Sciatica results from irritation, compression, or injury to the Sciatic nerve. The Sciatic nerve begins as multiple nerves exit the spine in the lower back and merge together to become the large nerve we’ve all heard of that travels into the buttocks and down the back of the leg.
Pain anywhere along the path of this large nerve is considered “Sciatica” and is often associated with the following conditions:
- Spinal Stenosis: A narrowing of the space in the spine where the nerve travels through. When this is severe it can compress the nerves causing pain that radiates down the leg. This is often caused by bone spurs.
- Herniated Disc: Where a fragment of the disc pushes into the spinal canal. In severe cases the disc can put pressure on the spinal nerve.
- Piriformis Syndrome: Where the Piriformis muscle compresses the Sciatic nerve as the nerve travels through the buttocks. This condition is rare.
It is important to note that, while spinal stenosis and herniated discs are relatively common findings on MRIs and X-rays, especially in the over 50 population, the chances of the above conditions causing true Sciatica is considered rare.
Other Risk Factors
In addition to the above conditions, the Sciatic nerve can also be irritated by chronic poor health habits such as, lack of sleep, dehydration, and increased stress levels. These habits can cause the nervous system to be heightened over time which means that the pain can occur with less stimulus than normally required to cause pain. Since the Sciatic nerve is the largest nerve in our body it stands to reason that it would be affected by these poor habits.
SYMPTOMS OF SCIATICA
True Sciatica is pain defined by the following very specific characteristics:
- Pain beginning in the low back radiating into the buttock and down one leg.
- The pain radiating down the leg is described as sharp, piercing, shocking, or electric.
- The pain pattern typically is no wider than 2-3 inches.
- Sciatica symptoms MAY also include decreased sensation or numbness in the leg as well as muscle weakness in the leg depending on the severity of the problem. [1]
However, more commonly we hear complaints about dull, gnawing, pressure pain radiating down the leg covering wide areas where the boundaries of the pain are difficult to define. [1] While these symptoms are not “true” Sciatica, per the definition above, they are often considered Sciatica because the pain radiates down the leg. As you can see, this can lead to misdiagnosis and mismanagement of the symptoms since the sources of the pain are different and often require a different course of treatment.
Further evaluation is imperative to determine the correct treatment. It is important to perform a physical examination along with a movement assessment in order to develop a movement diagnosis. Refer to my previous blog, A Different Take on Treatment for Low Back Pain, for more information about the importance of a movement diagnosis.
In short, a movement assessment can tell us what movements aggravate a person’s symptoms and if there are any restrictions that might be causing compensation elsewhere in the body. This is especially important when determining a course of treatment and what exercises to prescribe. For example, if a person’s symptoms increased with bending over in the standing position, one would not want to prescribe any exercises that mimicked this movement because it would likely cause the symptoms to worsen.
TREATMENT FOR SCIATICA
It starts with a healthier lifestyle.
In most cases, the symptoms of Sciatica are not severe and will not require surgery. Sometimes the symptoms will resolve on their own within a few weeks. However, if this doesn’t happen or you want to prevent the symptoms from returning, here are a few tips to address your symptoms.
It is important to address any poor health habits that may be contributing to the symptoms. As mentioned before, lack of sleep, dehydration, and increased stress over prolonged periods of time can lead to a heightened nervous system, which can contribute to the symptoms of Sciatica. Below are a few recommendations for a healthier lifestyle:
- Sleep: For adults it is recommended that we get 7 or more hours per night. [2]
- Hydration: It is recommended that men should drink about 15.5 cups of fluids per day, while for women it is 11.5 cups. This is a general guideline and may need to be modified depending on your activity level, environment, overall health, and intake of diuretics (i.e. coffee, caffeinated sodas, and alcohol). [3]
- Stress: A few recommendations for managing stress are: daily meditation, deep breathing, exercise, healthy eating, connecting with others, and limiting social media. [4]
Exercise Recommendations:
If your symptoms are not resolving on their own, we can help to prescribe a few exercises based on a couple of common scenarios and how your symptoms present. However, It is important to note that you should only perform the exercises below if you meet all of the criteria for either of the two scenarios. Otherwise, you could cause your symptoms to get worse. If you do not meet all the criteria for either of the above scenarios, it is recommended that you seek Physical Therapy and have a thorough evaluation so that the correct course of treatment can be prescribed.
- Scenario #1: Your symptoms get worse with sitting and bending over. In contrast, you get relief by standing upright. Also, typically, you are between the ages of 35 – 50. Then most likely your pain is due to irritation of the disc and you may benefit from the following exercises.
- Prone Press-up: Lie on your stomach on the floor. Next lift your head and chest while keeping your pelvis in contact with the floor by propping up on your elbows. Depending on how this feels and how flexible you are you can repeat this pressing up through your hands instead of the elbows. Hold the position for 10 – 20 seconds and repeat for 10 -15 repetitions, 3 – 5 times per day.
- Standing back extension: Stand with your hands on the back of your hips. Slowly lean back causing your back to arch. It is important to keep your hips directly over your feet and not to push your hips forward. Hold the position for 10 – 20 seconds and repeat for 10 – 15 repetitions, 3 – 5 times per day.
- Supine Bridges: Lie on your back with your knees bent and your feet flat on the floor. Next, flatten your back by rolling your pelvis up (bring your bellybutton toward your chin). Then press through your feet to lift your buttocks off the floor. Hold for 5 seconds and repeat for 10 – 15 repetitions, 2-3 times per day.
- Scenario #2: Your symptoms get worse with standing activities and you prefer to be in a sitting position. Typically, you are over the age of 50. This is a common presentation for a person suffering from pain due to spinal stenosis and the following exercises may benefit you.
- Single or Double Knee to Chest: Lie on your back and pull one or both knees toward your chest. If you can’t reach your knee(s) with your hands, place a belt or towel around your knee(s) for assistance. Hold this position for 30 – 60 seconds while you breathe. Repeat for 3-5 repetitions, 3 – 5 times per day.
- Supine Piriformis Stretch: Lie on your back with one knee bent and the foot flat on the floor. Place your other foot on the knee that is bent. Then pull the bent knee toward your chest. If you can’t reach your knee with your hands, place a belt or towel around your knee for assistance. Hold for 30 – 60 seconds while you breathe. Repeat for 3 – 5 repetitions, 3-5 times per day with each leg.
- We are available for a free 15 minute phone consultation to talk about how your pain is affecting you and to discuss your treatment options.
- If you are in pain and unsure about what your next steps should be, call us at (301) 539-3807 and ask how we can help.
References:
- Bodduk, N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 2009:147: 17 – 19.
