Sciatic nerve its root comes from lumbar 4, 5 segment and sacral 1, 2, 3 segment of spinal nerve anterior ramus. The five anterior ramus pass through the psoas major to form the sacral plexus and descend down this muscle. Most of the nerves of the sacral plexus merge into the sciatic nerve. It descends along the posterior wall of the pelvic cavity and passes out of the pelvic cavity into the buttocks at the inferior hole of the piriformis. The tibial nerve and the common peroneal nerve pass down from the posterior muscles of the buttocks to the middle and lower part of the thigh. Thus, the general sources of sciatica are first classified as root, plexus, and stem sciatica. At the same time, as a result of the sciatic nerve involved site and direct or not involved, three different sciatica, namely: radioactive, reflex, implicated. It is because of this that the manifestations of sciatica are numerous, diverse and complex, such as in the confusion, not to point out the real cause of the disease, to the treatment brought great difficulties.
Root sciatica (upper sciatica)
Common causes include lumbar disc herniation, lumbar spinal stenosis, soft tissue compression and inflammation at the nerve root outlet. The expression is the numbness of root of affected nerve innervate area, ache, acid bilges, fear cold to wait. Lumbar 4, 5 intervertebral disc herniation compression lumbar 5 nerve roots, often performance for the waist, hip back pain, thigh back side and leg anterolateral to foot back inside, thumb pain, hemp, acid, swelling, cold, etc. And lumbar 5 ~ sacral 1 intervertebral disc herniation compression sacral 1 nerve root, often performance for the waist, hip back pain, numbness, thigh back side, leg back lateral, dorsolateral to little toe, heel, sole pain, hemp, acid, swelling, cold.
Plexus sciatica (also known as middle sciatica)
The sacral plexus in the pelvic cavity is compressed or stimulated. Performance is leg ministry of lumbar buttock, much place, much segment, whole lower limb before, hind, lateral reach sufficient dorsum inside, lateral, sufficient heel, sole numb ache, acid bilges, fear cold to wait.
Sciatica (lower sciatica)
The main reason is that the sciatic nerve is compressed or stimulated in the path of the pelvic outlet and below.
Common causes include:
1. Lumbar disc herniation;
2. Compression and injury of nerve roots (spinal stenosis, spondylolisthesis, rheumatoid arthritis, tuberculosis, osteoporosis, etc.);
4. Congenital malformations.
1. Paravertebral tenderness, percussion pain and movement pain. At the same time, the posterior branch of the nerve root is involved.
2. Neck flexion test (+). As a result of the action of pulling dura sacula and root sleeve caused by.
When lumbar 4, 5 intervertebral disc herniation, lumbar 5 nerve root compression, pain performance for the buttocks, thigh back, leg anterolateral, foot back medial pain, numbness, and lumbar 5, sacral 1 intervertebral disc herniation, sacral 1 nerve root involvement, mainly in the ipsilateral leg posterolateral and foot back lateral and plantar hemp, pain symptoms. In the cervical spondylosis of the three vicious cycle: cervical disc degeneration and secondary changes in the peripheral tissue between the vicious cycle, also applicable to patients with lumbar protrusion. When there is lumbar disc degeneration, compression of the nerve root at the same time the anterior branch is involved, the posterior branch is also involved, and then the branch innervates the muscles, ligaments and other soft tissues of the paravertebral, which will cause pain and discomfort of these soft tissues and other symptoms. Speak conversely, the soft tissue of vertebra week, especially after the soft tissue such as muscle, ligament suffers strain, also can stimulate the hind branch of spinal nerve, reflex sex causes sciatica symptom.
The difference between radiation sciatica and reflex sciatica
Radiation sciatica sharp pain route clear route continuous
Reflex sciatica obtuse pain route obtuse route interrupted
In most cases, the degeneration of the intervertebral disc is an internal cause, and the peripheral soft tissue injury caused by wind, cold, dampness and strain is an external cause. The onset of lumbago and leg pain has several conditions:
1) sometimes, internal causes play a leading role, while external causes are not obvious. Some patients have no obvious symptoms of lower limb pain and discomfort.
2) in the other part of cases, external factors played a leading role, with extremely obvious symptoms of waist pain and discomfort, accompanied by lower limb symptoms;
3) there are some patients with obvious external causes, pain and discomfort in the waist for a long time, and internal causes have not changed a lot, so only low back pain and no 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 as follows:
Acute trauma in young patients
Young people, due to acute trauma, acute onset of disc fiber ring rupture, a short period of nuclear pulposus herniation, compression of nerve roots will occur in the following two situations:
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) when acute onset occurs, numbness, muscle atrophy, or saddle area numbness and incontinence, the curative effect of conservative treatment will decrease, and surgical treatment is the main choice.
Senile lumbar and leg 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, appendicitis.
2. Pelvic trauma, injury or inflammation of the iliopsoas and piriformis, and sacroiliac arthritis
1, multi – dry pain, that is, at the same time with multiple nerve stem involvement symptoms
The sciatic nerve radiates pain to the lower extremities
B. thigh n: pain radiating into the front of the thigh
C. superior gluteal n: radiating pain into the sacral region
D. subgluteal n: pain radiating into the buttocks
E. Obturator foramen n: alternating or concomitant radiating pain to the knee
F. Pudendal nerve: pain radiating into the perineum
Posterior femoral cutaneous nerve: pain radiating to the back of the thigh
Among them, b and e are the lumbar plexus and all have nerve fibers from the lumbar 4 nerve root.
