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For context, it's estimated that up to as many as 71% of adults will have some form of back or neck pain at some point in their lifetime. The good news is that most of us will recover without the need for surgery, as conservative care such as physical therapy usually gets as good of results when compared to surgery long term or even better.
Sciatica is a condition characterized by pain that shoots or radiates down the leg along the path of the sciatic nerve. The sciatic nerve is formed by a bunch of nerves that come together in your low back, which travels down along your glutes, hips, down the legs and into the feet.
The medical term for "sciatica" is Lumbar Radiculopathy.
Lumbar radiculopathy is where you have loss of strength or numbness down your leg or you have diminished/absent reflexes in your leg (think about when a doctor hits your knee cap to check for reflexes). These 3 symptoms: weakness, numbness or loss of reflexes can occur in some combination or all together.
Lumbar radicular pain is simply pain down your leg that is associated with an irritated nerve root in your low back. Here there is no loss of strength or reflexes, just pain down your leg.
This pain typically occurs when the sciatic nerve (the longest nerve in the body), or low back nerve roots, becomes irritated, or compressed. The discomfort can range from a mild ache to a sharp debilitating pain and is often accompanied by a numbness, tingling, and weakness in the leg as mentioned above.
Sciatica is not a medical diagnosis but rather a symptom of issues such as a herniated disc in the lumbar spine, spinal stenosis, osteoarthritis of the joints of the spine or a compression accident that can cause compression on the nerve and underlying tissue.
Understanding the specific cause of sciatica is crucial for effective treatment and management. If you suspect you have sciatica or are experiencing persistent pain, consulting with a healthcare professional for an accurate diagnosis and a tailored treatment plan is crucial for recovery.
Your low back is made up of 5 lumbar vertebrae (bones) that sit on top of one another. In between each of the vertebra is a gel-like piece of cartilage called the intervertebral disc. Think of the disc as round gel filled cushions. The outer part of the disc is called the annulus, and the inside is called the nucleus which is filled with gel-like material. When we are younger (30 years of age or younger) the disc is made mostly of gel-like material and water. As we get older, the disc dries up. The disc becomes thinner and less flexible, making it easier to injure. At times, the gel inside can push out through the disc and lead to a herniation “bulging disc”. Which can eventually compress, irritate or “pinch” on the nerves of the low back.
In most cases of sciatica, pain starts in the lower back or buttock region and travels down the back of the leg into the calf and foot. You may or may not have low back pain with this. Usually only one side will be painful as it’s rare to have sciatica on both sides but it can happen, usually in older individuals.
There can be many causes of sciatica and low back pain, and because of this, it’s possible to feel pain from the low back injury, in other parts of your body. This is called referred pain. Referred pain is when you have an injury in one area of your body but feel pain in another area of your body (crazy I know). This happens because all the nerves in your body are part of a huge, connected network. This is why it is crucial to understand the root cause of your pain when looking for long term results as the use of painkillers or modalities (heat, ice, TENS Units) only decrease pain temporarily.
When dealing with sciatica you may have mild to intense back pain or no pain at all. Herniated disks sometimes show up on MRI images of people who have no symptoms of low back pain at all. This is why an MRI should not be your only method to diagnose and or treat Sciatica or low back pain. There are usually a lot of different factors that play into sciatica and low back pain.
When a disk ruptures “bulges” and a portion of the disk pushes outside its normal boundaries, it can “pinch” or press on spinal nerves or the spinal cord. This condition is called radiculopathy. This can lead to back pain, numbness, or weakness in the legs.
Symptoms of sciatica may include:
Some factors that may contribute or exacerbate your sciatica pain can be:
Yes, sciatica can be treated and with great results. Most times it can be treated conservatively without needing surgeries, medication, or an injection. The most important factor when treating sciatica is to solve the root cause of your pain so you can get the best results long term.
