Sciatica is a clinical syndrome of pain along the sciatic nerve pathway and distribution area caused by associated irritation of the sciatic nerve root or trunk due to various diseases and pathological factors, developing along the lumbar region, the posterior aspect of the buttocks, the posterior lateral aspect of the thigh, and the posterior lateral aspect of the calf all the way to the lateral aspect of the heel, such a painful symptom is called sciatica. Strictly speaking, sciatica is not an independent disease, but a syndrome of clinical onset. Sciatica is divided into primary sciatica and secondary sciatica. Primary sciatica, also called sciatica neuritis, has an unknown cause and is relatively rare in clinical practice; most people with symptoms are mainly suffering from secondary sciatica, which can be further classified into radicular pain and dry pain. The sciatic nerve is formed by the confluence of four nerve roots in the lumbar vertebrae five, sacrum one, sacrum two and sacrum three, which is the thickest set of nerve lines in the human body, and its thickness is about the same as that of an individual’s little finger. Although the nerve roots of the lumbar four are also partly involved in the composition of the sciatic nerve, the lumbar four nerves are more often manifested as femoral neuralgia rather than sciatica after stimulation, and the location of the pain is obviously There is a clear distinction in the location of the pain. There are many causes of sciatica, and lumbar disc herniation is the most common cause of sciatica, which also includes spinal stenosis, spinal subluxation, lumbar spur hyperplasia, intervertebral foramen narrowing, and pear-shaped muscle syndrome. Others, such as intraspinal tumors, neuromas, and inflammatory nerve irritation, can also manifest as sciatica due to compression and irritation of the sciatic nerve. Therefore, proper examination and evaluation are required before an accurate diagnosis and the most appropriate treatment plan can be given. Diagnosis The diagnosis of sciatica is mainly determined by symptoms and signs. 1. Questioning By asking the patient’s symptoms and seeing where the patient’s main point of complaint is pain, to identify the symptoms for the next step of examination and diagnosis. 2. Examination (1) Straight leg elevation test A method to check whether there is a positive manifestation with bare hands, and is also a very common clinical monitoring tool. The physician or therapist takes turns to elevate the legs of a patient lying flat on the bed, slowly, and observes the patient’s response. A healthy person can elevate the legs to over 70 degrees with only the sensation of being pulled. If the sciatic nerve is compressed, the patient cannot lift the limb up to 65 degrees, and then lift it again to have radiating pain along the posterior lateral thigh, posterior hip, and lateral calf, which is a positive response to the straight leg lift test, and cannot exceed an angle of 30 degrees in severe patients. (2) Pain point examination Determine whether there are pressure points in the lumbar paraspinal, gluteal point (pear-shaped muscle pressure point), posterior femur, popliteal fossa, fibular point, and external ankle, as well as the location of the pain and the height of the pain location. (3) Muscle strength examination The external manifestations of nerve root involvement are different for different nerve roots. The common ones are compression of the lumbar V and sacral I nerve roots. Involvement of the fifth lumbar nerve is characterized by deep and raised big toes, abnormal sensation and numbness on the medial side of the dorsum of the foot. The involvement of sacral nerve is characterized by weakness of the whole foot, abnormal sensation and numbness of the lateral side of the dorsum of the foot, weakening or even disappearance of the Achilles tendon reflex on the affected side, and weakening or disappearance of the knee reflex. In addition, the height of the gluteal groin on both sides can be compared when standing and whether there is any shallowing. (4) Auxiliary examination X-ray examination mainly looks at whether there are changes in the sequence and intervertebral space structure, whether the intervertebral space is flat and whether the whole vertebral body is straight. Further differential examinations are done by CT and MRI to see the direction of disc protrusion and whether there is any intervertebral foraminal compression. The MRI can see more clearly whether there is spinal stenosis, tumors or metastases in the vertebral body, etc., which can only be seen through CT or MRI. Treatment The treatment of sciatica is divided into surgical and non-surgical treatment. Under the exclusion of abnormal disease triggers such as metastatic cancer or vertebral tumors, conservative non-surgical treatment is generally used, and 85%-90% of patients can obtain more satisfactory results through non-surgical treatment. If non-surgical treatment is ineffective and the patient’s normal life and work are affected and the numbness and pain are still present, surgical treatment can be considered, and only 10%-15% of patients are treated by surgery. Non-surgical treatment is mainly based on oral medication, local closure and various physical therapy for the cause of the disease, including various kinds of freehand treatment, exercise therapy, electrotherapy, ultrashort wave, magnetic heat therapy, acupuncture, massage, short wave, laser, etc. Surgical treatment includes disc removal, nucleus pulposus ablation and ozone therapy for disc herniation, and decompression surgery for pear-shaped muscle syndrome.