Low back pain is one of the more common complaints we deal with at Strive Physiotherapy & Performance. Often times, our clients will express concern about having sciatica, as they may have had it, thought they had it, or knew someone who had it in the past. Sciatica is sort of a complicated topic and often times, any back pain, or any leg pain is confused with sciatica.
This blog post aims to clear up a few things about sciatica. We will discuss:
What is Sciatica?
In short, sciatica is a neurological (nerve) problem that occurs when the sciatic nerve is entrapped or irritated. What exactly does a nerve do? In short, nerves send the signals that are responsible for telling our muscles to move, and for telling our brain how/what we feel.
Having sciatic nerve (“neurological”) symptoms means that you will be experiencing fairly intense pain in the buttock area, and down your leg. You may also experience 1 or more of the following:
The sciatic nerve is big, and it covers a lot of ground within our bodies. In fact, we have 2 sciatic nerves, one for the left low back and leg, one for the right low back and leg.
Our lumbar and sacral spines have 5 nerve roots each (labeled L1, L2, L3, L4, and L5; S1, S2, S3, S4, and S5). Each sciatic nerve comes from 5 different nerve roots within the lumbar and sacral spines. Our sciatic nerves branch from L4, L5, S1, S2, and S3 on each side.
The picture on the left is a front view and shows the left sciatic nerve coming off of the lower 5 nerve roots (L4-S3). It also shows a ‘piriformis’ muscle (remember that for later!). The picture on the right shows how the 5 nerve roots (L4-S3) come together to make the sciatic nerve (big green one!)
Although those 5 nerve roots come together to make 1 sciatic nerve, our bodies tend to keep track of each nerve root. We know that because we have ‘myotomes’ and ‘dermatomes’. A group of muscles that are supplied by a single nerve root is deemed a myotome. A dermatome is an area of skin that is mainly supplied by a single nerve root. Here are some examples:
Most common sciatica symptoms:
Much like almost every injury, each sciatica case can present somewhat differently. That being said, the most common symptoms include:
What can cause sciatica?
Many different things can cause sciatica. Some of the more common causes include:
What else could it be?
Sciatica can sometimes be misdiagnosed, which is why it’s important to get a proper assessment. Other possibilities include:
The last one, piriformis syndrome, has many of the same symptoms as sciatica, so I’ll try to differentiate things a little bit.
Both sciatica and piriformis syndrome will present with a variety of symptoms including back/buttock/leg pain, numbness/tingling, and/or walking difficulties.
Here are some differentiating features:
What can I do about it?
First and foremost, it is important to have your pain and injury assessed by a healthcare provider you trust. Sciatica can come from a variety of sources, and it is important to try and determine the most likely source. This is because, depending on the source, the management can be completely opposite. For example, if you have sciatica due to a disc herniation pressing on the L5 nerve root, then you will likely prefer extension-type exercises. However, if you have sciatica from spinal stenosis, then you will likely prefer flexion-type exercises. Additionally, if you do the opposite exercises than what would be most preferable, you may actually make yourself worse!
If you think you may have sciatica, one exercise you can do to try and improve how well your nerve is moving is called a sciatic nerve floss. Here’s a good video of a sciatic nerve floss:
Remember to look up as you bend your foot, and look down as you straighten your foot. Timing is important, and doing it opposite (i.e. bending foot up while looking down), can make you more irritable. You should only complete this exercise if it feels relieving or if it feels like a “nothing” feeling. If it hurts, stop, and consult your physiotherapist.
How do I know if I’m getting better?
I will try to keep this section short and sweet. If you’re getting better, your pain will be lessening in intensity and frequency, and you should be finding it easier to move around (walk, get out of bed, etc).
One important thing to note is that, as you heal, your pain will likely centralize towards your back (i.e. move UP your leg). This is a good thing. The downside, however, is that it might make you feel more intense pain in your bum or back. That being said, as long as you have less (or no) pain further down your leg, that’s actually ok!
In conclusion, sciatica is a painful neurological (nerve) injury that usually affects only one side of your back and leg. There are many potential causes of sciatica, and many other things it could actually be, meaning it’s important to get a detailed assessment.
Do you think you have sciatica? Are you interested in decreasing your pain? At Strive Physiotherapy & Performance, we are committed to providing an in-depth, one-on-one assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
As physiotherapists, friends and family often ask us:
“Hey, I have a [insert negative adjective (i.e. painful, weak, tight)] [insert body part (i.e. back, knee, shoulder)], how do I fix it?”
In fact, you may have asked a physiotherapist you know the same question, hoping to get some quick, free advice. The unfortunate part is you probably got a vague, or less than satisfactory answer.
I promise you that it’s not because we don’t like you, we don’t want to give free advice, or we don’t know the answer, it’s almost always because the answer isn’t that simple. The answer is, in almost all cases: “It depends”.
Now of course, in many situations, there are some general strengthening or stretching exercises that are safe for the majority of the population, and may help you a little bit. But what if these exercises aren’t appropriate, what if they’re not helpful, or worse, what if they’re harmful?
In short, physiotherapists are trained to assess, diagnose, and treat a variety of musculoskeletal, neurological, and cardiovascular conditions. “Treat” is listed third because the first two (assessing and diagnosing), are crucial first steps in arriving at the appropriate treatment (aside: in some cases, an exact “diagnosis” is not completely important providing red flags are ruled out, and a thorough assessment is conducted, but those are thoughts for another blog post).
While a thorough assessment is important for all areas of the body, it is especially true for the low back/spine. For example, while a ‘disc protrusion/herniation’ and ‘spinal stenosis’ can both cause back pain and radiating symptoms down the leg(s), they are often treated in nearly opposite ways. Further, using the “stenosis treatment” (i.e. flexion pattern), to treat a disc herniation can actually worsen pain and symptoms in many cases, leaving you frustrated and irritable.
The purpose of this blog post is two-fold.
First, it is to help you understand that, unfortunately, not all injuries, or people for that matter, can be treated equally, with the same techniques.
Second, it is to encourage you to seek out a good physiotherapist who will do a thorough assessment to determine the most appropriate and safe treatment for you.
In closing, although the quick answer to “how can I fix my sore back?” may not be the most immediately gratifying, it should comfort you to hear a physiotherapist reply with two simple words: “It depends”.
At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy and Performance
Strive Physiotherapy & Performance
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