When we hear a patient tell us they have sciatica, we are always a little weary because most of the time it's not sciatica or remotely close to their symptoms being close to sciatic-nerve pain. And that's okay, it's not the general population's job to know or understand the terms, however, it is something we hear nearly every day, and understanding how we address it and treat it are important.
First, the sciatic nerve is a large confluence of nerves originating in the lower lumber spine and going down the back of the thigh and calf to the bottom of the foot. Sciatica commonly refers to radiation from the spine down the back of the thigh and stopping at the knees. The radiation can feel like numbness, tingling, shooting, or sharp pain.
Second, very rarely is it the actual sciatic nerve that has become affected, but more the nerve root or spinal cord. From a potential lumbar disc derangement (fancy words for disc protrusion, herniation, extrusion, or sequestration), there can be physical or chemical irritation of the nerve root or spinal cord resulting in pain traveling from the lower back down the back of the leg. THIS is what we explain to our patients after examining a sciatica patient. This is the most important and understanding why addressing the spine becomes the most important part.
Third, the hamstring tightness commonly associated with sciatica is not actually a hamstring issue. What we mean is the sciatic nerve is under the hamstring muscles. Irritation of the nerve roots can result in the sciatic nerve being pissed off as well which then results in "tension". Most perceive this tension as hamstring tension, however, it is mostly neurological tension that results in the sensation of hamstring tightness. There are simple tests to determine this and are used for the diagnosis of lumbar disc derangements with radiculopathy.
Once a proper diagnosis is established, we begin a trial of conservative care. Depending on the severity and functionality or the patient, we may or may not refer for an MRI of the lumbar spine or refer out for a neurological consultation. If treatment is deemed appropriate, we begin with a combination of hands-on therapies to manage pain and physiotherapy to enhance mobility, stability, and function.
During intense, acute bouts of sciatica, we may place more emphasis on the pain-management aspect during the initial stages to provide relief and allow the patient to be more comfortable performing their rehab. This typically includes a combination of adjusting, Winback Tecar therapy and using the NxPro (pulsed direct current). Adjusting is to enhance mobility and reduce pain, while the Winback Tecar therapy and NxPro aid in reducing chemical irritation, reducing muscle spasms, and flood nociceptors to help reduce symptom intensity.
The physiotherapy component of treating sciatica during the early stages includes directional preference and end-range loading to increase the mobility of the spine and aid in any antalgic leans if present (think leaning the side or forward because of the pain). Once range of motion is restored, hip mobility exercises, core stability exercises, and nerve flossing or tensioning exercises are commonly prescribed.
Check out this Instagram video for our recommended exercises for sciatica!
If you've been dealing with sciatica or sciatic-like symptoms, it's time to stop following cookie cutter rehab and invest in the opportunity to learn how to manage your pain, increase your functionality, and get your life back. Schedule your FREE 30-minute Discovery visit today at strengthchiro.com and visit our offices in Tampa and Pinellas Park
