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Lower Back Disorders; Disc Herniation, Lumbalgia, Sciatic Nerve Neuralgia, Post-Isometric Relaxation & Back Rehabilitative Exercises.

Sciatic nerve neuralgia is considered to be one of the most difficult abnormalities of the support and movement system. Clinical expressions of sciatic nerve neuralgia include sharp pain irradiating to the lower extremities which increases during any of the patient’s attempts to move and of course limited range of motion on all axes and planes. Usually, when a patient appears at the doctor’s office with such a difficult clinical picture, in addition to prescribing painkillers, anti-inflammatory drugs, and/or utilizing injections, the doctor will usually refer the patient for radiological examination. Today, the most common radiological examinations are the MRI and/or CT scan. In many cases, MRI test detects bulging and/or herniation of discs. If symptoms are not alleviated in a period of a few weeks due to conservative methods of treatments (above mentioned oral or injected medication) consideration will be given to surgical intervention. The problem is that in many cases, this difficult neurological picture is not the result of the disc herniation, but is actually the result of piriformis muscle syndrome.

Anatomy of the Piriformis Muscles
The Piriformis muscle originates from the anterior surface of the sacrum and inserts into the greater trochanter. It shares the passage through the greater sciatic foramen with several important nervous and vascular structures including nerves which provide innervation to pelvic inner organs, the gluteals, and the lower extremities. The piriformis muscles can accumulate tension to the point that they will start compressing/ impinging sciatic nerve and awaking in some cases intolerable pain in the buttocks and lower back with irradiation to the extremities.

Sciatica nerve neuralgia can be the result of compression of the S1 spinal nerve as well as due to the compression of the sciatic nerve by over-tensed piriformis muscles. If patients with symptoms of sciatica have the ability to bend forward without awaking pain, most likely the sciatica neuralgia is the results of piriformis muscle syndrome.
The Causes for Accumulation of Tension in the Piriformis Muscles
1. Due to spondylosis, including herniation of disc, spinal nerves can be irritated (please do not confuse irritation of the spinal nerve with compression of the spinal nerve.) Irritation of the spinal nerves that provide innervation to the piriformis muscles (S1 spinal nerve) will cause a gradual accumulation of tension in these muscles, to the point that they will compress the sciatic nerve.
2. Physical overload of the muscles such as vigorous exercise, job performances that put too much static load on the piriformis muscles, hormone changes, exposure to toxins, physical and/or psychological trauma, etc.

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Edit (25/9/08) – I’m getting tired of the ‘what’s the difference’ and ‘there is no difference’ remarks regarding Endings 2 and 3. Anyone with eyes can see that they are visually identical, however (as stated in the video between 2 and 3) there is a difference in the tone of narration, 2 is angry while 3 is sad. Anyone who is not deaf or does not have broken speakers should be able to pick up on this, otherwise you’re lost! Ok fine this is a small difference and the game writers could have probably put in more effort to distinguish them more. Nevertheless they are still different endings in their own right because they have been achieved by playing Bioshock in a different way. If you get the sad ending (Ending 3) then you saved some little sisters but probably killed a few out of curiosity, so the narrator is sad that you gave in to temptation. But if you get the angry voice ending (Ending 2) you have probably rampaged your way through the game killing every little sister you came across with a big smile on your face as you plan which plasmid you’ll get next, so the narrator is angry that you have been so selfish and greedy.

Edit 11/2/2010 – Over 1 million views – thanks for watching!

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Expert: Dr. Robin Terranella
Bio: Dr. Robin Terranella has a medical degree from Bastyr University and has trained at Wu Hsing Tao Acupuncture School.
Filmmaker: Dustin Daniels

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