Radiculopathy and Radicular Pain -AND COCCYX PAIN/its relevance to the Osteopath
There is a subtle difference between radiculopathy and radicular pain and understanding the pathophysiology of both can help improve the osteopath's diagnosis, prognosis and treatment.
Radiculopathy is the term that describes the neurological state of blocked axon conduction in a nerve or a nerve root. If a sensory axon is blocked then it results in numbness. If a motor axon is blocked then it results in muscle weakness. A blocked axon normally occurs as a result of compression or ischemia of the affected axon. The most common causes of radiculopathy are vertical subluxation of a vertebrae and osteophytes from a disc.
The osteopath must realise that radiculopathy is a STATE OF NEUROLOGICAL LOSS and it does NOT cause pain neither in the back nor in the limbs.
If the osteopath finds that the patient describes pain as well as radiculopathy (neurological loss) then the osteopath should be aware that the mechanism of radiculopathy may not necessarily be the same as the mechanism of pain.
Radicular pain on the other hand is pain that arises out of IRRITATION of a spinal nerve or a nerve root.
Radiculopathy is the term that describes the neurological state of blocked axon conduction in a nerve or a nerve root. If a sensory axon is blocked then it results in numbness. If a motor axon is blocked then it results in muscle weakness. A blocked axon normally occurs as a result of compression or ischemia of the affected axon. The most common causes of radiculopathy are vertical subluxation of a vertebrae and osteophytes from a disc.
The osteopath must realise that radiculopathy is a STATE OF NEUROLOGICAL LOSS and it does NOT cause pain neither in the back nor in the limbs.
If the osteopath finds that the patient describes pain as well as radiculopathy (neurological loss) then the osteopath should be aware that the mechanism of radiculopathy may not necessarily be the same as the mechanism of pain.
Radicular pain on the other hand is pain that arises out of IRRITATION of a spinal nerve or a nerve root.
So, at the risk of sounding repetitive:
Radiculopathy – neurological state (weakness or numbness) caused by conduction of the axon being blocked.
Radicular Pain – Pain caused by nerve irritation.
Radicular pain may or may not occur with radiculopathy.
Radicular pain is sharp and shooting in quality and it travels down the limb along a band of no more than 2 inches. This is different from somatic referred pain which is more constant in nature, poorly localised and aching. It is important that the osteopath be aware of the differences.
A good example of radicular pain is sciatica. Sciatica is caused by the irritation of the sciatic nerve or one of its roots. However the term sciatica should only be used to describe a case when the pain is indeed sharp, shooting and is of 2 inches in width down the leg. The osteopath should clearly make a distinction between this and somatic referred pain which, as mentioned above is broad, achey and poorly localised.
The single most common cause of radicular pain is a disc herniation. The pathophysiology of this is still unclear - whether the nerve irritation is caused by an autoimmune inflammatory response from the nucleus pulposis or from ischemia.
Thus the osteopath should use the above information to make a diagnosis and treatment plan. The osteopath must be direct in questioning and in examination of the patient in order to be able to distinguish between a state of neurological loss and between pain. Once the osteopath has distinguished between these he should further examine the parameters and quality of the pain to distinguish between radicular and somatic pain. This way his diagnosis will lean more towards foraminal stenosis - vertical subluxation of the vertebrae or osteophytes if radiculopathy is suspected and towards a disc herniation if radicular pain is suspected.
Radiculopathy – neurological state (weakness or numbness) caused by conduction of the axon being blocked.
Radicular Pain – Pain caused by nerve irritation.
Radicular pain may or may not occur with radiculopathy.
Radicular pain is sharp and shooting in quality and it travels down the limb along a band of no more than 2 inches. This is different from somatic referred pain which is more constant in nature, poorly localised and aching. It is important that the osteopath be aware of the differences.
A good example of radicular pain is sciatica. Sciatica is caused by the irritation of the sciatic nerve or one of its roots. However the term sciatica should only be used to describe a case when the pain is indeed sharp, shooting and is of 2 inches in width down the leg. The osteopath should clearly make a distinction between this and somatic referred pain which, as mentioned above is broad, achey and poorly localised.
The single most common cause of radicular pain is a disc herniation. The pathophysiology of this is still unclear - whether the nerve irritation is caused by an autoimmune inflammatory response from the nucleus pulposis or from ischemia.
Thus the osteopath should use the above information to make a diagnosis and treatment plan. The osteopath must be direct in questioning and in examination of the patient in order to be able to distinguish between a state of neurological loss and between pain. Once the osteopath has distinguished between these he should further examine the parameters and quality of the pain to distinguish between radicular and somatic pain. This way his diagnosis will lean more towards foraminal stenosis - vertical subluxation of the vertebrae or osteophytes if radiculopathy is suspected and towards a disc herniation if radicular pain is suspected.
Coccyx Pain
From time to time osteopaths are confronted with a case of coccygeal pain. A vestigial joint exists between the sacrum and the coccyx and it is at this location that strain can occur. Most commonly it exists after pregnancy after a difficult labour. However it can also occur after a fall on one's bottom.
During pregnancy the mother's body undergoes drastic changes in a very short period of time. Not only is there a sudden weight gain due to the increase of the weight of the foetus, amniotic fluid and breast tissue but there are drastic hormonal changes occurring to prepare the mother's body for the upcoming birth. Let us not ignore the emotional changes that must be taking place too and the effect on the body tissues of perhaps anxiety or depression.
As the weight changes so does the posture. There are a variety of changes that occur through the lumber spine with an initial increase in the lordosis followed by a flattening of the lumber spine as the foetus grows and pushes out the ribs.
To accommodate the changes in the lumber spine the pelvis has to change it relative position by rotating either anteriorly or posteriorly depending on the stage of the pregnancy. The result is an increased tension in the sacroiliac joints as they attempt to accommodate the changes in the spine, illium and increased weight from above. The alteration would of course not be complete without making mention of the changes that have to occur in the femoral joints.
All ligaments connected to these areas will be under significant strain and it is no surprise that the sacroiliac, ischiosaral and coxxgeal ligaments will take much of the brunt.
During labour, the head of the baby passes through the pelvis and slides along the sacrum and coccyx to make its exit. These ligaments come up against enormous pressure as the contractions of the uterus force the head of the baby up against them.
During pregnancy the mother's body undergoes drastic changes in a very short period of time. Not only is there a sudden weight gain due to the increase of the weight of the foetus, amniotic fluid and breast tissue but there are drastic hormonal changes occurring to prepare the mother's body for the upcoming birth. Let us not ignore the emotional changes that must be taking place too and the effect on the body tissues of perhaps anxiety or depression.
As the weight changes so does the posture. There are a variety of changes that occur through the lumber spine with an initial increase in the lordosis followed by a flattening of the lumber spine as the foetus grows and pushes out the ribs.
To accommodate the changes in the lumber spine the pelvis has to change it relative position by rotating either anteriorly or posteriorly depending on the stage of the pregnancy. The result is an increased tension in the sacroiliac joints as they attempt to accommodate the changes in the spine, illium and increased weight from above. The alteration would of course not be complete without making mention of the changes that have to occur in the femoral joints.
All ligaments connected to these areas will be under significant strain and it is no surprise that the sacroiliac, ischiosaral and coxxgeal ligaments will take much of the brunt.
During labour, the head of the baby passes through the pelvis and slides along the sacrum and coccyx to make its exit. These ligaments come up against enormous pressure as the contractions of the uterus force the head of the baby up against them.
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