Sciatica: Causes and Treatment

Sciatica is pain caused by irritation of the sciatic nerve.  The sciatic nerve is the longest nerve in the body.  It begins in the lower back, passes through the buttock, back of the thigh, and into the lower leg and feet.

What Causes Sciatica?

Sciatica can be caused by injuries to many different structures such as arthritis to the spinal joints, muscle strains, and spinal stenosis.  The most common cause is an injury to the intervertebral disk.  The term “pinched nerve” is sometimes used synonymously with sciatica.  This is not always helpful because nerves are being pinched all day long as we move in and out of positions during the day.

What are the Symptoms of Sciatica?

Sciatica symptoms

Sciatica is a symptom.  It is not a diagnosis.  The symptoms can be felt as a deep ache or cramping sensation, tightness, sharp pain, numbness, or tingling.  Some or all these symptoms can be experienced anywhere along the course of the sciatic nerve.  Sometimes pain is worse while sitting or lying.  Other times pain is increased while standing or walking.

Who Gets Sciatica?

It is unclear how common sciatica actually is.  Estimates suggest 1% to 37% of the population will experience these symptoms at some time in their lifetime.  This variability is because sciatica is not a specific diagnosis and a universal definition is not agreed upon.  The development of sciatica has been associated with smoking, obesity, female sex, work-related factors, and poor overall health status.   It is believed that both physical and psychological factors play a role in the incidence and recovery.

Treatment for Sciatica

Because sciatica is not a specific diagnosis (sciatica is a symptom), treatment must be individualized.  Research shows inconsistent and short-lived symptom relief with treatments such as medications, injections, and surgery.  Physical therapists perform a comprehensive physical examination to determine the best course of treatment for each individual.  Common physical therapy treatments for sciatica include mechanical traction, manual physical therapy, and specific exercises.

Traction

mechanical traction

Traction is a form of treatment which seeks to separate or stretch apart the vertebrae of the spine.  Theoretically this might alleviate compression on a nerve in the back.  Traction is commonly achieved through mechanical devices used by physical therapists and chiropractors.  Some patients may experience temporary relief with traction.  However, the best available research suggests traction has little or no impact on long-term pain, functional status, and return to work among people back pain or sciatica.

Manual Physical Therapy

Manual mobilization or manipulation techniques are often incorporated to stretch tight joints and muscles around the sciatic nerve.   Treatment designed to improve joint mobility have been shown to be more effective than those attempting to reduce muscle spasm.  Physical therapists regularly perform manual therapy to the lumbar spine, pelvis, and hip joints for the treatment of sciatica.

Specific Exercise

Sciatica

Individually prescribed exercise is the staple treatment for patients with sciatica.  The proper exercise program can only be developed after a comprehensive physical examination is performed by the physical therapist.  Because sciatica is a symptom and not a specific diagnosis, there is no universal exercise which will help all patients with sciatica.  However, when a proper exercise program is developed, sciatica will improve or completely resolve in 90% of cases.

Conclusion

Sciatica describes pain or other symptoms experienced anywhere along the course of the sciatic nerve.  The large majority of people fully recover with conservative treatments.  Only a small percentage of people will require injections or surgery. Physical therapists incorporate manual therapy and exercise to alleviate the symptoms.  Most patients respond very well to this approach.

References

  1. Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M. Risk factors for first time incidence sciatica: A systematic review. Physiother Res Int. December 2013:1-14. doi:10.1002/pri.1572
  2. Donelson R, Long A, Spratt K, Fung T. Influence of directional preference on two clinical dichotomies: Acute versus chronic pain and axial low back pain versus sciatica. PMRJ. 2019;4(9):667-681. doi:10.1016/j.pmrj.2012.04.013
  3. Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: A systematic review. Spine (Phila Pa 1976). 2010;35(11):E488-504. doi:10.1097/BRS.0b013e3181cc3f56
  4. Jewell D V, Riddle DL. Interventions that increase or decrease the likelihood of a meaningful improvement in physical health in patients with sciatica. Phys Ther. 2005;85(1):1139-1150.

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