Sciatica
Condition Overview
Sciatica describes pain that originates in the low back and radiates down the buttock, back of the thigh and into the lower leg, following the pathway of the sciatic nerve. Symptoms of sciatica include burning, shooting, stabbing, numbness, and weakness in any or all of these areas. This pain may be constant or may come and go and typically worsens with prolonged standing, sitting, or sudden movements.
What Causes Sciatica?
Disc Herniations: this is the most common culprit for sciatica pain. There are a variety of types of herniated discs and each can cause irritation to the nerves in the low back. PT may be an optimal place to start if you feel sciatic pain that you think may have been caused by a disc herniation.
Piriformis Syndrome: this does not originate in the spine, but the sciatic nerve runs through the piriformis. The piriformis muscle is a deep hip rotator and is closely connected to the pelvic floor - if there is tension or weakness in the pelvic floor or your deep hip rotators this can cause sciatic pain.
Degenerative disk disease (DDD): this is the natural shortening of the vertebrae that can cause a narrow pathway for nerves to exit the spinal cord leading to irritation. Research shows many people have DDD asymptomatically.
Spondylolisthesis: this is when one vertebrae moves forward or backward on another again narrowing the pathway for which the nerve exits.
Osteoarthritis (OA): this is more typical in older adults, but OA can form bone spurs and compress lower back nerves.
What is the Treatment for Sciatica?
In physical therapy, we will perform a thorough low back, hip, and muscle assessment. We will assess your joint range of motion, muscle strength, functional mobility and body mechanics, and nerve length and irritability.
If you are having adjunctive pelvic floor symptoms, we can, with consent, perform an internal assessment but this may not be necessary depending on how your symptoms present.
From our findings we will set-up a treatment plan depending on the individual characteristics of your pain and external factors such as work related duties, home life, exercise regimen, and goals.
Unfortunately, there is no quick fix for sciatic pain, but in PT we will generally provide an exercise routine that looks into trunk strengthening, nerve glides, and repeated movements (McKenzie Method).
A lot of therapists and physicians will claim the goal of these exercises is to improve core stability, un-trap the nerve, or push disc material back into place. These things may be side effects but the real goal is to improve your function and reduce your pain so you can do the things you love!
We may also perform manual treatment to reduce pain, improve tissue mobility, and get you moving better - these treatments may include dry needling, myofascial release, and cupping.
With each session we will progress as able and learn new activities to include in your daily routine to manage and prevent worsening symptoms!