By Amelia Son, PTA
What Is Sciatica?
The quick answer is Sciatica is pain that radiates into buttock and down the leg. However, it must be understood that Sciatica can be resultant from many different things. The sciatic neve becomes irritated or pinched and the symptoms can be very painful. To learn more, you can also read this article on sciatica and severe low back pain.
Sciatica is a term used to describe pain radiating down the leg that may or may not include low back pain. The leg pain is caused by an irritation of the sciatic nerve. The question becomes what is causing the irritation of the sciatic nerve. The sciatic nerve is most commonly irritated by a disc bulge or ruptured disc (also called a herniated disc), degenerative disc disease, degenerative joint disease (which may lead to arthritic changes),
Common Causes of Sacro-iliac Joint Dysfunction
Sacro-iliac joint dysfunction, or a combination of these problems. Another less common cause of sciatica is
spondylolithesis. Spondylothesis is the slipping of a vertebrae caused by a fracture of the vertebrae which may be acquired or
congenital (from birth). Once the cause is determined, then an effective course of treatment can begin. Not everyone with pain
down the leg is necessarily treated in the same way. Initially, a person should see their physician who may take a history, perform an examination and possibly obtain x-rays to rule out serious pathologies and determine a diagnosis. An MRI is an expensive test that is not always considered necessary when determining a diagnosis; however, may be used if further testing is needed.
A dysfunction of the sacro-iliac joint may also cause the symptoms of sciatica. A malalignment of the sacro-iliac joint, which often occurs after a fall or during pregnancy (due to ligamentous laxity), may cause the piriformis muscle to become tight. The piriformis is a muscle that goes across the buttock and attaches to the outside of the hip. When the piriformis muscle becomes tight it may also put pressure on the sciatic nerve which runs in close proximity with it.
A malalignment of the sacro-iliac joint may present with pain in the buttock, hip, groin, thigh (front, side, or back) and/or the inside or outside of the knee. To correct the alignment of the sacro-iliac joint, the P.T. may perform manual joint mobilizations or instruct you in self-mobilizations. Deep tissue massage may also be used to restore proper muscle tone and flexibility to muscles that have been irritated.
Once the acute phase has been calmed down or the sacro-iliac joint alignment has been corrected, it is time to begin core stabilization exercises. You may have been instructed in some exercises along the way; however, strict attention needs to be placed on these exercises to return your normal strength and flexibility as well as emphasize stabilization of the lumbar spine. Restoring normal strength and flexibility, learning to stabilize the spine and using good posture and body mechanics will enable you to maintain a healthy back and prevent further injury or reoccurrence of back pain or sciatica.
How Does It Occur?
The sciatic nerve is formed by spinal nerve roots stemming from the L4 to S3 vertebra. It is a large and bulky nerve that eventually exits the pelvis and runs down the back of the thigh, eventually making it down to the foot. Sciatica originates from the lower back and is caused by compression and/or irritation of the sciatic nerve.
What Are The Symptoms of Sciatica?
Sciatica has many symptoms that are common and patients can have one or more of the following:
- Pain: It is usually a burning or shooting pain that can either be constant or intermittent. The pain originates in the lower back or buttock and can run down the front or back of the leg and even reach the feet.
- One Side or the Other: Sciatica usually affects one leg at a time, but in rare cases can affect both.
- Numbness: Another symptom of sciatica is numbness and tingling down the leg. The numbness and tingling can travel down in the thigh and can also be felt as low as the foot. With the numbness and tingling, some patients have a feeling of weakness that can affect their daily lives.
- Posture: Some people struggle with different postures with regard to sciatic pain. While some may feel relief from standing, others may not and may prefer to sit. Others feel pain when bending over, twisting, and even lying down. Some relief has been known to occur while staying in motion like walking, but once stopped and standing still, symptoms may resume.
What Are The Causes of Sciatica?
There can be many causes of sciatica. Some are more serious than others and may require intervention. The following are common causes for sciatica:
- Lumbar Spinal Stenosis: A constriction of the space used for the nerves to exit the spinal cord and reach their designated space in the body
- Lumbar Degenerative Disc Disease: When the discs between vertebrae are damaged and/or degenerating causing back and/or radiating pain.
- Muscle Spasm: A muscles normal protective mechanism to avoid overstretching and injury. Most spasms usually clear up on their own, but if they do not, it is best to seek out medical attention to make sure it is not a serious issue.
- Herniated Lumbar Disc: When the jelly-like center of a disc pushes through the weaker outer layers and places pressure on nerves
- Spondylolisthesis: A spinal defect that causes the vertebra to become unaligned in the spine and slip to one side or the other. This can usually cause back and/or leg pain in a patient.
- Sacroiliac Joint Dysfunction: When there is the improper movement of joints between the spine, sacrum, and pelvis. This can cause inflammation in the joints as well as pain in the lower back and down the legs.
Treatment for Sciatica
Often the physician will choose to take a conservative course of treatment. Including medicines to decrease inflammation, relax muscle tightness and decrease pain during the acute stages. The physician may also opt to send you to see a physical therapist. The physical therapist (P.T.) will also perform an evaluation. This is to help determine or reinforce previous findings as to the cause of the sciatica. The P.T. will also assess your back and leg range of motion, flexibility and strength. They will address deficits found in these areas. If you have been diagnosed with a disc bulge or ruptured disc, degenerative disc disease or degenerative joint disease, physical therapy will not eliminate the degenerative changes.
Instead, you will be taught how to protect your back. Instructions on how to correct your body mechanics to allow the body to heal itself. How to decrease the irritation and inflammation causing the pain. If the onset of pain is recent or acute and you have pain, inflammation and/or muscle tightness, your P.T. may choose to begin your treatment with modalities such as moist heat, ultrasound, or electrical stimulation.
Modalities are generally used to control the level of pain during the treatment; however, by themselves, they do little to correct the problem causing the pain. The program will include flexibility, manual therapy, modalities and strengthening exercises. The goal would be to decrease the inflammation around the sciatic nerve and improve the range of motion. Our therapists work closely with our physicians to design a treatment program with the best outcomes in our area.
Home Remedies for Sciatica
Often, patients ask us what can we do at home for sciatica? The best thing that you can do to help with your treatment is to avoid activities and positions that irritate or cause pain. Other home remedies are:
- Ice or Heat
- Over-the-counter medications like Tylenol or Advil
- Rice bags which heat in the microwave
- Voltaren Gel or Analgesic Creams
- SI Belts or lumbar belts
- Mild Stretching
Sciatica is not something to take lightly, although some light stretching can often help with symptoms, it is best to get a professional opinion to discover what is the underlying cause of sciatic pain being experienced. Here at Jacksonville Orthopaedic Institute, we have multiple spine surgeons that can help discover the root of the pain. You can all 904 JOI-2000, schedule online, or click below.
By: Ehren Allen, PT