A slim case of sciatica

Eighteen months ago, Mr J.R., a middle-aged truck driver, came to me with mysterious pains in his lower back and right thigh that had started more than three years earlier. He’d undergone MRI (magnetic resonance imaging) investigations to check the integrity of his intervertebral discs, but his doctors had drawn a blank.

A small army of orthopaedic surgeons, chiropractors, physiotherapists and osteopaths hadn’t been able to provide him with any lasting help, either.

I suspected that here was an example of short-leg syndrome, as even a discrepancy of only 5 mm in leg lengths can result, over time, in pain. When one leg is shorter than the other and the pelvic position is not absolutely horizontal, this, in turn, can affect the spine, even when the body weight is distributed equally between the two legs. The pelvic lopsidedness eventually leads to a lateral (sideways) shift of the spine as it moves away from the central gravity line to compensate for the loss of balance. It’s been well accepted for more than half a century that pelvic tilt is a cause of backache resulting from ligament problems as well as a cause of referred pain (Stoddard A. The short leg and low backache syndrome. Presentation at the International Congress of Physical Medicine, London, 1952).

Such lateral asymmetry may also stem from the feet. Faults in the structure of the feet and/or footwear frequently give rise to mechanical problems higher up the body.

Nevertheless, there was nothing untoward affecting Mr J.R.’s feet, and the usual clinical signs of a short-leg syndrome – the uneven relative positions of the gluteal folds, the dimples above the buttocks, the iliac crests (the uppermost ‘wings’ of the pelvic bone) and the creases behind the knees – were absent. Also, when a patient who has a short leg walks, the head rises and falls unevenly, sinking lower when weight is carried on the shorter leg – and this was not the case with J.R. For these reasons, I decided not to bother measuring his leg lengths, as I knew there wouldn’t be any discrepancy.

Instead, I quizzed him about his lifestyle and his job. I discovered that he was a jeans-wearing international truck driver who spent much of his day sitting behind the wheel of his truck. He ate an unremarkable diet at roadside eateries and drank hardly any alcohol. Nothing unusual there, then.

However, I did notice that he had a wallet, which was about 2-cm thick, bulging with credit cards, stuck in the back pocket of his jeans so that he was sitting on it. In answer to my question, he told me that he always carried this wallet in that back pocket, which meant that he always sat on it, because it was the safest possible place – certainly safer than in a jacket pocket.

This meant that, for all the hours he spent driving his truck, his pelvic bone was tilted. Added to this was the constant vibration from the moving truck that would certainly exacerbate the effects on his spine. The result was as though he had a short left leg. Similar problems have been reported in the literature, too (JAMA, 1978; 240: 738).

J.R.’s ‘credit-card sciatica’ was cured by a ‘walletectomy’ – and he has remained cured ever since.

Needless to say, I was pleased to have been able to help him by emptying his pocket for him.

Harald Gaier

Harald Gaier is a registered naturopath, osteopath, homoeopath and herbalist. He can be contacted at The Diagnostic Clinic, London, tel: 020 7009 4650

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Written by What Doctors Don't Tell You

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