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What is Sciatica/Sciatic pain? 

Sciatica refers broadly to pain that radiates down the path of the sciatic nerve. The traditional course of this pain begins in the low back and radiates to the buttock, down the back of the thigh, into the back or outside of the calf, and sometimes into the foot and toes. Some individuals also describe paresthesia, or numbness/tingling, in this same pattern. The pain can vary from sharp and stabbing to dull and aching, and generally presents on only one side rather than in both legs.

The Sciatic Nerve

The sciatic nerve is the largest nerve in the body. It is derived from the nerve roots of the lower lumbar and sacral region of the spine. After forming from the nerve roots it travels underneath (or through in about 20% of the population) the piriformis muscle, down the back of the thigh before branching at the back of the knee into two separate nerves which then travel down the lower leg and into the foot. Due to its large size and many branches, It provides muscle and sensory function to many of the muscles in the lower extremity.

How is Sciatica Diagnosed?

Sciatica is diagnosed through a patient’s subjective description of their symptoms along with a physical examination. In general, sciatica is diagnosed when a patient describes unilateral leg pain radiating down the leg and into the foot and toes along with additional signs of increased nerve tension. The most common nerve tension test performed is the passive straight leg raise wherein the physician or physical therapist will raise the patient’s leg keeping the knee straight. If pain is related to sciatic nerve tension, the patient will experience a reproduction of their symptoms between 35 and 70 degrees. Additionally, pain will sometimes be increased if the patient pulls their toes upward toward their shin.

Causes and Risk Factors

The main cause of sciatica is as a result of a herniated disc in the lumbar region of the spine. Other causes include spinal stenosis, or narrowing of the canal where the nerve roots travel. Another common cause of sciatica is compression of the sciatic nerve by the piriformis muscle, otherwise known as piriformis syndrome.

Risk factors for developing these conditions include age between 45 and 64 years, increased height, smoking, increased mental stress, as well as occupational risk factors such as regular bending, lifting, and twisting, and vibration from driving.

How is sciatica different from other low back pain or leg pain? 

Low back pain can present in many different ways, and as the result of many different conditions. In general, sciatica is considered as a diagnosis when the individual reports one-sided leg pain greater than low back pain, pain radiating into the foot or toes, numbness and tingling in this same pattern, and straight leg raise test inducing increased pain. In the absence of these symptoms and any other red flags, a diagnosis of non-specific low back pain would be considered.

 

Suggested Interventions

Increase mobility of the gluteal and posterior lower extremity musculature

*Mobilize piriformis  –

*Mobilize hamstrings –

Increase the strength of the deficit muscle groups – 

*Side lying hip abduction with isometric hip extension : 2 x 20

*Feet elevated isometric hip extension with lumbar flexion/extension: 2 x 20 reps

References

  1. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317. doi:10.1136/bmj.39223.428495.BE
  2. Güvençer, M., Akyer, P., İyem, C. et al. Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat 30, 467 (2008). https://doi.org/10.1007/s00276-008-0350-5

 

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