What Is Sciatica?
Sciatica is a nerve-related pain disorder in which pain radiates from your lower back, down through your hip, and all the way down your leg. This is the path of the sciatic nerve, and pain occurs when its corresponding disc in the spinal column is compressed in some way. Between 10% and 40% of people will experience sciatica pain in their lifetime.
Sciatica Causes
The main causes of sciatica are related to slipped or herniated discs in the spine. Between 1 and 3 percent of adults will have a slipped disc in their lifetime. The vertebrae along the spinal column are protected by annulae. Within each annulus, there is a mass of spongy tissue, which can be pushed out through a small tear due to injury or lifestyle. The pain you experience comes from the lack of protection for this vulnerable tissue.
Bone spur growth is another frequent cause of sciatica. A bone spur, also known as osteophytes, refers to when a bony growth develops in the joints or along the vertebrae. Bone spurs are usually the result of joint damage, often associated with osteoarthritis. Most of the time, symptoms go undetected but sometimes can cause pain and require treatment.
Other less common causes of sciatica include:
- Spinal stenosis, an abnormally narrow spine
- Spondylolisthesis, or instability of the spine
- Trauma injuries affecting the lumbar spine (lower back)
- Tumors or other growths that compress the sciatic nerve
- Piriformis syndrome, in which the piriformis muscle in the buttocks spasms
- Cauda equina syndrome, affecting the nerves at the end of the spinal cord
Sciatica Symptoms
The main symptom of sciatica is pain along the path of the sciatic nerve. You may notice any of the following:
- Pain that originates in the lower back or buttock and extends down the leg, usually on just one side of the body
- Mild numbness or weakness in those same areas, as well as your feet
- Pain that increases with movement or weight on the feet
- A sensation of “pins and needles” in legs, feet, or toes
Mild sciatica tends to lessen over time and requires only basic self-care to treat. However, there are times when the pain progresses or lasts for a long time. This is when you may require more serious treatment.
Sometimes, sciatica is a side effect of a more serious condition. Seek medical attention immediately if you notice any of the following:
- The pain in your back or leg is sudden, extremely severe, and is accompanied by an inability to feel or control your leg or foot
- The pain began as a result of a traumatic injury (e.g., a fall or car accident)
- You have difficulty controlling your bowels or bladder
Risk Factors for Sciatica
Age
As you age, the tissues in your spine naturally deteriorate. Sciatica is significantly more common in people aged 65 or older. On the other hand, it rarely develops as a primary condition in those under the age of 20.
Occupation
Some careers require labor that involves a lot of repetitive movement in the lower back, such as heavy lifting. Office jobs in which employees spend most of the day sitting can also be a risk factor for developing sciatica.
Level of fitness
Fitness and movement can affect the incidence of sciatica in multiple ways. Those who lead more sedentary lifestyles are more likely to develop sciatica due to the lack of musculoskeletal support and flexibility around the spinal column. Sedentary lifestyles can also lead to poor posture or a weakened core. Your core refers to the muscles of the trunk of your body, including your abdomen, back muscles, shoulders, and hips.
If you are active, it is also important to ensure that you are using the proper techniques for exercise. Improper body form for weightlifting, for example, can make you vulnerable to sciatica.
Smoking
The nicotine in tobacco causes accelerated disc degeneration, leading to nerve damage and conditions like sciatica.
Pre-existing conditions
Previous injuries and conditions like diabetes and osteoarthritis put you at a much higher risk of nerve damage and other issues that could result in sciatica.
Complications with Sciatica
While most people recover fully in a relatively short time, chronic sciatic pain is possible. Untreated nerve compression can also lead to irrevocable damage, causing muscle weakness. Some people experience sciatica as a precursor to loss of movement or feeling in the legs.
Diagnosing Sciatica
As with all conditions, your doctor will begin by asking you a series of questions and listening to you describe your symptoms. It is important to be clear, specific, thorough, and honest. The more detail you can provide, the better and more precise your doctor’s diagnosis will be.
