What Do I Do For Sciatica?

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What is sciatica?

Sciatica is a term used by medical professionals and the general public alike to describe pain that radiates down the leg. Let’s dive into a bit more detail on the definition, the causes, and how it can be diagnosed. Sciatica is defined by the Journal of the American Medical Association (JAMA) as “the term for low back pain that radiates into the buttock, hip, and down one leg to the foot. The pain often is associated with tingling, numbness, or weakness of the leg.”1

Sciatica and Pelvic Diagram

In the human body, nerves are the conduit for all information traveling back and forth between our tissues to our brain. In the case of sciatica, these nerves travel from our brain down our spinal column and then exit the spine through a space between adjacent vertebrae called the intervertebral foramen.

In the lumbar and sacral spine, after the nerves exit the foramen, they merge together to form the Sciatic nerve which travels down the leg to the foot.

What causes sciatica?

The term “Sciatica” is attributed to this condition because the symptoms follow the path of the Sciatic nerve. However, it is important to realize that the term “sciatica” defines a group of symptoms. The term doesn’t tell us about the cause for those symptoms. Sciatica symptoms result from any irritation to the nerves that transmit information between the brain and the leg. Nerve irritation is most commonly caused by contact with an irritating substance or by physical load (compression/shear/tension) to the nerve. Let’s get into the most likely conditions that can cause sciatica:

Sciatica and Pelvic Diagram

Understanding Sciatica

How is sciatica diagnosed and treated?

All of these pathologies can cause the same symptoms but the treatment for each cause is very different. It is also common to have more than one pathology occurring at the same time. A physical therapist is the biomechanical expert of choice to identify your specific pathology by performing a thorough physical examination. Physical therapists also provide treatment for conditions 1-5 above. If the physical exam is inconclusive, or if certain “red flag” symptoms are also present, your physical therapist may refer you to a medical doctor, doctor of osteopathy (DO), neurosurgeon, or to the ER to have imaging performed. If you think you have sciatica symptoms, do some homework and find a physical therapist with the right skillset to help you.

References
  1. Hildreth CJ, Lynm C, Glass RM. Sciatica. JAMA. 2009;302(2):216. doi:10.1001/jama.302.2.216.
  2. Takahashi NM, Yabuki, Shoji MD P, Aoki, Yoshihito MD P, Kikuchi, Shinichi MD P. Pathomechanisms of Nerve Root Injury Caused by Disk Herniation. Spine (Phila Pa 1976). 2003;28(5):435-441. . Accessed August 4, 2017.
  3. Filler AG, Haynes J, Jordan SE, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine. 2005;2(2):99-115. doi:10.3171/spi.2005.2.2.0099.
  4. Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014;36:273-280. doi:10.1007/s00276-013-1180-7.

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From injury recovery to movement and performance enhancement, patient success is our passion. Our therapists are committed to the application of evidence-based treatment techniques to ensure you experience the best in rehabilitation and preventative care and see progress with every visit.

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