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Sciatica... More Than Just a Pain In Your Butt

Approximately three million people annually complain of pain from their low back or hip that radiates down the leg. Pain that radiates from the back or hip and down the back of the leg past the knee, and sometimes into the foot, is commonly referred to as “sciatica”. Sciatica typically affects only one leg, but can radiate down both legs. The term sciatica refers to the irritation of the sciatic nerve which is the longest and thickest nerve in the body. The sciatic nerve originates from numerous levels in the spine and innervates many muscles. Thus, irritation to this nerve can be a major source of pain.


What causes sciatica?

In roughly 85-90% of cases of sciatica, the cause is a disc herniation in the low back. This can cause pressure on the nerve root and pain radiating to the leg down the path of that nerve. Arthritis in the spine can also lead to bone spurs or narrowing of the joint space and in turn irritation of the sciatic nerve.


Piriformis syndrome is another cause of sciatic pain. The piriformis muscle is located in the buttocks. It’s action is to rotate the hip and move the leg out to the side. This muscle can become tight or spasmed putting pressure on the sciatic nerve that runs underneath (or sometimes pierces through) the piriformis muscle.


Who is affected?

Sciatica can affect anyone and does not appear to have gender bias. Sciatica is most commonly seen in people in their 40s, and rarely seen in individuals younger than 20 years of age, unless there is a history of traumatic injury. Sciatica is also common in pregnant females as there is an increase in hormones causing joint laxity and increased strain on the low back and pelvis. This increased strain can lend to sciatic nerve irritation and radiation of symptoms to the leg. Other factors that can increase your risk of sciatica are increased body weight, core or hip weakness, jobs that require demanding positions/lifting, and previous injury.


What are the symptoms?

Sciatic pain is usually worse in the leg versus the back and is described as aching, burning or tingling pain that travels down the backside of the leg. It can range from constant pain to intermittent pain. The discomfort can also be described as numbness into the leg, foot or toes. The pain is usually moderate to severe and is either aggravated by increased activity or lack of mobility (ie prolonged sitting in the car). In more severe cases loss of muscle strength of the leg can be noted.


What can I do about it?

The good news is that for most cases of sciatica the symptoms can be remedied in 4-8 weeks. Within the first 6-8 weeks of symptoms, conservative management is the first line of treatment. This includes activity modification, physical therapy, stretching, strengthening of leg and core muscles, hands on techniques to improve joint and tissue mobility and use of hot and cold therapy to decrease complaint of pain. Some initial stretches and strengthening exercise can help take pressure off the low back and leg to decrease sciatica pain. Do not perform these exercises if they increase pain or aggravation of your symptoms. If you are experiencing more severe symptoms like leg muscle weakness or changes in control in bowel or bladder function contact your physician for treatment prior to starting exercises on your own.




Hamstring stretch:

Sit in chair with right leg stretched out in front of you propped on foot stool. Keeping knee straight and back upright, lean chest forward without rounding back until stretch is felt in the back of your right leg. Then repeat on left leg.










Gastroc stretch:

The gastrocnemius is a muscle that points the foot away from leg and aids in bending the knee. To stretch this muscle stagger the right leg behind left, toes facing forward and heel firmly on the ground with the knee straight. Place hands on wall and shift weight forward until the stretch is felt in the lower right leg without lifting the heel off the ground. Repeat on left leg.










Figure 4 piriformis stretch:

Sit in chair and cross right leg over left in figure 4 pattern and back up tall. Press knee down gently (without pain) with right hand, while leaning chest forward until stretch is felt in right hip/buttock. Repeat on left leg.






LTR:

Lie flat on your back with your knees bent and feet on the ground, gently take both knees to the right side until stretch is felt. Make sure to keep your shoulders flat on the ground. Repeat to left.











Hip ABD with band:

Lie flat on your back with your knees bent and feet on the ground. Tie a band around thighs, just above knees. Slowly take knees apart, stretching band apart as far as you can without lifting hips off floor. Slowly return knees together without letting the band bring your knees together too quickly. Focus is on control of the movement.






Hip ADD with ball:

Lie flat on your back with knees bent and feet on ground, place medium ball or rolled up blanket/towel between

your knees. Gently squeeze knees together putting pressure on ball/blanket/towel roll. Hold for 3-5 seconds then release pressure without letting ball/blanket drop to floor.






What can my Physical Therapist do for me?

Your physical therapist is a great resource to stop sciatic pain in its tracks! Your physical therapist will be able to provide you with a comprehensive evaluation to help determine the root cause of your sciatic pain. During your evaluation, your therapist will provide an individualized treatment plan to combat pain and restore normal musculoskeletal function. Hands on treatment, including soft tissue mobilization to improve tissue mobility and decrease pain, can help to restore pain free motion. Dry needling is another technique which may be utilized. This includes the use of a fine filament needle that is inserted into tight or spasmed tissue to improve mobility and promote healing in order to decrease pain. Once normal joint and tissue mobility is restored, it is important to strengthen your core and leg muscles as well as correct any impaired lifting or movement mechanics. Corrective exercises included in your physical therapy plan can help prevent injury in the future and keep you performing and living better.


Call us TODAY at Dynamic Physical Therapy and Wellness for your assessment to help you Perform Better, Live Better, Get Better!


References:


Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/


Jean-Pierre Valat, Stéphane Genevay, Marc Marty, Sylvie Rozenberg, Bart Koes. Sciatica. Best Practice & Research Clinical Rheumatology, Volume 24, Issue 2, 2010,

Pages 241-252, ISSN 1521-6942, https://doi.org/10.1016/j.berh.2009.11.005.

(http://www.sciencedirect.com/science/article/pii/S1521694209001417)


Al-Khodairy, AW.T., Bovay, P. & Gobelet, C. Sciatica in the female patient: anatomical considerations, aetiology and review of the literature. Eur Spine J 16, 721–731 (2007). https://doi.org/10.1007/s00586-006-0074-3



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