The Cure for Sciatica

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Jill Murphy, DPT, LAT, CSCS

PT for Sciatic

Catchy title, isn’t it? Doesn’t everyone want a cure for sciatica, that icky, burning, painful feeling down the back and outside of your leg, sometimes accompanied by numbness, tingling, and of course low back pain and/or hip pain? What even causes sciatica? Is there really a cure? Is it really that simple? Read on to learn all of the issues surrounding sciatica and a smart, all-encompassing approach to keep it in check.

Sciatica is an interesting phenomenon in that while it can be a diagnosis, it is really a better descriptor of a symptom of a dysfunctional nervous system. While it shoots pain into your lower extremities, the cause of your sciatica is more likely somewhere in the low back and pelvis.

There are at least five (or arguably even more) possible causes or sources for sciatic nerve compression or irritation. The most common source of sciatica is nerve root irritation in the low back, particularly in the lower lumbar spine. The L4-5 and L5-S1 levels in the spine bear the brunt of our daily wear and tear on our bodies, because this is the location of our center of gravity. This means that if you had an MRI, the joints and discs in this region tend to be the first areas of the spine (and probably the whole body) to demonstrate degenerative changes associated with aging and just daily living.

The sciatic nerve is made up of combined nerves that exit the spine at these areas. Any disc changes can create a mechanical pressure with bone or disc components physically, directly pushing on the nerve roots, leading to compression and sciatica type symptoms. While this direct compression can happen, probably equally if not more common is a chemical irritation of the nerve root. This type of compression comes and goes based on your position, and is especially evident after prolonged postures or heavy lifting, which reduces blood flow. The nerve can also be mechanically or chemically irritated from reduced or excessive segmental spine mobility creating asymmetric space in the foramina where the nerve exits the spine. Additional places and spaces where the nerve can be compressed include the piriformis in the back of the hip, which runs across the sciatic notch, right where the sciatic nerve exits the pelvis. In 25% of the population, the sciatic nerve actually cuts right through the middle of the piriformis muscle, making excess tension in this area yet another possible reason for sciatica. Regardless of the reason for the irritated sciatic nerve, the symptoms are always in the same pathway down the back and side of the leg.

With a more severe compression and/or irritation of the nerve, you may not only find sensory type changes down your leg, but also begin to experience calf tightness, cramping, and weakness. This cramping may extend to all of the muscles innervated by the sciatic nerve, including the plantar fascia at the bottom of your foot, the hamstring behind the thigh, the outside of your thigh (tensor fascia lata/iliotibial band) and the back of your hip. You can also lose feeling in the sciatic nerve pathway as well. Thankfully, for most patients these severe symptoms can be alleviated relatively easily through physical therapy. The overwhelming majority of cases do not need surgery to relieve any compression.

How do you know if you are in the 5% or less of cases that may require surgical decompression of the nerve for relief? Some signs that you may need a surgical consult are prolonged, complete loss of sensation (numbness) that is unrelenting, and/or significant weakness in your leg, causing you to trip, drag your foot, or consistently stub your toe. Rarely a severely herniated disc with extruded pieces of the disc in the space where the nerve exits the spine does need surgical attention to clear away these pieces and relieve compression of the nerve root. However, the good news is that this case is very rare, and the symptoms are very obvious to your provider, so if this describes your case, you will receive more expedited imaging tests and consults.

Fortunately, for the rest of us with sciatica symptoms, these symptoms can be effectively relieved with hands-on, manual therapy treatments that improve mobility at the joints of the lower lumbar spine, stretching to reduce tight muscles and referred pain in the back of the hip, icing for inflammation in the low back, neural mobilization techniques to improve flood flow and reduce nerve adhesions, and finally strengthening and stabilization exercise for the lumbar spine, hip and abdominal region to both improve overall function and to prevent sciatica from returning. Building your functional strength is very important, because sciatica is really a symptom of underlying spine degeneration that all of us are undergoing at this very moment. While not all of us feel the symptoms of this process, being as strong as possible and being smart about your daily lifestyle and postures are the best way to prevent and reduce sciatica symptoms throughout your lifetime.

Other than hands-on, manual physical therapy, what else can you try to alleviate sciatica symptoms? There are lots of tricks that can help. Click here to learn 10 of them.