One of the most common complaints seen by orthopedic surgeons, physical medicine specialists, as well as primary care physicians is “sciatica“. But, what exactly is it?
Sciatica is a symptom of pain in the leg, at times associated with tingling and numbness, and even weakness. There are many causes of sciatica. It is important to distinguish the source of the pain, as the treatments will depend on the precise diagnosis.
The most common cause of sciatica is lumbar disc herniation, leading to radiculopathy, commonly known as a pinched nerve in the back. Another source from the back is spinal stenosis, which is narrowing of the central canal from either degeneration (arthritis), disc herniation, spondylolisthesis (slippage of one vertebrae over another), and tumors.
Another very common condition is piriformis syndrome. Piriformis muscle is a short thick external rotator of the hip that is deep in the buttock area. Injury or spasms of this muscle lead can lead to compression on the sciatic nerve, which is usually directly underneath that muscle. Sacroiliac joint pain, (joint between spine and pelvis) and sacroiliitis can also lead to pain down an extremity. This should not be confused with nerve pain.
It is imperative to properly diagnose the source of sciatica.
Tests such as X-rays, MRI, and EMG (electromyography and nerve conduction study) are usually performed to arrive at a diagnosis.
Treatments in Physical Therapy will be dictated depending on the results. For example, disc herniations are usually improved with extension exercise, whereas spondylilisthesis protocol involves flexion. Piriformis syndrome treatments are geared toward that area.
Cortisone injections, such as spinal epidural steroid injections, sacroiliac injections, piriformis injections are also considered.
The good news is most of the causes of sciatica will improve non-surgically.
If you are experiencing back, hip, or leg pain, it is important to seen by a specialist, which will lead to quicker road to recovery.