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. Its 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 pregnancy 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 (i.e. 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 complaints of pain. Some initial stretches and strengthening exercises can help take pressure off the low back and leg to decrease sciatic pain.
Do not perform exercises without the guidance of a healthcare professional if they increase pain or cause 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.
What can a Physical Therapist do for me?
Your physical therapist is a great resource to stop sciatic pain in its tracks! Rebekah will be able to provide you with a comprehensive evaluation to help determine the root cause of your sciatic pain. During your evaluation, she 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. function. You can read more about dry needling at Rebekah's PT Posts here.
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.
Have more questions? Call or text Rebekah at 513.204.9071 or book your appointment at TerraLuna via her schedule here Rebekah is ready to help guide you down the right path to help you perform better, live better, and 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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