Sciatica Treatment & Therapy
What Is Sciatica?
Sciatica is an umbrella term that is used to describe symptoms of leg pain, tingling, numbness, or weakness that radiates down from the low back and affects the sciatic nerve in the back of the leg. Sciatica is more of a description of the symptoms, rather than a back injury that is causing the pain (the diagnosis) – which can vary. The good news is we have achieved great success with proper sciatica treatment through physical therapy.
Following are the diagnoses that can cause sciatic symptoms (read on about the nature of the diagnoses):
- A lumbar disk herniation
- Spinal stenosis
- Degenerative disc disease
Sciatica Symptoms and Presentation
Patients who suffer from sciatica usually have one or a combination of the following symptoms:
- Pain that originates in the low back or buttock and then radiates down along the sciatic nerve distribution: down the back of the thigh and sometimes to the calf and foot
- Pain that is aggravated sitting
- Leg pain characterized by burning, sharp shooting pain, numbness, tingling, shooting or aching
- Weakness in moving the leg or foot
- Low back pain may be present as well, but patients typically complain that the leg pain is more severe in intensity than the low back pain.
- Pain is alleviated with lying down or walking but aggravated by prolonged standing or sitting
Sciatic pain can vary in intensity: it can be infrequent but irritating, or it can be constant and debilitating. The reason for this variability is because the diagnosis causing it can vary in both location and severity. Though sciatica can be very intense, it is rare for sciatic nerve damage to be permanent.
Folks who suffer from sciatica tend to be in their middle ages, and rarely occur before the age of 20. Sciatica is gradual in onset and tends to develop over time, rather being attributed to one injury or one event.
A vast majority of patients who experience sciatica recover within a few weeks to a few months with non-surgical treatment. Because the causes are different, sciatica treatment is focused on solving the underlying cause of nerve impingement, such as stenosis or a herniated disc. In severe cases where physical therapy and conservative sciatica treatment is not helping to abate symptoms, surgery may be indicated.
When To Seek Immediate Medical Attention
Though rare, if sciatica symptoms worsen very quickly, seek medical attention for surgery may be indicated. Following are times when interception by a physician or a surgeon is necessary:
- Sciatic nerve symptoms continue to worsen and cannot be relieved. Typically, nerve pain travels further down the leg and may encompass more nerve-like symptoms, such as more intense numbness and weakness.
- Symptoms occur in both legs
- Loss of voluntary bowel or bladder function may indicate cauda equina syndrome and means that there is impingement of the vulnerable nerve roots that control bowel and bladder function. This may cause permanent paralysis so immediate medical attention is necessary. The incidence of cauda equina is about 2% of patients suffering from lumbar disc herniations.
The Sciatic Nerve
Sciatica symptoms are a result of impingement, or compression, of the sciatic nerve. The sciatic nerve is the largest nerve in the body and is comprised of connected individual nerve roots stemming from the spinal cord in the back. The sciatic nerve runs from the posterior hip down through the buttock and then down the back of each leg. Further down the chain, the sciatic nerve then branches out to each leg and separates into the tibial nerve and common fibular nerve to innervate the calf, foot and toes.
Specific sciatica symptoms large depend there the impingement of the nerve is. For example, if an L5 nerve root is being pinched (a nerve originating from the spinal cord at the level of L5), weakness in the ankle and the big toe may ensue.
The common causes of sciatica
There are 6 lumbar problems that cause sciatica:
Lumbar Disc Herniation
A lumbar disc herniation occurs when the soft nucleus of an intervertebral disc pushes out of the disc’s outer annulus fibers, herniates, and compresses a lumbar nerve root. The result is inflammation and pain, along with nerve symptoms like numbness, tingling, burning and shooting.
Degenerative disc disease
Disc degeneration is a very normal process of disc dessication that happens with aging. The annulus fibers of the disc wears down and the resultant inflammatory proteins inside the disc irritates the nerve root that lives near the disc.
This condition happens when there is a small stress fracture in the pars articularis, a small bridge of bone that connects facet joints of one vertebra above to the one below. This fracture may cause the vertebra to slip forward and the result is disc space collapse and the nerve in the area of the vertebral slippage can cause sciatica.
Lumbar spinal stenosis
This is characterized by narrowing of space where nerve travel. There is a foraminal stenosis, which is a narrowing of the nerve root space, or there is central stenosis where the spinal canal is narrowed due to old age. Stenosis is can be caused by enlarged facet joints and degenerative discs.
The sciatic nerve passes under, and sometimes through, the piriformis muscle in the buttock region. If the piriformis muscle is tight and pinches down on the sciatic nerve, it can cause sciatica.
Sacroiliac joint dysfunction
Irritation of the sacroiliac joint – between the sacrum and the pelvis bone – can irritate the L5 nerve that is located near the top of the SI joint, and cause sciatic pain.
Physical Therapy and Sciatica
The purpose of sciatica physical therapy is to address the underlying causes of the pain. A controlled and progressive exercise program is often prescribed by a physical therapist to decrease irritation of the nerve root and the sciatic nerve.
The initial phases of sciatica treatment involve decreasing the symptoms of pain through stretching of tight tissue and joints, and soft tissue mobilization and joint mobilization to relieve impingement of the nerve.
For causes that are discal in origin, strengthening and posture re-education is very important in reducing skeletal compression of the nerve root. Activity modification and movement modification can help quite a lot in reducing the incidences of the nerve root being pinched. Such as in the case of central stenosis, for example, teaching the patient to avoid movements of lumbar extension (bending backwards) can help decrease the frequency of nerve pinching.
For instances when a joint is compressing on the sciatic nerve or one of the lumbar nerve roots, joint mobilization is necessary to free up the space to let the nerve move. This is done very effectively for patients who have SI joint dysfunction or facet stenosis.
Exercise therapy plays a big part in relieving sciatic pain – in fact bed rest is the worst type of therapy for treating low back pain and sciatica. For without exercise and movement, back muscles will become even more deconditioned and cause further pain. Active exercise is important for the health of spinal discs and vertebral segments and their joints. Movement of the spine allows for freedom of motion and promotion of vertebral flexibility. Sciatica treatment must include movement to help with circulation and nutrient exchange that help keep discs healthy and decrease inflammation.
The fundamentals of exercise therapy is to address core muscles strength. Strengthening of the abdominal, back and gluteal muscles will help provide more support to the spinal column as we perform our daily activities. Strengthening of these muscles also help bolster our posture and allow us to stand and sit with healthier postures for longer. Good, proper posture helps our spines recover faster and reduce the progression of causes for sciatic pain.
The largest benefit from going to physical therapy for sciatic nerve pain has to do with properly diagnosing and treating the exact cause of it. Performing the wrong type of exercise or movement can worsen sciatic pain, so it is important to have your joints, muscles and spine analyzed by a physician and a physical therapist. Please contact one of our Physical Therapy Clinics in Portland and have one of our therapist relieve your sciatic paint today!