Sciatica, what is it?

‘Sciatica’ is when the Sciatic nerve (that runs from your lower back/ pelvis, all the way down the back of the leg and into the foot) becomes compressed, stretched or inflamed. This leads to pain in the lower back and back of the leg and foot, often accompanied by pins and needles, numbness and/ or weakness in the leg. It is important to note that the leg pain is often worse than the lower back pain. Another common  symptom of ‘Sciatica’ is the inability to pull your foot up when you walk, giving the appearance of dragging the foot when walking.

The Sciatic nerve is one of the most common nerves to injure in the lower extremity due to the many sites of potential injury. 


What causes it?

The most common reason for Sciatic nerve pain is direct trauma or surgery around the hip. Hip fracture and dislocation are also reasons for potential Sciatic nerve entrapment. It has been documented that 1-3% of all hip replacement surgeries result in Sciatic nerve injury. 

Piriformis Syndrome, another term you may have heard of, is another area where the Sciatic nerve can become irritated. If the muscle, Piriformis (which is located deep to the buttock muscles), is overly tight then this can lead to buttock tenderness and pain into the back of the thigh. Prolongued sitting, bending forward and certain hip movements can exacerbate these symptoms, often accompanied by numbness into the back of the thigh.

The nerve then traverses down in between the Hamstrings where a muscle strain can compress the nerve. The Sciatic nerve then divides behind the knee where one branch wraps around the top of the Fibula bone. A fracture here can then lead to pain in the calf and foot, along with pins and needles, numbness and/ or weakness of the ankle and foot.


What can you do?

This is entirely dependent on the reason why the Sciatic nerve is being compressed. As physical therapists, we are trained to diagnose the reason for a patient’s signs and symptoms through special tests. This is where it is important to differentiate between nerve root irritation (where the nerves that exit the spine are inflamed) and peripheral nerve entrapment (where the spinal nerve roots converge) as the signs and symptoms are similar but not the same.

If the Sciatic nerve is being compressed by muscles or tendons, then physical therapy can be very effective in helping to alleviate these symptoms. Very specific stretches and the use of ice and/or heat can also help.

Due to the vast number of causes for low back pain and leg pain, it is best to speak to a physical therapy specialist to help diagnose and treat the area in question as it is important to identify where the origin of pain lies so it can be treated accordingly.

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