Sciatica

Gerald Schwartz wrote the book for lawyers, published by the Virginia Trial Lawyers Association, explaining sciatica. Join Gerald Schwartz as he explains why a herniated disc can cause severe pain radiating down your leg called "sciatica."

The sciatic nerve is the longest nerve in the body. It is formed from the L4, L5, S1, S2, and S3 nerve roots in the low back. The sciatic nerve runs down the low back, the buttocks, hip and the back of the leg to the toes.

Tom was badly hurt in a Manassas, Virginia car accident on I-66. He is left with a herniated disc in his low back compressing his sciatic nerve.

A herniated disc in the low back at the level of L4-L5 or L5-S1 can "pinch" or "compress" nerve roots at these levels causing pain to radiate down the course of the sciatic nerve. Patients feel radiating pain in the buttocks, hip and down the back of the leg, going down below the knee. Numbness and tingling, along with weakness, are often present.

Pain from the pinching or compression of the sciatic nerve is found along the course of the nerve, and is named in honor of the sciatic nerve -- sciatica.

Larry was rear-ended in a Woodbridge, Virginia car accident while stopped on Dale Boulevard. His car was totaled. Larry developed low back pain. A few weeks later, he felt pain radiating down his right leg down to his ankle with numbness and tingling. Larry was examined by his family doctor who found a positive (+) straight leg-raising test. Larry's doctor reported that he had a herniated disc causing sciatica as a result of the Woodbridge car accident.

The straight leg-raising test is a classic test that doctors perform to diagnose sciatica. The test is abbreviated in medical records as "SLR."

The straight leg-raising test is a tension test. The sciatic nerve is placed on "stretch" by the examining physician. The physician performs the test by taking up the normal "slack" in the long sciatic nerve. This increases the compression and tension on an already compressed and irritated nerve root. The result is reproduction of radiating pain along the course of the sciatic nerve - a positive (+) test. A normal sciatic nerve (not irritated) does not cause pain when put under stretch by the straight leg-raising test.

The straight leg-raising test is performed with the patient lying on his/her back on the examining table. The physician lifts the patient's leg off of the table, flexing the hip in the direction of the patient's head. The test is positive (+) if the patient reports radiating pain down the course of the sciatic nerve before a 90° angle is reached. The physician records the angle at which the sciatic pain is reproduced, for example, 60°. Generally, the more severe a patient's condition, the lower the angle is required to reproduce the sciatic pain. The opposite (normal) leg is also tested and will result in a positive (+) straight leg-raising test with sciatic pain being reproduced in the involved leg. This test is called a "contralateral straight leg-raising test." This test is often performed by defense medical examiners to show the patient is faking symptoms. For example, if the patient reported sciatica radiating down his left leg, and the doctor raised the opposite leg, one would expect the patient to feel pain radiating down the left leg not the right leg. If the patient reported pain radiating only down the tested right leg, this is consistent with "malingering" -- a medical term used to describe "faking symptoms."

A positive straight leg-raising test is an indication of nerve root compression in one of the nerve roots that form the sciatic nerve. A patient with a herniated disc which does not compress the nerve root will generally experience only localized low back pain (or be free from symptoms) and will have a negative straight leg-raising test.

The results of the straight leg-raising test usually vary from one office exam to the next depending on periods of decreased symptoms and periods of increased symptoms. In addition, the results of the straight leg-raising test may be altered if a patient is taking painkillers since his/her threshold for experiencing sciatic pain may be increased. For example, the test may be positive only by raising the leg at a higher angle in order to reproduce the sciatic pain.

Betty injured her low back in a Prince William County, Virginia auto accident on I-95. She sustained a herniated disc at L5-S1, resulting in a diagnosis of sciatica. Betty was examined by a doctor selected by the other driver's insurance company for what the insurance company said was an "independent medical exam," -- an "IME." The insurance doctor performed two different straight leg-raising tests on Betty.

In addition to the lying down straight leg-raising test, physicians often do a variation by having the patient seated at the edge of an examining table with his/her legs dangling off of the edge. This is called the "seated straight leg-raising test." It is performed by raising the patient's leg upward to the horizontal position by straightening the patient's knee. The sciatic nerve is thus stretched and the symptoms of sciatica are reproduced.

Defense medical examiners often have the patient perform both a lying down and seated straight leg-raising test to observe discrepancies between the tests in an effort to rule out malingering (faking). Both tests should give the same results.

Manassas personal injury lawyer, Gerald Schwartz, has spent 30 years studying herniated disc injuries. Schwartz has represented hundreds of Prince William County residents who have suffered ruptured disc injuries. He has convenient locations in Manassas and Woodbridge. For a free consultation, call Gerald Schwartz at (703) 690-0055.