b and e are lumbar plexuses with nerve fibers from the nerve root of lumbar 4.
2. Pain of percussion in lumbosacral area and report "comfort"
3. Knee tendon reflex and heel reflex weaken or disappear at the same time
4. Pelvic problems
1. Deep tenderness in the "circular jump", accompanied by pain and numbness of lower limbs and feet caused by radiation. 60% of the patients were accompanied by popliteal pain and common peroneal nerve pain, and there was no obvious tenderness, percussion pain and movement pain in the waist.
2. Lower extremity rotation test (+), about 10% of piriformis muscle was damaged, external rotation test (+).
3. Symptoms of dry localization: sensory motor and reflex disturbance in the tibial n and peroneal n dominant area.
4. Plantar numbness (more than 90%).
There are 12 etiologies of dry sciatica
Piriformis injury – leading to sciatica
Characteristics: tenderness and abnormal changes in the gluteus medius muscle, accompanied by sciatica symptoms, at this time, through the piriformis muscle intermediary, sciatica symptoms, clinical analysis: 2/3 of the gluteus medius muscle injury caused the sciatica symptoms, 1/3 of the piriformis muscle injury caused the sciatica symptoms. The above symptoms are typical radioactive sciatica, another condition: gluteus medius muscle itself injury, gluteus medius muscle by sciatic nerve branches superior gluteus n, injury of gluteus medius muscle affects the gluteus medius nerve, thus, reflexive caused sciatic nerve symptoms.
We can imagine the nervous system into the home of circuit system, the main damage, the branch will be affected by severe, in turn, a single electrical problems arise, other electrical appliances also can appear a certain degree of influence, but this effect is smaller, as hip muscle injury caused by itself in the sciatica is often not typical, fuzzy.
According to this electrophysiological line of thought to think, so, the intricate sciatica, numbness symptoms will gradually straighten out the clue.
Lumbar 3 transverse process syndrome
A, at the beginning of this sign, can cause ipsilateral gluteus muscle spasm, gluteus medius, piriformis muscle spasm – sciatica
Intermittent claudication: the reason is to cause gluteal muscle spasm – gluteal muscle and piriformis muscle spasm – gluteal muscle pain spasm
This is an ischemic intermittent claudication of the artery, different from the intermittent claudication of spinal stenosis, as shown in the following table:
Lameness of spinal stenosis — short distance to begin lameness — sensation of beginning lameness: radiating numbness and pain along the sciatic nerve or femoral route — relieved posture: must be completely squatted, sit for a while, or stand for no relief
Ischemic claudication of the superior gluteal artery — claudication begins with a longer distance — claudication begins with a feeling of muscle soreness and weakness accompanied by mild numbness — relieved posture: sit, stand, lean for a moment to relieve, squat can also be
Treatment: for patients with lumbar spinal stenosis, sacral therapy is effective. A high cure rate can be obtained by releasing the nerve roots in and out of the nerve roots at the same time.
For patients with lumbar 3 transverse process syndrome, acupotomology is very effective. Generally one to two can be cured.
C, transverse process syndrome will cause ipsilateral gluteus muscle atrophy in the later stage.
Damage to three myofascial areas can cause dry sciatica
A. paracral area:
C. External gluteal area: outer margin of gluteus maximus, slightly posterior to the greater trochanter.
These three areas are stressed, oriented, and active, and are prone to injury affecting the related lumbar and gluteus muscles and then the sciatic nerve trunk sciatica.
Bursitis of the descending posterior femoris muscle group – sciatica
Previously referred to as the five symptoms of lumbar disc herniation residual symptoms. I think, when lumbar dash forward disease, often amalgamative have afore-mentioned 5 kinds of diseases at the same time.
It affects the common peroneal nerve
A slight shift of the fibula head backwards affects the common peroneal nerve
Location: around the middle and lower 1/3 of the lower leg, there is fascia outlet at the fibula, adhesion tension and compression n, and typical peripheral n compression syndrome occurs when pulling n.
Feeling numbness, discomfort and pain in the first, second or third digits, metatarsophalangeal joints and palmar. Location: dorsal side of the first and second metatarsophalangeal joint, near a vein.
Sciatica, from where it starts to the end of the toe. Different parts of the journey, different degrees, different forms of compression or stimulation, will cause different manifestations of sciatica. In clinical practice, it is not feasible to use monism to explain and guide the treatment of this disease without careful differentiation. Therefore, different treatment schemes should be formulated according to different conditions, so as to reach a new height in the treatment of sciatica.
No matter how good a treatment method is, it must be done with confidence, before the knife can be god. The standard treatment for sciatic nerve pain does work wonders, but the knife works differently in different hands. If the doctor first causes the sciatica the reason not to be clear, still USES the western medicine lumbar process monism to guide the clinical treatment, certainly will suffer the very big setback.
"Jingji stunner", which is very difficult to learn, is used to get the disease out of hand