2. Percussion pain in the lumbosacral region and complaint of "comfort"
3. Knee tendon reflex and heel reflex weaken or disappear at the same time
1. "circular jump" deep tenderness, accompanied by radiation resulting in pain and numbness of lower limbs and feet. Sixty percent of the patients were accompanied by popliteal and peroneal pain, and no significant tenderness, percussion pain or motion pain in the lower back.
2. Rotation test of lower limbs (+), about 10% piriformis muscle was damaged, and external rotation test (+).
3. Dry localization symptoms, including sensory movement and reflex disturbance in the dominant areas of tibial n and total peroneal n.
4. Foot numbness (over 90%).
There are 12 causes of dry sciatica
Piriformis injury – causes sciatica
Gluteus medius injury – gluteal pear syndrome – sciatica
Characteristics: tenderness and abnormal changes in the gluteus medius, accompanied by sciatica symptoms, at this time, through the piriformis mediators, sciatica symptoms will appear, clinical analysis: two-thirds by the gluteus medius injury caused sciatica symptoms, 1/3 by piriformis injury caused sciatica symptoms. The symptom that causes above is more typical radioactivity sciatica, another kind of circumstance: injury of gluteal medium muscle itself, gluteal medium muscle by the branch of sciatic nerve on buttock n is innervated, the injury of gluteal medium muscle affected gluteal upper nerve, from this, reflex sex causes sciatic nerve symptom.
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. WeChat public platform: spinal health alliance
Go thinking according to the train of thought of this electrophysiological circuit, so, the symptom of labyrinthian sciatica, hemp can step by step manage give order to come.
Lumbar 3 transverse process syndrome
Clinical significance of lumbar third vertebra transverse process syndrome:
A. in the early stage of this sign, it can cause ipsilateral gluteal muscle spasm, gluteal muscle spasm, piriformis spasm — sciatica
B, intermittent claudication: the reason is caused by gluteal muscle spasm – gluteal muscle and piriformis spasm – gluteal muscle pain spasm
This is an ischemic intermittent claudication of the artery, unlike intermittent claudication in spinal stenosis, as shown in the table below:
Narrow lameness – short distance to begin lameness – feeling of beginning lameness: numbness pain radiating along the route of the sciatic nerve or femoral nerve – relief posture: must be completely squatted for a while while sitting or standing
Superior gluteal artery ischemic claudication – longer distance to begin claudication – sensation of beginning claudication: muscle soreness and weakness with mild numbness – relieved posture: may be relieved by sitting, standing, leaning for a moment, or squatting
Treatment: for patients with lumbar spinal stenosis, sacral therapy is better. A high cure rate can be obtained by simultaneously loosening the nerve root and the nerve root.
For patients with lumbar 3 vertebra transverse process syndrome, the effect of acupotomy is excellent. Generally one to two can be cured.
C, transverse process syndrome will cause ipsilateral gluteal muscle atrophy to the later stage.
Damage to three myofascial areas can cause dry sciatica
A. paracral region:
B. posterior iliac region: posterior 1/3 iliac crest region;
C. Outer gluteal region: outer margin of gluteus maximus, slightly posterior to the greater trochanter.
These three areas are stressed, directional, active, and prone to injury affecting the relevant lumbogluteal muscles and then affecting the sciatic nerve stem sciatica.
Posterior femoris descending bursitis – sciatica
These five symptoms were previously known as residual symptoms of lumbar disc herniation. I think, when lumbar protrusion disease, often have above 5 diseases concurrently.
It affects the common peroneal nerve
The medial margin of the biceps femoris tendon affects the common peroneal nerve. Ankle can not lift, feel powerless.
A small backward shift of the fibula head affects the common peroneal nerve
Anterolateral leg discomfort
Anterolateral leg discomfort (heavy, swollen, acid, pain, numbness) symptom persistence, similar to the compartment high compression syndrome.
Popliteal fossa and the back of the leg pain, swelling, discomfort
The popliteal and posterior sliding bands affect the tibial nerve.
Superficial peroneal n fascia outlet clamping
Position: about the middle and lower 1/3 of the lower leg, fascia outlet at the fibula, adhesion, tension and compression n, traction n, typical peripheral n compression syndrome.
The medial terminal branch of the deep peroneal n is jammed
Numbness, discomfort, and pain in the first, second, or third digits of the metatarsophalangeal joint and volar. Position: dorsal side of first and second metatarsophalangeal joint, proximal one vein.
Tendinitis of flexion toe
The 1st and 2nd digits were the most, treated by stricture tenosynovitis.
Sciatica, it starts at the end of the toe. Different parts of the journey, varying degrees and forms of compression or stimulation, can cause different manifestations of sciatica. If do not try to differentiate carefully in clinical practice, only monism will explain, with monism to guide the treatment of this disease, is not feasible, must be appropriate, in view of different conditions to develop different treatment plans, so that can really in the sciatica treatment to reach a new height.
No matter how good a treatment method is, it must be done with confidence, before the knife can be as god. Standard therapy with arc-blade needles works wonders for sciatic pain, but the knife works differently in different hands. If the reason of causing sciatica is not clear and the monism of lumbar protrusion disease is still used to guide the clinical treatment, there will be a lot of frustration.
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