Sciatica

Sciatica or lumbar radiculopathy is a term often used to describe pain which starts in the lower back and shoots down the back of the thigh, calf, and sometimes all the way down to the heel. Radiculopathy can also occur down the front of the leg, side of the leg, or originate from the neck and travel down the arm to the fingers. In most cases, sciatica will resolve on its own in 2-4 weeks and won’t require extensive treatment.(1) But what causes it and what about when it doesn’t go away on its own, what can be done?

The most well known and reported causes of sciatica and contributors to low back pain is a disc herniation, also known as a “disc bulge.” Stenosis, a narrowing of the space where the nerve roots exit, is also sometimes a culprit of sciatica. But why does compressing the nerve root cause sciatica, and, more importantly, what about people who have stenosis and disc bulges but don’t have any symptoms, how do we explain that?

When a nerve root is compressed, it’s possible for the nerve to become hypoxic (lacking oxygen). When a nerve is starved of oxygen, there are a variety of chemical changes that take place within the environment of the nerve. (2) This hypoxic environment can then sometimes send noxious (danger) signals to the brain. These signals can then be interpreted and then felt as painful. Think about when you’ve had a great night of sleep and woken up only to find that someone else’s arm is in your face. You find this to be troublesome because you were in bed alone… in the middle of your freakout, wondering why this extra appendage is in your bed, you recognize that it is in fact your arm. Your arm was asleep. This phenomenon is likely a similar experience as the compression of the nerve root. From sleeping on your side and having your arm in a certain position, a hypoxic environment was created. This hypoxic environment then caused your arm to fall asleep.

Another example is when you’re sitting on the toilet for a tad too long, maybe you were reading a really fascinating article, or just scrolling through your instagram. You finish your business and stand up, and all of a sudden you’ve got this numbness and tingling all the way down your leg, into your foot. This typically goes away in a few minutes if you keep moving. This is likely due to a hypoxic environment being created, a compression of the sciatic nerve and associated blood supply. This has likely happened to everyone and is not dangerous, just a very uncomfortable feeling.

There have been a few large studies performed in the past 10-15 years which have demonstrated that people who do have x-ray or MRI confirmed disc changes, stenosis, etc. can be asymptomatic (have no symptoms). (3) What this means is that even though something looks “bad,” on advanced imaging the likelihood of this being bad is actually not that high. In most cases, when people have a disc herniation, sciatica like symptoms (radiculopathy), stenosis, it tends to get better over time in most cases and people tend to get back to what they were doing before with minimal discomfort. Surgery is a last case scenario and is not required in a majority of cases.

The most clear way to put this is:

Advanced imaging is not necessary or indicated in the large majority of back pain cases unless the symptoms below are present. Imaging should not be the first thing your healthcare provider chooses to use to ‘help’ diagnose your issue. If this happens your likelihood of getting a false positive finding is HUGE.

What To Do If You’re Dealing With Sciatica?

First we must determine whether this radiculopathy is dangerous or not. By dangerous, I mean something that will require immediate medical intervention. We can test this by checking reflexes with a reflex hammer. Second we will need to test your sensation and strength. If your sensation is intact (you can feel light touch on each side equally) and your strength is relatively equal on each side, that’s good news. You’ll likely improve fairly quickly and most importantly it’s not dangerous. On the off chance there are these more troubling symptoms occurring, that’s okay. There is a lot that can be done in physical therapy to address these symptoms and if necessary we can refer you to physicians we trust.

Once we’ve ruled out it’s not dangerous, it’s important to determine which directions of movement worsen your symptoms and which ones improve them. This can be done by performing a simple movement screen involving bending forwards, backwards, side to side, rotating, and performing other motions that you do on a daily basis including a squat, deadlift, golf swing, running, etc.

After we’ve done our movement screen it’s time to move on to the treatment side. Treatment is individualized to the patient depending on irritability level of symptoms, directional preference (which directions feel best), and what a patient’s goals are. It is not possible to simply write a few exercises to do without knowing these things, however for most patients a few exercises will be beneficial. They’ll be listed below:

1. Pelvic Tilts | https://www.youtube.com/watch?v=3FDRc8888Ek
2. Sciatic nerve glide (be gentle with this one) | https://www.youtube.com/watch?v=zwiiy_hfSe8
3. Child’s pose/Prayer Stretch | https://www.youtube.com/watch?v=2vJKSlfLX10

Disclaimer:

This is NOT medical advice as we have not done an evaluation with you. We recommend you see a professional before beginning any exercise or rehabilitation routine so that you can be guided in the correct direction.

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Cases where severe sciatica persists for greater than 6 weeks is the typical time period when individuals should consider seeing their healthcare provider and schedule an appointment.

Symptoms to be aware of:

1. Progressively worsening numbness and tingling in leg and down to the feet.
2. Progressive muscle weakness with a significant side to side difference.
3. Loss of knee jerk reflexes.
4. Loss of control of bowel and bladder functions.
   1. See your physician immediately in this case.