By Fortino Gonzalez, PT, Dip MDT, FAAOMPT, OCS
Everyone knows at least one person that is dealing with or has dealt with an episode of sciatica. Sciatica is a medical condition characterized by pain, numbness, tingling and/ or weakness that may go down
into one or both lower extremities below your knee that may or may not produce lower back or buttock pain. If you think this definition is confusing, try doing a Google search, or better yet, go and see a medical professional that treats sciatica. If you see 10 different clinicians, you may get 10 different opinions. Let’s strip it down and help you make better sense of this condition that affects up to 40 percent of North Americans at least once in their lives. Most of these cases will resolve spontaneously over the course of six to eight weeks no matter what you do; however, the recurrence rate can be as high as 88 percent, and with each recurrence the episode is typically more debilitating, symptoms are more intense, and they travel further down into the leg and take longer to resolve.
Sciatica is often referred to as a lumbar radiculopathy by many practitioners, which in essence implies that a nerve root from your lower spine is being compressed causing symptoms into a specific nerve distribution pattern known as a dermatome. The most common analogy I use when explaining this to patients is the “funny bone” experience that we have all had the displeasure of going through. If you compress your “funny bone” which is actually your ulnar nerve with enough force, you will experience symptoms and/or pain along the path of that same nerve. Compress your “funny bone” with enough force, and your fourth and fifth digits will quickly let you know. So, put simply, sciatica is caused by abnormal compression of a nerve that runs into your lower extremity. That being said, the solution to this problem lies in finding a way to take the pressure off the nerve. Symptoms or pain will be influenced by position, posture, and/ or movement. If certain positions or movements increase your pain, then there should be certain positions or movements that will in turn decrease or abolish your symptoms/pain.
About 90 to 95 percent of sciatica cases are caused by a disc pressing on one or more lumbar or sacral nerve roots. The remaining 5 to 10 percent of these cases can be caused by spinal stenosis (bone spurs, spondylolisthesis, or inflammation), “piriformis syndrome”, or pregnancy with less than one tenth of one percent of cases being attributed to spinal tumors. In a few cases if the nerve is compressed with enough force over a prolonged period of time, the patient may experience lower extremity weakness (foot drop) or bladder dysfunction (bladder retention) and/or loss of anal sphincter control causing bowel dysfunction (cauda equina syndrome); all of which require immediate medical care by your physician. About 66 percent of the time, patients report an insidious onset, meaning that there was not a one time incident that caused their symptoms/pain. In these cases we must take a hard look at what that patient is doing throughout their day helping them identify potential sources, and contrary to popular belief, seldom is it the bed.
The bare essence is that the vast majority of sciatica cases are influenced by position, posture, and/or movement; thus, it should be evaluated with this in mind. Simply put, if you treat the symptom, in this case the leg pain, you will be “chasing your tail” in hopes that the problem will resolve itself. Generally speaking, the stretching of a compressed nerve root is highly discouraged as this can often make the nerve root more angry and irritated, which could lead to further problems. It is well documented that sciatica needs movement; however, the question becomes do you want to be specific with your movement (Mechanical Diagnosis and Therapy Assessment guided by the evidence) or general (try the “sciatica exercises” that your well meaning friend or practitioner gave you)?
Fortino Gonzalez is a physical therapist, Diplomat of the McKenzie Institute, Certified in Mechanical Diagnosis and Therapy (Dip MDT), Fellow of The American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), and a Board Certified Orthopedic Clinical Specialist in Physical Therapy (OCS) serving the Rio Grande Valley from his practice, McAllen Physical Therapy. To learn more, visit www.fortinogonzalezpt.com or call (956) 661-1964