A 97-year-old man presents with pain and weakness in the back of his thigh after wrestling with an angel the night before. At some point in the match, he sustained a traumatic injury and is now walking with a limp.

Sound familiar?

It was explained in the Midrash, and further popularized by Maimonides, that “everything that happened to the patriarchs is a sign for the children.” Many of Jacob’s experiences foreshadowed future events in the lives of the Jewish people. Unfortunately, that includes sciatica.

The term “sciatica” is often used casually to describe back or leg pain, but in clinical practice, I find that it’s not well understood. In reality, sciatica refers to a specific kind of nerve pain, and the chances are that someone you know has dealt with it.

Back pain is a leading cause of disability worldwide. About 80% of people will experience back pain at some point in their lives, and up to 40% will experience true sciatica, which involves radiating pain along the path of the sciatic nerve.

It affects everyone—grade-school children lugging heavy backpacks, teenagers on the JV team, new mothers, plumbers, accountants, yoga instructors, and yes, even Rummikub enthusiasts. Pain doesn’t discriminate.

But back to Jacob. Didn’t he injure his hip? Is sciatica caused by the back or the hip? Let’s take a closer look at Genesis 32:25–29:

“And Jacob was left alone, and a man wrestled with him until the break of dawn. When he saw that he could not prevail against him, he touched the socket of his hip; and the socket of Jacob’s hip became dislocated as he wrestled with him… And he said, ‘Your name shall no longer be Jacob, but Israel, because you have struggled with God and with men and have prevailed.’”

I was taught in medical school that patients don’t walk into the room with Post-it notes on their foreheads telling you what’s wrong. But Jacob may be the exception—his injury comes with a divinely transmitted history of present illness.

Based on the text, it appears that Jacob suffered a posterior hip dislocation—a traumatic event that could injure the sciatic nerve directly. But even so, if Jacob walked into my clinic today, I’d still want an MRI of his lumbar spine.

Why? Because the sciatic nerve is formed by contributions from the L4, L5 (lumbar) and S1-S3 (sacral) nerve roots. Irritation can occur at the spine level before the nerve even forms. Alternatively, the nerve can be injured farther downstream—at the buttock, hip or thigh.

The symptoms can be nearly identical: pain or discomfort in the back, buttock, thigh or foot. Weakness might show up in the thigh, lower leg, or foot muscles. That’s why a precise diagnosis is essential.

If Jacob were my patient, I’d begin with a detailed history and physical exam. Then I’d likely order imaging—X-rays and MRIs of both the hip and lumbar spine. Even though we know he dislocated his hip, I wouldn’t want to miss a possible spinal component. Of course, not every patient needs both; each case is different, and imaging decisions depend on the clinical picture.

To get even more specific, I’d perform an EMG (electromyography)—a test that provides detailed information about nerve function. It helps localize the injury, determine whether it’s coming from the spine or the peripheral nerve, and assess the severity.

At Kayal Orthopaedic Center, I work closely with fellowship-trained orthopedic surgeons who specialize in both hip and spine surgery. For urgent cases, I coordinate same-day consultations when appropriate. The patient stays in the examination room, and a subspecialized orthopedist will come evaluate safety and potential surgical necessity.

My own board certifications are in interventional pain management and physical medicine and rehabilitation. I treat sciatic pain using minimally invasive, image-guided procedures. Depending on where the injury lies, treatment might include an epidural steroid injection via the lumbar interlaminar, lumbar transforaminal, sacral transforaminal, or caudal approach.

In this column, we’ll continue to explore common but often misunderstood pain conditions affecting the neck, back and joints. If there’s a pain topic you’d like me to cover, feel free to email me at [email protected]. And if you or someone you know needs a personal evaluation, I’d be happy to meet in one of our many offices throughout Bergen, Rockland and Hudson Counties.

After all, not everyone wrestles with angels—but many of us wrestle with back pain.