How To Stop Sciatica Pain

Sciatica Pain

Generally, Sciatica is a term that is commonly used to describe pain, weakness, numbness, or tingling that radiates down the back of the leg. Typically, the symptoms follow the distribution of the sciatic nerve, but there can be some confusion as to the source of the pain especially when the patient’s symptoms are referred. Our job as PTs is to determine the source of the nerve irritation or referral origin and treat it accordingly. This is often accomplished with a thorough musculoskeletal exam and typically without the need for costly medical imaging. Below are the most common causes of sciatica seen in PT and how we typically treat them.

 

Disk Herniation:

The most common source of sciatica is pressure on the sciatic nerve from a herniation or protrusion of a spinal disc. This pressure on the nerve can create an irritation and inflammatory response causing symptoms to radiate down the leg following the path of the nerve that is compressed.

What can physical therapy do to help patients with sciatica caused by a disc herniation?



Stenosis:

Narrowing of the space where the spinal cord or nerve roots exit the spinal canal is called stenosis. If the space is narrowed, that can create pressure on the cord or the nerves causing pain to radiate down the leg.

Stenosis is typically seen in a condition called degenerative disc disease. Our discs are located between the bony vertebrates and over time they can start to lose some of their height. This loss of height causes the narrowing of space seen in stenosis.

 

Another cause of stenosis is tiny little bone spurs called osteophytes that can form in the spinal cord or nerve root space.



What can physical therapy do to help patients with sciatica caused by stenosis?

 

Piriformis Syndrome:

Deep in your buttock/gluts is a muscle that runs diagonally from the outside of your hip to the lowest part of your spine. This muscle, called the piriformis, can get short and tight or even be in spasm. In 85% of the population, the sciatic nerve runs just beneath the piriformis and in the other 15% it runs through the muscle. The sciatic nerve can become compressed and irritated when the piriformis is taught or in spasm creating symptoms of sciatica down the back of the leg.

What can physical therapy do to help patients with sciatica caused by piriformis syndrome?

 

Trigger Point Referral Pain

Trigger points are tender knots in skeletal muscles that often cause radiating or referral pain. In the case of sciatica, trigger points in the gluteus minimus, gluteus medius, and piriformis muscles are common sources of radiating pain into the back of the leg. Trigger points are located in almost all muscles in the body but usually lay dormant without referring pain. Dysfunction of movement patterns, compensation for weaknesses, or postural deficits, among many other things, can cause the trigger points in the dysfunctional muscle to become active and painful.


What can physical therapy do to help patients with sciatica caused by trigger points?

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