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Nerve Root Irritation
The spinal nerves exit from the spinal cord via the neural (or intervertebral) foramina, and may become compressed or inflamed. (The cervical, thoracic and lumbar vertebrae all have these intervertebral foramina).
One possible reason for this inflammation that may cause nerve root irritation could be a herniated lumbar intervertral disc or disc fragment. However this may also not be the cause, and it may even be the facet (zygapophyseal) joint that has become restricted or other surrounding tissues or muscles compressing or irritating the spinal nerve(s) near their root, or triggering an inflammatory response.
If the cause of the lumbar nerve root irritation is primarily a restricted zygapophyseal (facet) joint, then osteopathic manipulation to this joint may produce a good result, increase the range of motion of the joint, relax associated spinal muscles through the associated reflex at that spinal level (or levels) and the result will be less pain and more movement. Even if the cause of the nerve root irritation is swelling, blood congestion, inflammation or adjacent structures or muscles, then osteopathic articulation may also have a beneficial effect and be able to moderate this and reduce pain and increase the range of movement of the affected area.
Sometimes the pain will go down the leg, as the affected spinal nerve (or nerves) are irritated. This is called radiculopathy where one or more nerves are affected and do not work properly (called a neuropathy). The location of the injury is at the level of the nerve root (radix=root) affected. This can result in pain, radicular pain, weakness, numbness, foot-drop (with difficulty in walking) or weakness in certain muscles.
Pain and/or altered sensation (parathesia) is often felt as numbness, tingling or ‘pins and needles’, and this will follow the dermatomal distribution, e.g. the L5 nerve root dermatome commonly effects the foot (usually inside edge) and big toe, the S1 dermatome more the little toes (outside edge of the foot) or the back of the foot and calf muscle area — although there can be some overlap and dermatomes are only approximate.
Symptoms of numbness or altered sensation down the leg (parathesia or altered sensation) may not necessarily be caused in this way by nerve root irritation. A disc bulge, disc prolapse or herniation (commonly, though not accurately sometimes called a ‘slipped disc’ although the disc does not actually slip) that presses on or irritates the spinal nerve(s) can also cause this.
Please see the previous page ‘Disc injuries’.
The term sciatica, although often used, is not very accurate, and only suggests pain down the leg, without identifying its cause. Other causes for numbness and pain radiating down the leg can also include a piriformis muscle syndrome, where the sciatic nerve is irritated or compressed by a hypertonic (tight) piriformis muscle.
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