Sciatica
Have you ever had a tingling or pain running down your leg that may have felt like an electrical shock, burning, sharp, or even a deep ache?
Most would call this “Sciatica”.
Sciatica is an umbrella term that is often used for nearly any pain or similar symptom that runs down a person’s leg.
More precisely, the Sciatic Nerve is the largest nerve of the body and is nearly the size of your pinky finger.
It begins its journey as a conglomeration of nerve roots that exit each side of the spine. These nerve roots from the 4th and 5th level of the Lumbar (low back) spine along with the Sacral (tail bone) nerves of S1, S2 and S3. They all join together forming the Sciatic nerve as it passes through the pelvis heading downwards to eventually end at the your big toe (amongst other areas along the way).
Classically, symptoms commonly referred to as “Sciatica” is a pain, tingling, or burning that runs down the back of the leg into the calf and foot. It may also generically include groin pain, pain in you buttock, pain in your tailbone, or pain on the bump on the side of your hip bone as well.
There are many potential causes of what we Physical Therapists call radiating pain (pain that a therapist can reproduce with testing) and referred pain (pain that cannot be reproduced). These definitions are important in finding the cause of your “Sciatica” symptoms.
The challenge is to find the cause of your leg symptoms. This is where a skilled therapist really comes into play. Your therapist should be able to assess you, and your symptoms, coming up with a proper diagnosis and cause of those symptoms.
There are numerous reasons as to why a person may develop their “Sciatica”. Some of them may include direct or local trauma to muscle, bone, or nerve tissue in the back, pelvis, or the leg itself.
There may also be local pathology to the nervous tissue to include compression of the spinal cord ( central stenosis of the spine), compression or irritation of the nerve roots as they exit the spine, (foraminal stenosis) and later downstream to the actual peripheral nerves (which control the individual muscles and give us sensation as well).
Disc compression/Herniation, muscular impingement/compression, bone spurs etc. could all lead to this.
Another cause is vascular in nature. Lack of proper blood flow in your legs can mirror “Sciatica” type leg symptoms as well.
Yet another cause of your “Sciatica” may be more mechanical in nature. In the spine there are a pair of joints above and below each level that allow you to move through the great range of motion that we are given. Potentially, when a joint is dysfunctional (not moving in its intended manner) it may become irritated and cause leg symptoms as well.
Lastly, when a joint or spinal segment moves excessively and is not restrained by its normal mechanisms of joint, ligaments, and muscles it may become unstable.
Instabilities can easily cause leg symptoms that are also lumped into the “Sciatica” category.
One can easily see that there is a myriad of potential causes for leg pains that are all routinely lumped into the category of “Sciatica”.
Our job, as highly skilled therapists, is to sift through all of the information that the body gives us and find the true culprit as to your leg pain. Is it in your back? Is it in the pelvis? Is it in the leg itself?
Most often the leg pain that one feels has very little to do with the leg at all. This is sometimes challenging to grasp as one can put their finger on his/her pain, press, and cause it to hurt locally. Unfortunately, this is one way that the body can be very misleading. Buttock pain, Hamstring pain, Hip bone pain, calf pain, and medial (plantar fasciitis) pain are frequent examples of these pains often caused by the spine.
With this information from careful testing, we will develop a strategy to best treat you, getting your symptoms under control and getting you on with your normal, functional life.
Much of our treatments will include work on posture, regaining spinal mechanics (mobilizations and manipulations) along with stabilization of the spine as well. Positioning, activity modification and other modalities can also play a helping hand in reaching the end range goal to rid a person of their “Sciatica”.
Kelly Jorschumb MPT, CSCS
St. Luke’s-Elks Rehab, Cloverdale McMillan Site Manager
Filed under: Common Aches & Pains