When thinking about treatment for sciatica we use a very simple analogy that helps get our message across. Lets say the fire alarm goes off in your house. The purpose of the alarm is to protect you and make you aware that there is something unusual is going on, i.e. that there is a fire in your house. The "fire alarm" is like your sciatica pain (its your body’s way of telling you something is wrong) and the “fire” is the root cause. When the fire alarm goes off, you don’t run upstairs and just turn it off, right? Or throw water on the fire alarm? You run through the house with the fire extinguisher, trying to find where the fire is. You try to find out what caused the alarm to go off so you can put it out. Once the fire is out, then the fire alarm will turn off. Same with sciatica! You have to solve the “root” cause of your pain, and then the pain eventually goes away.
This is the same with physical therapy and rehab. If you are just treating the low back with massages, stretches, modalities like a TENS unit, heat or ice your back may feel better in the moment but the pain most likely will come back.
So often you will hear people say “oh when my back pain returns I do these few stretches or low back exercises to help with the pain”. Now if the pain and symptoms return, you are probably not treating the root cause of the injury.
So many healthcare clinicians treat the pain like this and thus show poor treatment outcomes which results in the pain coming back. Why? Because they are not treating the cause of your low back pain and sciatica. Same thing happens when patients depend on injections, nerve blocks and other surgeries which are still not effective long term because the actual problem is not solved, their treatment was just chasing the pain.
The first step in treatment is to identify the root cause of your pain. An individualized treatment approach for your sciatica can lead to a successful outcome for you and resolve your symptoms for the long haul.
Regardless of which physical therapist you chose, a thorough initial evaluation is crucial in identifying the root cause of your sciatic pain. If you see a physical therapist and their evaluation last 10 minutes with a some brief questions, a strength test and range of motion measurements, this is not enough! A proper physical therapy evaluation should be thorough as sciatica pain is complex and typically caused by many different factors.
Typically a physical therapy evaluation will include a combination of test and measures mentioned below:
If you have loss of muscle strength and loss of sensation or very severe pain, special diagnostic tests, such as magnetic resonance imaging (MRI), electromyography, or nerve conduction studies may be needed. Physical therapists work closely with doctors and other health care providers to make sure that you receive an accurate diagnosis and appropriate treatment.
Looking at the research on the topic of low back surgery and pain, most studies show that surgery may provide better short term relief of pain, and faster recovery but long term outcomes (after 2 years) is usually the same with non-surgical management such as physical therapy.
Non surgical management such as physical therapy may be preferable before having the surgery because surgery doesn't guarantee success, it comes with its own risk and cost and long term the outcomes are similar.
I am a physical therapist so there is inherent bias and when making any medical decision you should always get multiple opinions, including from your medical doctor, orthopedic surgeon and other health care professionals.
Below I will leave some excerpts from some research articles with their links in regards to the topic of low back surgery.
Is there one best exercise for low back pain and sciatica? NO!!! There isn't one exercise or one routine that works for all people or all low back pain symptoms. You'll find resources on the internet that will promise a "quick fix" and many times they can provide a temporary or even permanent fix, which is great. However, it is important to set realistic expectations. Even though sciatica has a preferable recovery for most, symptoms don't always get better quickly and can be persistent in peoples day to day lives or become episodic where the sciatica will come and go.
There are many types of exercises that can help aide low back pain and sciatica. A lot of times exercises targeting the hips or upper back may indirectly help improve low back symptoms as our body is like a bunch of standing dominoes. If one area of the body is affected the rest of the body will also be affected.
Below I am going to demonstrate 3 categories of exercises that are usually done for low back pain. These 3 categories of exercises are usually done in some combination with other exercises or modalities that may directly or indirectly help with low back pain/sciatica.
These categories are:
I must preface this by saying that you should consult with a medical professional before trying these exercises as not all exercises are appropriate for everyone even if diagnosed with the same injury. We all have unique bodies, with different demands from our everyday lives and there is no one cookie cutter way to treat sciatica or low back pain.
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