by Britney Ashburn, DPT
March 28, 2017
Sciatica is a common diagnosis we see on many of the referrals our patients bring to us. More often than not, many patients know the term sciatica refers to "pain down my leg". As a general definition that is correct! True sciatica occurs when the sciatic nerve has been compressed or irritated in some way as it exits the spine, courses through the bottom muscles, and branches into other nerves down into the leg. In addition to pain, sciatica could also create sensations of tinging, numbness, or heaviness in the leg.
A good percentage of the time the low back (or lumbar spine) is contributing to your sciatica. You may be asking, how can my low back cause pain in my foot? I will briefly explain. The sciatic nerve is formed from nerve roots exiting between each vertebra in your low back through spaces called neural foramen. Your nerve is sensitive and likes to have a large bubble of personal space around it. If there is anything narrowing that space, then your nerve is likely to get compressed or irritated. Things that could narrow the nerve's "space" include boney growth or degenerative changes from arthritis or a disc bulging into your nerve's space. Even chemicals released due to inflammation could irritate your nerve. Remember when I said your sciatic nerve exits your low back and continues through the bottom, branching into other nerves all the way to your toes? Your sciatic nerve getting compressed at your low back could send pain signals all the way down its pathway to your toes!
On your first visit, a physical therapist will discuss your condition with you and perform a thorough examination of your low back and legs.
If it is determined that your low back is to blame for your sciatica, then physical therapy will be focused on decreasing the pressure on your nerve or stabilizing your back so that the nerve's space is preserved. This is done through specific exercises and exercise positions, and may also involve manual techniques.
Just because you have "pain down your leg" does not mean your low back is to blame. It could be your pelvis, bottom muscles being too tight, or even a problem occurring in the thigh or below the knee. It is the job of the physical therapist to determine where the "pain down your leg" is originating from.
An x-ray of your low back will give you a good picture of each vertebrae's position and any degenerative changes that have taken place. An MRI will give you a good picture of other structures including discs and muscles. However, both an x-ray and a MRI can be deceiving. Sometimes an x-ray will show awful arthritis and degenerative changes, but these are not necessarily the cause of your sciatica. Depending on the findings of your examination, your physical therapist can give you further recommendations.
AT HIGHLINE PHYSICAL THERAPY, WE STRIVE TO EDUCATE OUR CLIENTS ABOUT THEIR CONDITION SO THEY MAKE THE BEST HEALTHCARE CHOICES FOR THEMSELVES. OUR THERAPISTS ARE COMMITTED TO ENSURING WE EARN YOUR TRUST BECAUSE WE VALUE THE OPPORTUNITY TO GETTING YOU "BACK TO FUNCTION, BACK TO LIFE."