Author: Dr. Andrea Sigsbee, PT, DPT
What is Sciatica and How Does it Feel?
Sciatica is a condition that affects between 10-40% of people within their lifetime and its symptoms can affect one’s quality of life in terms of how they move on a day-to-day basis and the activities or hobbies they enjoy doing. It is equally prevalent in both males and females and tends to be the most common in those 40 years and above as well as those who have physically demanding jobs or jobs that require them to stay or move in a certain position for long periods of times (machine operators, construction workers, truck drivers, sedentary desk job workers, stay at home moms, etc.) Its symptoms are usually felt in the low back or the back of the leg and are usually exacerbated by bending over which can include picking up an object off the floor, putting dishes in the dishwasher, sitting down, or standing up from a seated position. The back part of the leg can include anywhere from the butt to behind the knee and even as far down as the bottom of the foot and into the toes. The most common complaints of sciatica are sharp, shooting pains, decreased sensation or numbness, and weakness in the legs. Many times patients will come into my clinic and say, “I felt this sharp, shooting pain down the back of my leg when I bent over to pick up a pen from the floor,” or they’ll say, “When I stood up from sitting on the couch, I felt this electrical shock go from my low back down to the back of my knee”. Patients will also mention, “I’ve noticed that my dominant leg has been fatiguing a lot quicker than it usually does when I’m going up the stairs or after walking for long periods of time.” These are all normal and common complaints of what sciatica can feel like and Physical Therapy is one of the few interventions that can help lessen or completely eliminate these symptoms.
Root Causes of Sciatica?
Sciatica, in a simple explanation, is compression of the sciatic nerve at one of these two areas in the body- either the low back or tight/contracted muscles in the legs. It’s important for your Physical Therapist to identify where the root cause of your sciatica is coming from so that you receive the correct exercises and treatment interventions. If the root caue is coming from compression in the low back, it will either be due to a herniated/bulging disc or foraminal stenosis of the lumbar spine (narrowing of the spine). Both of these diagnoses can compress the sciatic nerve causing radiating symptoms down the back of the leg. The sciatic nerve originates from L4-S3 in the lumbar and sacral spine. “L” stands for lumbar, the “S” stands for sacral, and the number stands for the vertebral level. Therefore, a herniated/bulging disc or stenosis at any of these levels in the spine can put pressure on that sciatic nerve. The second root cause is from muscle tightness in the leg muscles including the deep glutes muscles (piriformis, gemelli, obturator internus) or the hamstrings. And this is where it can get a little tricky. Most people think muscle tightness means they need to stretch the muscles. However, it can also mean that they need to strengthen the muscles. Here’s the problem. If the patient has a weak muscle, that muscle is going to do everything in its power to hold onto the bone it is attached to and the weaker it is, the more tension it’s going to create in its muscle fibers to hold on. So, in the case of muscle tightness due to weakness of that muscle, the answer would be to strengthen it, not stretch it. This concept is very important for your Physical Therapist to identify because if the muscle needs to be strengthened and instead it is stretched, it’s not getting to the root cause of the sciatica and will take longer for your symptoms to improve.
What can Physical Therapy at Motion Rx do to Help?
We’ve talked about what sciatica is, what it feels like, and where its root causes come from. So now, how are these problems treated in Physical Therapy? Well, if the root cause is coming from compression of the nerve in the low back, we are going to work on low back mobility especially extension (bending backwards). Many of my patients develop sciatica because they have been accustomed to being in an overly bent over position for long periods of time whether it’s because they sit for long hours for work or they do a lot of bending over either for their job or at home. Therefore, it’s important to gain the ability to bend backwards because it will not only decrease the nerve compression from the disc, but it will also allow the patient to gain full mobility of their spine allowing them to move in more pain free ways and not have to compensate for it. We will also work on other techniques to help take pressure off the sciatic nerve including nerve glides (mobilizing the nerve), lumbar distraction techniques (creating extra space in the spine temporarily), and strengthening lumbopelvic musculature (muscles in the low back and hips). If the root cause is stemming from tight deep glutes or hamstrings, we will either strengthen or stretch those muscles depending on if they are tight or weak, and then we’ll also look at other areas of the low back, hip, and knee that are weak and strengthen those as well. Strengthening other weak muscles will help decrease the pressure being put on the deep glutes and the hamstrings and therefore decrease the pressure being placed on the sciatic nerve.
Another important factor of sciatica that many physical therapists gloss over during the initial evaluation and throughout the course of treatment, is really getting a sneak peak into the patient’s daily life and seeing what habits they are doing that could be exacerbating their symptoms. For example, if the patient has a sedentary desk job and sits 8 hours a day in severe lumbar flexion, it would be a good idea for them to get up every hour and do some lumbar extension exercises to allow the spine to move the opposite way. Another good exercise that could be done every hour are some bodyweight RDLs to help stretch out the hamstrings from being contracted due to their knees being bent while sitting. These simple daily habit changes will not only lessen their symptoms but will also help contribute to the patient’s overall health by encouraging them to move more. It doesn’t always have to be so complicated. Sometimes “fancy fails and simple prevails”.
If you've been dealing with sciatica, or any of the symptoms described in this article give us a call or email. We have over 10 years of experience helping patients like you!