A physical therapy and rehabilitation blog covering common athletic injuries. This is an offshoot of my work blog where I cover surgical and non-surgical rehabilitation. This is in no way intended as a blog or journal of the super intricate and technical aspects of therapy and rehab. For that there already is a wealth of information. It is my hope that this can be used to in some way simplify and make readable the truly necessary info that patients are looking for. Feel free to give feedback and or requests of topics. Good luck!
www.rehab101.wordpress.com
www.rehab101.wordpress.com
Sciatica -What is it?
Posted 06-30-2011 at 03:54 PM by big10fan
First off, before we get too far into this, it is important to note that sciatica is a set of symptoms and not a true diagnosis. Just like how low back pain is a symptom, but can have many different causes, so is the case with sciatica. And if you have it or have had it, you know it can be a real pain in the butt!
Lets start with some of the main symptoms of sciatica. Most of the clients that I've worked with display a very typical pattern of pain. It usually starts in the SI region - where the sacrum (base of your spine) connects to the ilium (wide brimmed bone of your pelvis/hips). But it doesn't end there. It most often travels from there down into your butt, down the back of your thigh, and into your lower leg and foot. It usually is a sharp, zapping type of pain (as nerve pain usually is), that can come on in any number of ways depending on the actual cause (which I'll discuss below). Since the sciatic nerve has a motor (muscle) component as well as a sensory (feeling/pain) component, there can be muscle and/or reflex inhibition as well. This may show up as knee buckling or the feeling that your leg is just going to give out on you. Most people experiencing sciatica only have the symptoms on one side, as pain in both legs probably signifies a different (and usually more serious) problem.
The hard part about treating all this is that there can be multiple causes, each with a slightly different treatment method and prognosis (chance for recovery). If the problem is from degenerating discs in the spine (which can lead to spinal and foraminal stenosis), compressed nerve roots may be alleviated from a program designed to promote lumbar flexion and increase abdominal strength. If the symptoms are due to a herniated or "bulging" disc, lumbar extension exercises may help to center the disc back and relieve the pressure on the nerve root. Piriformis syndrom is caused because the sciatic nerve is entrapped underneath a tightened piriformis muscle. This can be treated though stretching, gait training, and even something as simple as orthotics (custom or over-the-counter shoe inserts).
As mentioned above rehab will vary depending on the source/cause of the sciatica. Often in the early/acute stage therapy will focus on abdominal bracing exercises, which focus on activating the transverse abdominus (TA) muscle. The TA is the body's natural back brace in that it provides support for the low back. Other exercises will generally be performed in either a flexion biased (Williams) or extension biased (McKenzie) posture - click here for a description of each method. Modalities like electrical stimulation or a TENS unit may be helpful in controlling pain levels and decreasing the need for pain medication. Advanced exercises will focus on continuing to strengthen your abdominal muscles, as well as hips, legs, and even your back muscles.
Nerve pain can take quite awhile to get rid of. Persistent sciatica will usually warrant further testing (MRI or CT scan) to determine if there is disc involvement. Surgery is only recommended in serious cases or where long-term nerve damage is threatened (like severe spinal stenosis). Most surgeons and neurologists will recommend injections and conservative measures like physical therapy before even considering serious measures. Don't lose heart, it may take awhile but you'll get there. Don't give up.
Pub Med article - Sciatica - PubMed Health
Web MD - Sciatica | Sciatic Nerve Pain | Causes, Diagnosis, and Treatment of Sciatica
Wikipedia sciatica article - Sciatica - Wikipedia, the free encyclopedia
Piriformis syndrome - Piriformis syndrome - Wikipedia, the free encyclopedia
Flexion vs Extension based rehab - Back exerecise -- Williams Flexion versus McKenzie Extension
Lets start with some of the main symptoms of sciatica. Most of the clients that I've worked with display a very typical pattern of pain. It usually starts in the SI region - where the sacrum (base of your spine) connects to the ilium (wide brimmed bone of your pelvis/hips). But it doesn't end there. It most often travels from there down into your butt, down the back of your thigh, and into your lower leg and foot. It usually is a sharp, zapping type of pain (as nerve pain usually is), that can come on in any number of ways depending on the actual cause (which I'll discuss below). Since the sciatic nerve has a motor (muscle) component as well as a sensory (feeling/pain) component, there can be muscle and/or reflex inhibition as well. This may show up as knee buckling or the feeling that your leg is just going to give out on you. Most people experiencing sciatica only have the symptoms on one side, as pain in both legs probably signifies a different (and usually more serious) problem.
The hard part about treating all this is that there can be multiple causes, each with a slightly different treatment method and prognosis (chance for recovery). If the problem is from degenerating discs in the spine (which can lead to spinal and foraminal stenosis), compressed nerve roots may be alleviated from a program designed to promote lumbar flexion and increase abdominal strength. If the symptoms are due to a herniated or "bulging" disc, lumbar extension exercises may help to center the disc back and relieve the pressure on the nerve root. Piriformis syndrom is caused because the sciatic nerve is entrapped underneath a tightened piriformis muscle. This can be treated though stretching, gait training, and even something as simple as orthotics (custom or over-the-counter shoe inserts).
As mentioned above rehab will vary depending on the source/cause of the sciatica. Often in the early/acute stage therapy will focus on abdominal bracing exercises, which focus on activating the transverse abdominus (TA) muscle. The TA is the body's natural back brace in that it provides support for the low back. Other exercises will generally be performed in either a flexion biased (Williams) or extension biased (McKenzie) posture - click here for a description of each method. Modalities like electrical stimulation or a TENS unit may be helpful in controlling pain levels and decreasing the need for pain medication. Advanced exercises will focus on continuing to strengthen your abdominal muscles, as well as hips, legs, and even your back muscles.
Nerve pain can take quite awhile to get rid of. Persistent sciatica will usually warrant further testing (MRI or CT scan) to determine if there is disc involvement. Surgery is only recommended in serious cases or where long-term nerve damage is threatened (like severe spinal stenosis). Most surgeons and neurologists will recommend injections and conservative measures like physical therapy before even considering serious measures. Don't lose heart, it may take awhile but you'll get there. Don't give up.
Pub Med article - Sciatica - PubMed Health
Web MD - Sciatica | Sciatic Nerve Pain | Causes, Diagnosis, and Treatment of Sciatica
Wikipedia sciatica article - Sciatica - Wikipedia, the free encyclopedia
Piriformis syndrome - Piriformis syndrome - Wikipedia, the free encyclopedia
Flexion vs Extension based rehab - Back exerecise -- Williams Flexion versus McKenzie Extension
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