Sciatica? Really, is that the best you can come up with?


Sorry for the tone of the title. It mostly reflects my attitude toward diagnosing these days and the overemphasis on trying to categorize illness as opposed to focusing on health and restoring or maintaining it. Don’t get me wrong, a diagnosis can be critical in certain situations. However, a diagnosis like “Sciatica” is completely useless!

Here is why. How would you feel if you took your car into the mechanic because there is a pinging sound at 50 mph and he came back and told you that you have “Pingatica Pentavra.” When you ask him what that means he says you have a ping in your engine at 50 mph and then hands you a pair of ear muffs so you can’t hear it anymore? Oh, and the bill, of course.
The only thing the mechanic did was give you a fancy name for something you already knew and then gave you a remedy that didn’t really solve anything. And yet, you are supposed to be comforted by both. Are you? We settle for this all the time in our sick care society.
So what about sciatica? The sciatic nerve is the biggest conglomeration of nerves in the body. It forms in the back/buttock area and runs down the back of the thigh to about the knee. If it is irritated, it is painful and they call it sciatica. Sciatica is not a diagnosis; it’s a fancy word that describes your symptoms.
The real question is what is causing the sciatica. Is it a bulging or herniated disc? Is it inflammation around the vertebrae and therefore the nerve roots which will form the sciatic nerve? Is it dysfunction of the sacroiliac joint? Is the piriformis muscle (or any other muscle in the area) tight or have lesions? Is the chair the person sitting on hitting the sciatic nerve and causing a direct irritation to it?
Furthermore, we need to ask what is causing all of the above mentioned things to happen! Why is the disc bulging or herniated? Why is there inflammation? And the list goes on. Then, we need to ask at what level do we want to treat? Do we mask the symptoms and hope the body will figure it out? Do we help the body restore function? Once we have, do we try and maintain or prevent?
At the end of the day, health is a sliding scale. There is proper function at the high end and improper function at the other. So often we try to pinpoint a single cause of dysfunction when the reality is that there are almost always multiple and complex causes. With that in mind, does it really matter what we call the symptoms if the goal is simply to restore function?

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