A simple guide to a common problem. We cover the sciatic nerve anatomy, elated pain, and physical therapy treatments proven to relieve sciatica.
Sciatica is a term used to describe pain along the sciatic nerve. The Sciatic nerve is made up of five nerve roots; two at the lumbar spine (lower back) and three at the sacrum (lowermost part of the spine). These nerve groups combine to make up the left and right sciatic nerve.
What does Sciatica feel like?Pain is normally one of the first symptoms a person suffering from sciatica experiences. This pain can either be constant or intermittent down one leg( although both legs can experience this pain). The most common symptom of sciatica is a sharp, burning feeling. Other sciatica symptoms include:
- Electric shock-like, shooting pain
- Numbness and tingling feeling at the back of the leg
- Throbbing or pulsating pain
- Dull aching feeling
- Discomfort that comes or goes
- Weakness at the lower back, leg, or foot
What causes Sciatica?Some of the most common reasons for the onset of sciatica include:
- Herniated or Slipped Disk that puts pressure onto the nerve roots. The Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/12792-sciatica) estimates that about 1% to 5% of people will experience a slipped disk at some point in their lives. When too much pressure is applied to the vertebrae of the spine, it can “push” out a disk causing it to bulge( herniate). A herniated disk along the lower portion of the spine can put pressure on the sciatic nerve.
- Degeneration (https://www.spine-health.com/conditions/sciatica/sciatica-causes) of the tissues along the lumbar spine, facet joints, and the actual vertebral bone can all cause pressure to the sciatic nerve through compression and inflammation.
- Spinal Stenosis is the actual narrowing of the spinal canal (the passageway where your sciatic nerve runs through). Spinal Stenosis is most common for people over the age of 60, resulting in pinching of the sciatic nerve.
- Spondylolisthesis occurs when one vertebra slips out of line with the vertebrae above it. A good example of this is when the L5 vertebra slips forward over the S1 vertebra, causing sciatic nerve compression. Spondylolisthesis is most common with young adults and can result in pain along the right and left sciatic nerves.
- Osteoarthritis and the bone spurs (jagged edges of bone) that develop with age can also compress the sciatic nerve.
What are the treatment options for sciatica?Most often, patients experiencing acute or chronic sciatica will receive nonsurgical treatments by their primary care physician or spine doctor. Nonsurgical treatments for sciatica often include rest, physical therapy, medications, or therapeutic injections. Physical Therapy can be one of the most beneficial treatments for sciatic pain. Combining pain management techniques with flexibility and strengthening exercises can be a long term solution for patients to:
- Restore pain-free functional movements
- Relieve lower back, buttock, thigh, and leg pain
- Reduce muscle spasms
- Improve lower body mobility
- Promote a better soft tissue healing environment for the lower back
- Prevent future flare-ups
- Restore function of the lumbar spine and sacroiliac joint
What should I expect when going to physical therapy for Sciatica?If you have received a referral for physical therapy to treat your sciatica, the first step would be to undergo an initial evaluation with a licensed Doctor of Physical Therapy. This first appointment serves to provide your therapist with a baseline knowledge of your current condition. Your physical therapist will use this time to learn about your specific sciatic symptoms, past medical history, lab tests (MRI or X-rays), lifestyle habits, and short/long-term goals. Your therapist will also test specific functional movements such as range of motion, flexibility, posture, and reflexes. From there your therapist will craft a therapeutic program designed to reach your goals based on the results found from the initial evaluation. A typical sciatica treatment program will consist of passive and active techniques. Depending on the severity of symptoms, your physical therapist will progress these techniques as required. Passive techniques for sciatic nerve pain serve to help patients with promoting blood flow, reduce muscle spasms, and decrease pain. The passive portion of a sciatica treatment program can consist of modalities such as:
- Hot/Cold packs
- Manual Therapy
- Transcutaneous Electric Nerve Stimulation (TENS unit)
- Neuromuscular Electric Muscle Stimulation.
- McKenzie Method
- Abdominal and Back Exercises
- Abdominal and Back Stabilization
- Hip Mobilization
- Functional stretching of the hamstrings, quadriceps, and deep lower back muscles