Sciatica 101

By Erin Higgins, DPT
Jumpstart Physical Therapy

Sciatica is a commonly used term and diagnosis - but what the heck is it? This term is a catch-all term for nerve pain down the back of your leg. It can be quite debilitating, as can any nerve pain, so proper awareness and treatment is important.

Symptoms: The sciatic nerve, the longest and largest nerve in the human body, runs down the back of your leg. Irritation of the nerve can lead to pain, numbness, and tingling throughout the length of the nerve. The symptoms typically start in the back or buttocks and go down your leg, anywhere from your thigh to your knee to your ankle. The pain is typically worse with certain movements, such as bending forward or prolonged sitting. It may be constant or may come in sudden, sharp jolts of pain with movement. Long-term nerve compression can also lead to muscle weakness or sensation loss in your leg. The exact area of tingling or numbness can vary depending on where the nerve compression begins.

Cause: As mentioned, sciatica comes from irritation of the sciatic nerve, typically in the back or buttocks. Specifically, the pain is often caused from nerve root compression from a herniated disc in your lower back. Occasionally, tight muscles in your buttocks (specifically a small muscle called your piriformis) may also compress the nerve and lead to similar symptoms. By pushing the fluid back into the disc or loosening your piriformis muscle, you can find pain relief.

Treatment: The treatment of sciatica varies depending on where the nerve is being compressed. The general treatment goals include improving core/hip strength and flexibility. For instance, if piriformis tightness is the cause of your nerve pain, a Figure 4 stretch will loosen the piriformis and thus decrease nerve compression in that region. Regardless of the cause, be careful with hamstring stretching and bending over, as this stretches your sciatic nerve and may lead to irritation. Traction, the act of separating the vertebrae, is one way to relieve the stress on the herniated disc. You can do this by hanging from a bar or having someone pull on your leg. Additionally, be careful to avoid aggravating motions or activities. Activity modification, such as avoiding heavy lifting, is extremely important in order to decrease stress on the nerve.

How to know if you're getting better: As is true with any injury, decreased frequency and intensity of pain/symptoms means that you are improving. Additionally, with nerve pain, you also want to look for "centralization of symptoms." In other words, if the nerve pain was initially all the way to your ankle and now only goes to your knee, you are improving. Sometimes people with sciatica can get frustrated because the pain may still be severe or frequent; however if the pain is moving up closer to your back (the cause of the pain), it is important to remember that you are still making good progress.

If you continue to have pain despite activity modification and gentle strengthening and stretching, it may be wise to seek a medical professional in order to receive an individualized treatment plan to address your specific needs. Additionally, if you experience weakness or constant numbness, you should seek medical attention as this typically indicates more severe or more chronic nerve compression.