Sciatica
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What is Sciatica?
“Sciatica” is an umbrella term commonly used by healthcare providers and common folk alike to describe a radiating pattern of pain or sensory disturbance (numbness, tingling) down the backside of a leg. These symptoms can be concentrated in the glute or be felt as distal as the foot in some cases.
Inherently, “Sciatica” relates to the Sciatic nerve. The Sciatic nerve is the largest nerve in the human body. It is effectively a bundle of nerve roots from the lumbar and sacral spine region (L4-S3). The Sciatic nerve and its eventual branches (Tibial, Common Fibular) innervate most of the muscles throughout the posterior thigh and leg.
What can cause Sciatica?
Sciatica can have numerous musculoskeletal causes. In order of prevalence, the most likely reasons for Sciatica-like symptoms are Disc Pathology, Neuroforaminal Stenosis, Sciatic Nerve Neurodynamic Dysfunction, or Piriformis Syndrome.
• Disc Pathology categorizes a wide range of possible injuries to an intervertebral disc. This can include many common diagnostic terms such as herniations or bulges. Discs can cause Sciatica pain by way of referral or by making direct contact on lumbar nerve roots (radicular pain).
• Neuroforaminal Stenosis describes a grouping of disorders that narrows the intervertebral foramen. The foramina are holes in the spine in which nerve roots exit laterally. If the holes become too small contact can be made by various structures on lumbar nerve roots, thus causing Sciatica symptoms.
• Sciatic Nerve Neurodynamic Dysfunction relates to the mechanics or movement of the Sciatic nerve. Nerves and nervous tissue are similar in composition to that of musculoskeletal tissue. Therefore, physical properties such as stretching, sliding/gliding, and compression can irritate the Sciatic nerve and cause a Sciatica like presentation.
• Piriformis Syndrome is a condition in which the Piriformis muscle, a posterior hip stabilizer located near the Sciatic nerve, causes mechanical pressure on the Sciatic nerve. A small percentage of the population also has a Sciatic nerve that pierces or runs through the Piriformis. This can cause irritation of the Sciatic nerve during various movements or postures.
How is Sciatica Diagnosed?
Sciatica is diagnosed through an appropriate patient history and mechanical examination. Depending upon a patient’s presentation, specific tests will be selected to rule in or out any causes of Sciatica symptoms. This may include neurological testing, orthopedic testing, functional movement screens, and end-range loading tests. Upon completion of the exam, a strategy of treatment will be determined, and frequency of care will be established.
How is Sciatica Treated?
Treatment for Sciatica will be directed by its causal factor determined on examination. This may include manipulations or adjustments to the spine, specific rehabilitation exercises, and soft tissue therapies. Often, at-home exercises will be prescribed to continue the treatment process while away from the office. These exercises are often relieving for Sciatica symptoms, and vital for the progression of care.