Sciatica is a commonly misunderstood diagnosis that can be extremely unpleasant. This little word is often batted around like a birthday piñata with few people penetrating the exterior to truly understand its meaning. Sit back, relax, and take a moment to kick your sciatica misconceptions to the curb!
NAMES ARE EVERYTHING: First, sciatica itself names a problem, NOT the cause of your problems. The word is Latin for inflammation or irritation of the sciatic nerve which we often proclaim as pain in the butt. This nerve emerges from your lower spine and travels through the buttock and back of your thigh to the knee. The nerve continues past the knee but its name changes to the tibial nerve – much like a long road might. This road terminates at your toes. You have 2 sciatic nerves, one in each leg. Point to remember: Sciatica is NOT a root cause of pain; it is just a structure that transmits pain and irritation. There is always another mechanism responsible for aggravating this nerve and causing sciatica pain.
A CAUSE TO GET BEHIND: So what are some potential causes for sciatic pain?
Disc Alignment: Disc herniation is a great starting point. When a disc herniates (which can range from a bulging disc to a complete rupture of the disc), it can protrude and put pressure on one of the nerve roots that feeds into the sciatic nerve. The pressure on the nerve root irritates and potentially damages the nerve. This can create pain, numbness, burning, or many other symptoms that may travel down the nerve. Now that nerve becomes irritated. The pressure can cause problems further down the line (that road we talked about earlier).
Picture yourself grabbing a bare electrical wire (pleasant, I know). That current may have originated many miles away but you still experience a shock because the electricity travels. That’s why nerve problems close to the spine can cause pain farther down a limb.
Other Spine-Related: There are a few other causes of sciatica that involve the spine. These include bone spurs, stenosis, and some other less frequent causes. The bottom line is, all of these causes apply pressure on the nerve which causes, you guessed it, sciatica!
Piri-what? Sciatic pain does not always originate from the spinal area, however. Let’s discuss another mechanism which causes sciatic pain AWAY from the spine. The Piriformis is a small but very important muscle in the back of your hip/pelvis (AKA your butt) and sure enough, that sneaky sciatic nerve runs very close to it. In fact, a portion of the population has their sciatic nerve run directly through the muscle! So, if this muscle is tight or in spasm, it can harm the adjacent sciatic nerve. This cause of sciatica is called piriformis syndrome.
HOW DID THIS HAPPEN? Sciatica can occur gradually or suddenly with little to no warning. It sounds better to have had a good reason (saving a child in a burning building, making the winning TD… you get the picture) but sometimes it can happen when simply standing up from your couch. Frustrating, I know, but it happens.
HOW TO DEAL: If you, or a loved one, has sciatica, you could be in a lot of pain and wondering where to turn for help. Physical therapy is a great starting point! You may have been expecting to hear this from a physical therapy provider. However MANY health professionals (in addition to those directly in the field) view physical therapy as an important first treatment option. Let’s dig deeper into these strategies to fight sciatica.
FIRST LINE OF DEFENSE: Physical Therapy is, in fact, one of the first lines of defense against sciatica. Physical therapy utilizes exercises and manual techniques to promote nerve gliding, spine mobility, muscle flexibility and increased strength to heal the area of pain. Of course, the specifics vary from patient to patient. There is no magic list of procedures that cures every sciatic problem. Instead, a physical therapist will create a custom program that fits each individual’s specific needs. It all depends . . . . on YOU!
INJECT SOME RELIEF: If you have tried physical therapy, to no avail, there are other more radical approaches. One such approach is steroid injections. It sounds intimidating, but it is a brief and relatively easy procedure. An injection places a steroid directly at the irritated nerve. The steroid is a way to force your nerves to be calm and decrease inflammation. Sometimes injections from your physician are a supplement to therapy and will help to increase its effect. Steroids can also be administered orally but they are usually less effective as the medication must be absorbed into your entire body, instead of focusing on the area causing pain.
WHEN ALL ELSE FAILS: Finally, surgery is the most invasive treatment option. The actual steps in the procedure depend on the CAUSE of your sciatica. Generally, the surgeon tries to remove the source of the nerve irritation and fix any other structural issues.
Well, that was a great start, but believe it or not, there can be much more to the problem! Now that you know the basics about sciatica and can use this term correctly. Hopefully you will never have to experience it yourself, but if you do, feel free to give us a call. We’d love to help you!
Laura McEllhenney, Licensed Physical Therapist Assistant, HARTZ Physical Therapy, Lititz, PA