We’ve all heard of it. If you’ve ever experienced it, you don’t want it back. Sciatica is painful and can be debilitating. Up to 40% of the population will experience sciatica at some point in their lives. But, what is sciatica, really? Is the cause always the same? Do other conditions mimic sciatica’s symptoms? Is there help?
What is sciatica?
Sciatica is a term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve from the lower back to the buttocks and leg. The medical term is lumbar radiculopathy.
The vast majority of sciatica symptoms result from lower back disorders between the L4 and S1 levels that put pressure on or cause irritation to a lumbar nerve root.
Most commonly, sciatica is caused by a disc problem, such as a herniated disc that is pressing against a nerve root.
It can also occur when a disc degenerates, which releases inflammatory proteins that irritate the adjacent nerve. There are many additional causes of sciatica.
Causes of Sciatica
Lumbar radiculopathy is a separate disorder from piriformis syndrome, although the symptoms may be practically identical. The most common cause of sciatica is a disc problem, such as a herniated disc pressing against a nerve root.
Other causes include degenerative disc and/or joint disease; spinal stenosis (a narrowing of the spinal canal); sacroiliac joint dysfunction; spondylolisthesis – a medical condition characterized by the slipping of a vertebra forward over the vertebrae found below; ankylosing spondylitis – an uncommon type of arthritis that can affect the vertebral column and the pelvis in which the bones of the spine tend to fuse together leading to a rigid spine; muscle strain; piriformis syndrome; pregnancy; poor posture, spine trauma in the past, as well as remaining in certain positions for many hours during the day while working are all predisposition factors for back problems, including sciatica.
Because the causes of sciatica are different in every patient, the treatment for this condition will also be different. Regardless of the cause, however, sciatica will affect the surrounding musculature, which can worsen the symptoms.
Some cases of sciatica resolve themselves within about 18 months. But, don’t wait to see if that will happen. It’s important to know what the cause of your sciatica is – a herniated disc is much more likely to resolve, for instance, than spinal stenosis or spondylolisthesis.
Clinical tests for sciatica
Examples of clinical tests for sciatica may include:
- Straight leg raise (SLR) test. This test includes the patient lying on his/her back and lifting one leg at a time with the other leg flat or bent at the knee. A pain encountered while lifting the affected leg usually indicates sciatica.
- Slump test. This test includes the patient seated upright with hands behind the back. The patient bends (slumps) forward at the hip. The neck is bent down with the chin touching the chest and one knee is extended to a degree possible. If pain occurs in this position, sciatica may be present.
These tests, however, may be positive only when the sciatic nerve is mechanically compressed at any point along its origin, such as from a herniated disc. Other causes of sciatica such as inflammation or chemical irritation of the nerve may not cause pain in these tests, so it’s important not to self-diagnose the cause of your pain.
Your doctor may recommend various invasive therapies, injections, physical therapy, even traction or surgery depending on the cause of your sciatica. And, that may be the route you choose.
There are less invasive alternative therapies that may also help. The National Institutes of Health state that acupuncture is significantly more effective than conventional medication in the treatment of sciatic pain. Manual therapies can also help you heal.
In some cases, sciatica can be controlled in just a few sessions. Other more severe causes may require ongoing treatment, or even multiple therapies. Adding functional and corrective exercises will give you the techniques necessary to help you control your sciatic pain.
The most important consideration is to get you comfortable again, and that’s what I do best. Regardless of whether you choose traditional massage or the advanced techniques of bodywork therapies, the goal is to get you back to living your best life!