Physical Examination
Your doctor will also perform a physical exam to see how your pain affects your gait and posture. They will ask you to walk normally to see how your spine moves and supports you. Walking on your toes, then your heels, will allow your doctor to examine the strength of your calf muscles. A straight leg test can help your doctor identify whether there is an issue with a disc. You will lay on your back with your legs straight while the doctor slowly raises one leg at a time. They will ask you to say when your pain begins.
After making the official diagnosis, the doctor will recommend treatment. Common forms of treatment include over-the-counter pain medication, lifestyle adjustments, and even surgery. Among some of the most effective treatments that doctors often prescribe to teachers is physical therapy.
Physical Therapy & Sciatica
Benefits of Physical Therapy
In general, physical therapists can support a myriad of injuries and conditions through individualized treatments that target specific problems. Physical therapy is an excellent way to reduce or completely eliminate pain, improve mobility and flexibility, strengthen your muscles, and avoid future injury. For sciatica specifically, physical therapy will address the underlying cause of your pain and reduce the potential for future episodes of sciatic pain.
What to Expect from Physical Therapy
Your first physical therapy appointment will ask you a series of questions, much like a doctor. They may go deeper into your medical history and ask you to discuss previous injuries, even those that may not seem like they are related to the pain you’re experiencing. This is because there are plenty of conditions and injuries that can put stress on the lumbar spine and lead to a compressed sciatic nerve.
Just as your doctor asked you to move in certain ways to identify the specific nerves that may be affected, so will your physical therapist ask you to perform a series of movements to identify your strengths and weaknesses. Along with this physical exam, the physical therapists will assess how your pain is affecting your daily life. Based on the information they learn, they will develop a treatment plan individualized to your needs, with goals for reduced pain and improvement of daily functioning.
Physical Therapy Treatment for Sciatica
Most physical therapy treatments require consistent practice to be effective. There are many things that your physical therapist can do for you during clinic visits to temporarily relieve pain. These are called passive treatments, as you do not have to do anything to make them work. However, regularly practicing the more active forms of therapy both in the clinic and at home is the best way to ensure long-term benefits.
Passive Treatments
Deep Tissue Massage
This is a form of massage that targets specific muscles and fascia (the connective tissues between muscles) in the spine, lower back, hips, and buttocks. The physical therapist will use a variety of techniques to apply direct pressure to release tension.
Temperature Therapy
The application of heat and cold both have beneficial properties that can help with reducing pain. Heat will allow for better blood flow in the target area, while cold can slow the circulation there. More blood flow increases the oxygen that is carried through the muscles in a specific area, while less can reduce inflammation and pain.
TENS (transcutaneous electrical nerve stimulation)
When administering TENS, a physical therapist uses a special machine to stimulate your muscles. It can help reduce muscle spasms and will also cause your endocrine system to release endorphins, which are your body’s natural painkillers. There are also TENS machines that can be used at home and may be covered by insurance as a medical device.
Ultrasound
This form of therapy uses sound waves that penetrate muscle tissues to create heat and enhance circulation. Increased circulation is associated with reduced muscle spasms, swelling, stiffness, and pain, all of which often accompany sciatica.
Active Treatments
Each time you visit the clinic, your physical therapist may work with you to teach you the proper form for a variety of stretches and exercises, which you will be expected to practice at home between sessions. These techniques are specially designed and adapted to your needs. By practicing them, you can release the tension that may be placing pressure on your sciatic nerve. You will also be able to strengthen the core so that your lumbar spine does not need to carry so much of your weight. The exercises are gentle and will not put you into more pain, as is often the fear around movement when dealing with a chronic pain condition.
Physical therapy is one of the most beneficial methods of treatment for sciatica. Not only is it a minimally invasive therapy that will limit the need for surgery or other more intensive treatment, but it also will help you reduce your current pain even as it limits the possibility for future flare-ups of sciatica. If you are experiencing sciatica pain, contact an AICA physical therapist today to get started.