Sciatica: Causes, Symptoms and Effective Strategies for Pain Management

Sciatica can be one of the most debilitating and painful conditions. It’s estimated nearly 40% of people will experience sciatic pain at some point. In this post we’ll define sciatic pain, list some of the most common causes, and provide solutions for managing the pain. 

What Is Sciatica?

Sciatica is a term that describes a painful condition caused by an irritated sciatic nerve. The sciatic nerve is made up of 5 nerve roots originating in the lumbar spine. These nerve roots exit the spine and combine together at the pelvis forming the largest nerve of the body.  Once combined, the sciatic nerve emerges through the hips and the buttocks extending down the back of both legs. 

The sciatic nerve provides motor function to the hamstrings, lower extremity adductors, and indirect motor function to the calf muscles, anterior leg muscles and some foot muscles. It also provides sensation to the posterior and lateral lower leg as well as the plantar aspect of the foot. Any condition that structurally impacts or compresses the sciatic nerve may cause sciatica symptoms.

Some of the most common causes of sciatica include herniated or bulging discs applying pressure on the sciatic nerve. The pain often radiates down the back of the leg and can sometimes be confused as a hamstring strain. The pain can be either constant or intermittent and can result in numbness or tingling sensation in the leg.

What are the risk factors?

• Previous back Injury – having a previous injury can increase your risk of developing sciatica. 
• Spondylosis / Spondylolisthesis – The narrowing of the vertebral foramen leads to compression of the nerve root resulting in sciatic pain.
• Occupational – Heavy lifting and repetitive bending can often lead to injury and make you more susceptible to developing sciatica. 
• Sedentary lifestyle – Sitting for prolonged periods and not exercising can lead to muscle imbalance and weakness which increases your risk. 
• Core muscle weakness – The core muscles are essential for providing a brace for the lumbar spine. When they become weakened you become more at risk of inuring your spine and/or developing sciatica. 
• Obesity – Your spine is a vertical column that functions best in a neutral position. When your weight is excessive, it can place more pressure on the spinal discs causing your muscles to work harder to support your body. 

Sciatica symptoms 

Sciatica can present almost anywhere along the sciatic nerve pathway. Symptoms may include: 

• Pain in the back, buttocks, hip, or lower extremities
• Mild, sharp, or radiating pain along the nerve pathway
• Numbness or weakness in the lower back, buttocks, leg, or foot
• Pain that increases with movement 
• Loss of movement / walking difficulties
• Burning sensation, foot numbness or weakness

How is sciatica diagnosed?

A thorough evaluation of the spine is conducted to determine the root cause of your pain. Active movement tests, muscle testing, reflexes, and specialized tests such as a straight leg raise are typically performed to localize the source of the problem.

Sciatic pain management

• Rest – Rest and activity modification are the most underrated and important aspects of managing this condition. Identifying what triggers the pain and modifying your daily routine and lifestyle will be important to allow adequate healing. Typically, avoiding prolonged sitting, standing, and bending of the spine are good places to start. Lying down eliminates the forces of gravity and can provide relief. 
• Prescription medication – Your doctor will typically prescribe some anti-inflammatory medication (NSAIDs) which helps alleviate the pain. Muscle relaxers can also be prescribed to reduce muscle spasms. 
• Spinal Injections – A specialist can administer epidural corticosteroid injections which can help alleviate much of the pain and allow you to move better and perform your daily activities with less pain. 
• Physical Therapy – Working with a physical therapist can be extremely helpful to manage sciatica. Modalities such as ice, heat, and/or electrical stimulation can help manage the pain. Education on posture, body mechanics, and activity modification will be important to learn early in the process to avoid aggravating the condition. Manual therapy in the form of soft tissue mobilization, massage, and exercise instruction will guide and speed the healing process.  

Conclusion

Sciatica can typically be treated conservatively and may not require surgery. Rest, along with learning how to protect your spine by modifying your activity is typically all that is needed to improve your level of pain. Strengthening your core and improving your level of fitness will help prevent future recurrences. 

If you are experiencing symptoms of sciatica, don’t hesitate to reach out. Our team will provide you with a comprehensive evaluation to determine if you can benefit from physical therapy treatment. If treatment is deemed necessary,  we’ll teach you the movement patterns and strategies to avoid future sciatica related issues. 

In good health,

Ruben Salinas, PT, DPT, OCS, CSC