Pathophysiology of Ischialgia

Human vertebrae is consist of cervical, thorakal, lumbar, sacral, and coccyx. Part of vertebrae that form the lower back is the lumbar 1-5, the intervertebral disc and lumbar plexus also the sacral plexus. Lumbar plexus, exit through lumbar 1-4, which consists of iliohipogastric nerve, ilioinguinal nerve, femoral nerve, genitofemoral nerve, and the obturator nerve.

Then, exit to sacral plexus, from 4 lumbar-sacral 4 consisting of the superior gluteal nerve, inferior gluteal nerve, nerve ischiadicus, superior femoral cutaneous nerve, pudendal nerve and the ramus muscularis. Ischiadicus nerve is the nerve bundles left lumbosacral plexus and foramen infrapiriformis and headed out on a limb in the middle of the surface folds of the buttocks. At the apex of the popliteal spasium, ischiadicus nerve branched into two nerve perineus communist and tibial nerves. Ischialgia arising from stimulation of sensory fibers from the posterior roots of the lumbar sacral 4 to 3, and it can occur on any part ischiadicus nerve before reaching the rear surface of the leg.

       Ischialgia is pain that radiates along the way n.ichiadicus L4 - S2 . Ischialgia is started from the location of the foramen infrapiriformis and spread by traveling nerve ischiadicus cum poroneus nerve and tibial nerve should be suspected as a primary manifestation ischiadicus or entrapment neuritis with a trap in the area sacroiliaca.

         Ischialgia perceived, starting from lumbosacral vertebral or lumbosacral paravertebral area and spread according to one of the nerve roots are involved in setting up ischiadicus. Before going ischialgia always preceded with Low Back Pain, such as feelings of pain, aches, pains or feels uncomfortable in the lumbar region, buttocks, which of triggers by various causes, ranging from the most obvious as one position, germs, until the cause is not clear psychological stress. Ischialgia can be classified into Traumatic and non traumatic, with or without primary or secondary neurological disorder, with or without acute or chronic neurological disorders.

          Pain or discomfort that spreads should be interpreted as a manifestation of the results of stimulation of the sensory nerves. Nerve pain was felt throughout the course of the peripheral nerves. it started from the sensory nerves are stimulated and spread by a trip to the peripheral sensory fibers. Stimulation of the peripheral nerve bundles usually means stimulation of the motor and sensory nerves. Impaired sensibility that feels all the way peripheral nerve and usually also accompanied by motor disturbances that called neuritis. Neuritis in the legs can occur due to certain nerve bundles are infected or affected patologic around.

       Pain sensitive buildings, containing nociceptive receptors (pain) are stimulated by various local stimuli (mechanical, thermal, chemical). Stimulus spending will be responded with a variety of inflammatory mediators that will create the perception of pain. Pain is a protective mechanism aimed at preventing the movement so that the healing process is possible. One form of protection is a muscle spasm, which in turn can lead to ischemia.

        Pain may be incurred inflammatory pain on the tissue with the involvement of various inflammatory mediators; or neuropathic pain caused by a primary lesion in the nervous system. Irritation neuropathic nerve fibers can lead to 2 possibilities. Firstly, emphasis only occurs in the nerve -rich membrane wrapping nociceptors , from nervi nevorum painful inflammation . Pain is felt along the nerve fibers and nerve fibers increased with stretching , for example due to movement.  The second possibility, the emphasis of the nerve fibers. In this condition there is a change in which the accumulation of biomolecular ion channel Na and other ions. This buildup causes the onset of mechano-hot spots are very sensitive to mechanical and thermal stimuli . This is the basis Laseque examination.