Changing Concept of Sciatica: A Historical Overview

Low back pain and sciatica have been considered as the common morbidities of human kind throughout the history. The explanation of the etiology has been changed during the centuries and still remains a dilemma. Reviewing ancient theories may lead to novel findings about the etiology and its better treatments. First writings about sciatica: among available iranian traditional medicine (ITM) books, the oldest writing about sciatica syndrome was found in " Adab al-Tabib, " a book on medical ethics in the 2nd century AH (719 Ad-816 AD). In this book, sciatica is mentioned as a chronic and poor prognosis disease, which agitates the physicians. The oldest textbook discussing sciatica is "Ferdos-al-Hekmah," a medical book by Ali ibn Sahl Rabban al-Tabari lived in 260 AH (9th century AD). He described the etiol-ogy, risk factors (individual, environmental, sexuality), and therapies (medical and manual) for this disease. One of the complex drugs formulated in this book is attributed to Masarjawaih, a Jewish physician in 1st century AH (7th century AD) (1). After Tabari, Rhazes (865 AD-925 AD) described sciatica in one exclusive chapter of his comprehensive textbook on medicine; Al Havi (Liber Continent). He cited the former physicians' ideas like Ibn Masouyeh (857 AD) besides his own idea and practices about this disease (2). Definition, etiology, and treatments of sciatica were explained in the most Persian and Arabic medical books until 14th century AH (19th century AD) like " al-harooniah treatise, " " Golden treatis, " " Kāmil al-Sinaā al TibbiyaKāmil al-Sinaā al Tibbiya " Mansuri-fi-Teb, Qanun fi al-Teb (Canon) (3), " Zakhireye Kharazmshahi " (4), " Shar-hol asbab, " " Taqwim al-abdan " (5), " Kaholasa al-Hikmah, " " Exir Azam " etc. All authors expressed the same main idea, which has gradually expanded with more comprehensive explanations. Persian medicine perspective on sciatica: in ITM books, this problem is called "Ergho Nasaa" which means the pain in "Nasaa" (Noosa, according to Galen) vein pathway in the lower limb. "Ergho Nasaa" has been translated to sciatic and the pain in its location to sciatalgia. However, "Nasaa" refers to a vein, so "Ergho Nasaa" points to the disorder in the pathway of this vein, but nowadays "sci-atic" is the name of a specific nerve not vein and sciatalgia refers to pain due to sciatic nerve problems. Despite the misnomer, description of sciatalgia and "Ergho Nasaa" are almost the same. ITM, like other Humorism systems of …