Sciatica
What Is Sciatica?
In your lumbar spine (lower back), you have two large nerves exiting on the right and left sides of your spinal column. These nerves, called the sciatic nerves, are the largest in your body and provide motor and sensory input to your legs. Several different nerve roots join together to form the sciatic nerves, which then divide and branch as they travel into the legs.
With sciatica, something irritates and compresses one of these nerves near the spine, leading to inflammation and tissue damage (along with a variety of symptoms, which we’ll discuss shortly). Sciatica can also be referred to as lumbar radiculopathy (with radiculopathy being a general term to describe spinal nerve impingement).
What’s compressing the sciatic nerve in the first place? Often it’s an injured spinal disc. When a disc ruptures and leaks (herniates) or protrudes out of place (bulges), it can press on the nearby nerve. This may happen due to wear and tear, acute trauma, or chronic repetitive stress on the disc.
The presence of another underlying condition can cause compression of the sciatic nerve as well, which includes:
- Degenerative disc disease: progressive thinning and breaking down of the spinal discs due to age-related wear and tear
- Stenosis: progressive narrowing of the spaces through which the spinal cord and nerves travel
- Osteoarthritis: inflammation of spinal joints, which also leads to joint space narrowing
These conditions can lead to generalized low back pain with or without nerve impingement.
More rarely, sciatica can be caused by bony tumors. A more distal portion of the sciatic nerve can also be compressed by a muscle in the hip called the piriformis, in a similar yet unique condition aptly known as piriformis syndrome.
Symptoms of Sciatica
Though the sciatic nerves originate in the lower spine, it’s not uncommon for some people experiencing sciatica to have no back pain at all! Instead, their symptoms primarily follow the motor and sensory distribution pattern of the nerves as they travel into the right or left leg. These symptoms may include:
- Pain that radiates into the buttocks, back of the leg, and sometimes the foot (sciatica pain often feels sharp, numb, burning, stabbing or shooting)
- Numbness and tingling in the leg
- Weakness in the leg
- Decreased reflexes in the leg
Other symptoms can include spinal muscle spasms and tenderness, back stiffness, decreased tolerance to exercise, and decreased range of motion in the hips. A person’s sciatica pain may be worse first thing in the morning or after prolonged bouts of sitting or standing.
How Physical Therapy Can Diagnose & Manage Sciatica
Robust research has proven that physical therapy is effective for those who suffer from sciatica pain. It’s safe, cost-effective, drug-free, and non-invasive, and recommended by professional organizations including the Centers for Disease Control and Prevention (CDC). Physical therapy treatment can even reduce the need for pain medications and expensive imaging studies like MRIs and X-rays!
When a physical therapist works with you for relief from your sciatica pain, the main goal will be to reduce your symptoms and alleviate the pressure on the sciatic nerve so that your symptom relief is longer lasting. Additional goals will be to heal the injured tissues, reduce inflammation, improve core stability and strength, restore function, and ultimately get you on a sustainable exercise program to help you maintain your outcomes.
In order to achieve these objectives, your sciatica plan of care may include:
- Manual therapy, including massage, active release technique (ART) and spinal traction
- Non-invasive modalities, including cold laser therapy, electrical stimulation, diathermy, and therapeutic ultrasound
- Aquatic therapy
- Dry needling
- Therapeutic exercises, stretches, and evidence-based core stabilization protocols (this means scientific studies have been done to vet the exercises’ effectiveness)