01/21/2022
SCIATICA⚡️😫
Sciatica is a form of nerve pain characterized by sharp, shooting, electrical-type pain into the back of the lower extremity (buttock, thigh, calf, etc.). This irritation of the sciatic nerve may coincide with lower back pain and stiffness. The leg pain may be accompanied by numbness or tingling in areas of skin, or weakness in muscles innervated by the sciatic nerve, its divisions, or the spinal nerve roots that combine to form it.
The symptoms may be due to an issue in the lower back, such as a lumbar intervertebral disc injury, which will likely be accompanied by back pain. The leg pain experienced is typically more severe than the back pain and is a result of irritation to the previously mentioned nerve roots. Alternatively, the nerve could be compressed/irritated along its path down the back of the leg, most commonly by the piriformis muscle at the hip. The sciatic nerve passes just underneath this small muscle, so excessive tension can lead to compression. This is known as piriformis syndrome where there is often no back pain, rather a deep pain felt in the buttock region. This form of sciatica is common in those who sit for large portions of the day and are lacking hip mobility!
Management of sciatica will vary depending on the mechanism and severity of symptoms. No matter the cause, it is key to relieve the compression/irritation and restore mobility to the neural tissue. A detailed history and physical exam help determine what is driving the sciatica with the initial goal of ruling in or out the spine as the main culprit. A large majority of sciatica is a result of lumbar disc injury, where we’ll first look for movements of the low back that reduce the leg pain (directional preference). With piriformis syndrome, the goal is to reduce tension within the external rotators of the hip. With both these conditions, manual therapy such as soft tissue work and adjustments help improve range of motion and decrease sensitivity of the sciatic nerve. Long-term conservative management of these conditions will involve rehabilitative exercises with the goal of improving torso stability, loading mechanics, and addressing movement deficits. 💪🏼