Sciatica refers to pain caused by irritation of the sciatic nerve. The sciatic nerve is the largest nerve in the body and originates at the lumbosacral plexus at L4-S3 and has branches all the way down into the foot.

When most people think about sciatica they think of compression from the L4-L5/S1 or piriformis tension.

The lasegue test is a common test for sciatic nerve pain resulting from lumbar disc compression. To preform the lasegue test the patient lies supine (on their back) with legs straight and the practitioner passively (without help from the patient) lifts the leg. If lifting the leg between 30 and 70 degrees elicits pain in the leg it is considered a positive result for disc compression. However, if the practitioner inhibits (compression in a particular direction depending on their evaluation) the pelvic ovarian zone and it produces immediate improvement in hip flexion by up to 30 degrees it’s an indication the origin of the pain is not a disc problem but is rooted in an ovarian or uterine restriction, displacement (especially retroversion) or enlargement. Enlargement may be from a fibroid, adenomyosis, venous congestion or large cyst.

pelvic ovarian zone

Pelvic ovarian zone highlighted in the red circle. The “feed me” has nothing to do with this information. Just me being silly.

Pelvic ovarian zone: If you draw a line from ASIS to pubic symphysis the ovarian zone would be in the lower third.

ovarian restrictions can also cause low back pain typically in the premenstrual phase. If movement increases pain then the root may be more mechanical in nature and involve disc problems. Ovarian restriction causes of low back pain wouldn’t cause more pain with movement.

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

Eur Spine J. 2007 Jun; 16(6): 721–731.
Published online 2006 Apr 19. doi

Abstract:

“The principal author was confronted few years ago with the case of a 38-year-old woman with a 5-month history of ill-defined L5 sciatic pain that was referred to an orthopaedic department for investigation and eventual surgical treatment for what was suspected to be herniated disc-related sciatica. Removal of her enlarged uterus found unexpectedly close to the sacroiliac joint upon lumbar MRI abolished her symptoms. Review of the literature showed that the lumbosacral trunk is vulnerable to pressure from any abdominal mass originating from the uterus and the ovaries. Physiological processes in the female patient and gynaecological diseases may be the source of sciatica, often not readily searched for, leading to fruitless investigations and surgical treatments. The aim of the paper is to highlight gynaecological and obstetrical causes of sciatica and sciatica-like symptoms. To prevent unproductive expenses and morbidity, a thorough gynaecological examination should be done even though neurological examination may be suggestive of a herniated intervertebral disc, and the cyclic pattern of pain related to menses should be routinely asked for.” READ full article HERE.


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