The following symptoms and complaints may indicate sciatica/lumboischialgia:
- Pain in the buttocks
- Pain radiating into the leg → lumboischialgia (root irritation syndrome in which pain occurs in the lumbar spine and in the supply area of the sciatic nerve, see below).
- Pain in the groin area
- Gentle posture
- Movement restriction
- Tension and the hardening of the muscles
- Pressure painfulness of the spinous processes of the vertebral bodies
- Pain in the lumbar spine (lumbar spine)
In addition, the following symptoms may occur when nerves are pinched:
- Intensification of pain when coughing or sneezing; cough test: worsening of leg pain without a concomitant increase in back pain:
- Significantly increased likelihood that a herniated disc was present (OR 2.50)
- Findings of nerve root compression on MRI (OR 2.28).
- Sensory disturbances in the same dermatome (skin area supplied by the sensory fibers of a spinal nerve root; see below).
- Paralysis (see below).
- Attenuation of reflexes such as the Achilles tendon reflex (ASR, also triceps surae reflex).
Common forms of lumbar radiculopathy (sciatica syndrome).
| Spinal roots | Incidence (%) |
| L4 | 5 |
| L5 | 40 |
| S1 | 55 |
Sciatic nerve (nerve branches and supply areas).
| Localization | Nerve branch | Innervation area | Function |
| From sciatic nerve | Tibial nerve | ||
| N. cutaneus surae medialis | N. cutaneus surae lateralis to the N. suralis Rami calcanei N. cutaneus dorsalis lateralis | Sensory: heel skin, lateral edge of foot, and little toe. | |
| From tibial nerve | Rr. musculares | M. popliteus | Knee flexion (knee flexion) |
| M. gastrocnemius | Plantar flexion of the foot (and flexion at the knee joint). | ||
| M. soleus | |||
| M. plantaris | |||
| R. articularis genus | Knee joint | Sensitive | |
| Rr. musculares | M. tibialis posterior | Supination and plantar flexion of the foot. | |
| M. flexor digitorum longus | Flexion of the terminal phalanges of the toes | ||
| M. flexor hallucis longus | Flexion of the great toe, assists flexion and supination (outward rotation) and adduction (bringing a body part laterally or placing it against the longitudinal axis of the limb) of the foot | ||
| Sensitive branches | Tibia, fibula | ||
| R. talocruralis | |||
| Rr. calcanei mediales | Skin to heel and medial edge of foot | ||
| Medial plantar nerve | |||
| Rr. cutanei | Skin of sole of foot | ||
| Nn. digitales plantares communes, Nn. digitales plantares proprii | Skin of 1st toe to medial side of 4th toe. | Sensitive | |
| Rr. musculares | M. abductor hallucis | Abduction (splaying of a body part toward the longitudinal axis of the limb) and plantar flexion of the great toe | |
| M. flexor digitorum brevis | Flexion (bending) of the middle phalanges (middle phalanx) of the 2nd through 4th (5th) toes | ||
| M. flexor hallucis brevis | Flexion of the proximal phalanx (proximal phalanx) of the great toe | ||
| Mm. lumbricales I-II | Flexion in the metacarpophalangeal joint and extension in the metatarsophalangeal joint of the toes | ||
| Lateral plantar nerve | |||
| Rr.muscular | M. opponens digiti minimi | Abduction of the lesser toe | |
| M. flexor digiti minimi | Plantar flexion of the little toe | ||
| M. abductor digiti minimi | Plantar flexion and abduction of the little toe | ||
| M. quadratus plantae | Flexes the toes and increases the action of the flexor digitorum longus muscle | ||
| R. profundus | Mm. interossei | Adduction of the 3rd to 5th toes to the 2nd toe, flexion of the proximal phalanx, extension (stretching) of the middle and distal phalanges | |
| M. adductor hallucis | Plantar flexion and adduction of the big toe. | ||
| M. flexor hallucis brevis | Plantar flexion of the big toe | ||
| Mm. lumbricales III-IV | Flexion of proximal phalanx, extension of middle and distal phalanx. | ||
| R. superficialis | Nn. digitales plantares proprii | Lateral (lateral) half of the 4th and 5th toes. |
Warning signs (red flags)
- Anamnestic information:
- Age <20 years or >50 years:
- Children: progressive reluctance to walk and play.
- > 50 years with atypical lower back pain → think of: Prostate carcinoma/prostate cancer.
- Patients of advanced age → think of: Plasmocytoma (malignant neoplasm; non-Hodgkin’s lymphoma of B lymphocytes).
- Inflammatory rheumatic disease
- Weight loss
- HIV
- Recent severe trauma* /contusion* (direct blunt force trauma).
- Osteoporosis
- Tumor disease (the only confirmed warning sign of a malignant (malignant) event of the spine)/metastases (daughter tumors):
- Advanced age
- General symptoms: Weight loss, anorexia (loss of appetite), rapid fatigability.
- Pain that increases in the supine position
- Severe pain at night
- Drug history (intravenous drug use).
- Immunosuppression (measures taken to suppress immune responses).
- Long-term steroid therapy/therapeutic use of corticosteroids (> 6 months)* .
- Age <20 years or >50 years:
- Infection (fever > 38 °C).
- Laboratory: CRP elevation, pathological (abnormal) urine findings.
- Localized pressure pain + elderly patient* → fresh osteoporotic fracture (fracture) possible.
- Acute pain after minor trauma
- Increasing pain
- No decrease in pain at rest
- Night pain
- Morning stiffness > 1 h → suspected rheumatologic disease (e.g., polymyalgia rheumatica, rheumatoid arthritis).
- Back pain without restriction of mobility and without exacerbation during back movements → Suspicion of disease of other localization (e.g., kidney disease, pancreatic cancer (pancreatic cancer), gastrointestinal disease/gastrointestinal disease, pelvic disease in women)
- Decrease in body size → think of: Osteoporosis (bone loss)
- Neurological symptoms
- Continence disorders (bladder and/or bowel dysfunction) [neurological emergency!]
- Breech anesthesia (loss of sensation of the genital and buttock region, as well as the inner thighs) + bladder emptying disorder (e.g., urinary retention, increased urination, incontinence) = Kauda syndrome).
- Paresis (paralysis)
- Meningismus (painful stiffness of the neck)
* Warning sign of fracture (broken bone).