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The Infamous ‘Sciatica’ Deconstructed: Sciatica vs. Back Pain

If you’ve been diagnosed with sciatica, you likely have lots of questions. In order to understand this common diagnosis, let’s start with the most important question, What is sciatica? Some people think it’s back pain, some leg pain. So what is it? Sciatica is nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area. The sciatic nerve is the longest and thickest nerve in the body. It’s actually made up of five nerve roots: two from the lower back region called the lumbar spine and three from the lowest part of the spine called the sacrum. The five nerve roots come together to form a right and left sciatic nerve. On each side of your body, along the back of your leg, the sciatic nerve runs through your hips, buttocks and down your leg, ending just below the knee. The sciatic nerve then branches into other nerves, which continue down your leg and into your foot and toes.

A true injury to the sciatic nerve, aka “sciatica,” is actually rare, but the term “sciatica” is commonly used to describe any pain that originates in the lower back and radiates down the leg. Common nerve symptoms include irritation, inflammation, compression or a pinching sensation in your lower back and down the back of your leg.

If you have sciatica, you experience mild to severe pain anywhere along the path of the sciatic nerve—that is, pain starting in your low back, and/or the back of your hip/buttock and/or down the back of your thigh or leg. It can also cause muscle weakness in your leg and foot, numbness in your leg, and an unpleasant tingling pins-and-needles sensation in your leg, foot and toes.

People often describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting or jolts of pain. Others describe this pain as burning, electric or “stabbing.”

The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when you twist your upper body. A forced and sudden body movement, like a cough or sneeze, can also make the pain worse. Sciatica typically affects only one side of the body.

Is radiculopathy the same as sciatica?

Radiculopathy is a broader term that describes the symptoms caused by a pinched nerve in the spinal column. Sciatica is a specific type, and the most common type, of radiculopathy.

What are some possible causes of sciatica?

Sciatica can be caused by several different medical conditions. The most common cause of sciatica is a herniated disc that causes pressure on the nerve root. Disks are the cushioning pads between each vertebrae and when there is pressure on the vertebrae, the gel-like center of the disc can bulge or herniate through a weakness in the outer wall and press on the nerve root that leads into the sciatic nerve. This can occur during a bending or twisting motion in your activities of daily living.

The second most common cause of sciatica is degenerative disc disease (DDD) in the lower back. DDD is the natural wear down of the disks between the vertebrae, which shortens the disc height and leads to nerve passageways becoming narrower, a condition called spinal stenosis. Spinal stenosis is an abnormal narrowing of the spinal canal. The narrowing can pinch the sciatic nerve roots as they leave the spine.

Spondylolisthesis, which is a slippage of one vertebra on top of another so that it is out of line with the one above it, is another common cause for sciatica. This slippage creates a narrowing of the opening through which the nerve exits, which creates pressure on the nerve creating pain along the nerve path. Additionally, osteoarthritis or bone spurs (jagged edges of bone) can form in aging spines and compress lower back nerves. This is sometimes termed Spondylosis.

Other common causes of sciatica are trauma to the sciatic nerve and piriformis muscle syndrome. Piriformis syndrome is a condition that develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms. This muscle lays right over the sciatic nerve and when it spasms, or gets tight, it can put pressure on the nerve and irritate it, causing pain.

The most dangerous cause of sciatica is Cauda Equina Syndrome. This is a rare but serious condition that affects the bundle of nerves at the end of the spinal cord called the cauda equina. This syndrome causes pain down the leg, numbness around the anus and loss of bowel and bladder control.

How can I tell if pain in my hip is a hip issue or sciatica?

Hip problems, such as arthritis in the hip, usually cause groin pain, or pain when you put weight on your leg or when the leg is moved around. If your pain starts in the back and moves or radiates towards the back of the hip or down the back of the leg and you have numbness, tingling or weakness in the leg, sciatica is the most likely cause.

How is sciatica diagnosed?

Your healthcare provider will review your medical history and ask about your symptoms.

During your physical exam, you will be asked to walk so that your healthcare provider can see how your spine carries your weight. You may be asked to walk on your toes and heels to check the strength of your calf muscles. Your provider may also do a straight leg raise test. For this test, you’ll lie on your back with your legs straight. Your provider will slowly raise each leg and note the point at which your pain begins. This test helps to pinpoint the affected nerves and determines if there is a problem with one of your disks. You will also be asked to do other stretches and motions to pinpoint pain and check muscle flexibility and strength.

Depending on what your healthcare provider discovers during your physical exam, X-rays, MRI and EMG tests may be done. In addition, your healthcare provider can refer you to physical therapy to get a customized treatment program.

How can Physical Therapy help sciatica and low back pain?

If someone has sciatica, physical therapy can help! Your physical therapist will evaluate you and treat you based on the findings and the signs and symptoms of the special tests used during the evaluation. Using manual techniques such as soft tissue mobilization and myofascial release, as well as special exercises and stretches, the physical therapist will decrease the soft tissue restrictions and improve movement patterns to decrease the impingement on the sciatic nerve and improve mobility of the restricted joints. The therapist will also provide you with an exercise plan to help strengthen your core and leg muscles in order to return you to your previous level of function. Depending on what is causing the sciatica, the physical therapist will educate you on appropriate exercises to perform for a home exercise program.

In addition, the physical therapist will educate you on changing certain postural habits that may be contributing to the pain. Suggestions may include setting a timer to get up from a chair every 30-60 min, using a lumbar roll in your chair, sitting with feet on the floor with hips higher than knees and making sure the computer work station is set up at the right height. Lastly, they may include some tips such as not sitting with your wallet in your back pocket, which could place undue stress on your sciatic nerve.

Physical therapists understand how to address your pain as quickly as possible with the least invasive treatments available, so that you can get back to your extracurricular activities, sports or activities of daily living.

Jessica Lowy and Michal Porath are owners at Prime Orthopedic Rehabilitation, 111 Dean Drive, Tenafly NJ 07670. To schedule an appointment call 201-503-7173. www.Prime-Rehab.com

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