As my dad always used to say if I had a nickel for every time…. That phrase applies nicely to this diagnosis, if I had a nickel every time I saw this diagnosis written on a prescription or if I had a nickel for every time someone asked me about this diagnosis at a party, I would be be retired by now. This has become what I like to refer to as a garbage can diagnosis. People have come to use this term to define any condition where you have pain going down your legs, whether it be one or the both of them, whether that pain is intermittent or constant. So basically if you have pain in your back and it goes down your legs, some medical professionals will tell you you have sciatica.
What people don’t understand is that while sciatica is a legitimate diagnosis it does not really provide any information or insight into your condition. Sciatica, in its most rudementary form, is just an irritation of the sciatic nerve. The sciatic nerve is a large nerves that runs down from the back into the legs.
The reason I state that scatica is a garbage can term is the fact that this irritation causing the inflammation could be coming from a number of sources. And where that irritation is coming from allows for a more accurate diagnosis and the ability to possibly cure the inflammation. A lot of time there should be a different diagnosis altogether and this differential diagnosis will more accuratley describe the problem.
This blog is only going to touch on a few possible scenarios of sciatica. If you feel like you have sciatica or something discussed in this blog, you should be seen by a healthcare professional and not try to make the determination yourself, as other factors besides the one I am going to list will go into it.
The first source of ‘sciatica’ could be a herniated or bulging disc. When a disc is herniated it presses on nerves that run down the back and leg. This can present as pain, numbness or tingling. Most often when you are dealing with a nerve issue that is being irritated by a herniated disc you will feel numbness and tingling. Herniated discs can require surgery if they are bad enough and can actually begin to attack motor function, meaning limbs can actually stop working. If you have ever heard of drop foot, this is a nerve issue, the foot is literally unable to be picked up when walking and it drops. There is no pain associated with this it is just an inability to do it. Most often when there is numbness/pain/tingling going down both legs this is indicative of a disc disorder and not a muscle imbalance. Physical therapy for herniated discs involves stabilization of the spine through abdominal exercises in order to help support the disc that is bulging.
Another cause for ‘sciatica’ is the tightening of the piriformis muscle. This muscle is shown in the above picture. As this muscle gets shorter in length and it can begin to rub up against the sciatic nerve. This can create feelings of pain going down the leg. When refering to this type of sciatica it can also be refered to as piriformis syndrome.
People who have this also report literally having a pain in their butt. This muscle can become so shortened that it begins to rub on the nerve, causing pain down the leg. While this diagnosis can also cause weakness it is not as likely to as the herniated disc. This type of rehab involves manual therapy to relieve the trigger point located in the piriformis and then stretching and strengthening exercises to balance out the muscles that have begun working against each other.
There is also the sciatica that involves both a tight piriformis muscle and a herniated disc. Sometimes a disc becomes herniated and that will irriate the nerve coming out of the back. This irriatation will cause a person to compensate using the muscles in the back and legs in order to help try to lessen the pain. This is an unconscious process so you would have no way of knowing that you are doing it until it is pointed out to you. The rehabilitation process for this is stabilization, manual therapy, stretching and strengthening. One of the key components to rehabing sciatica, no matter what the cause, is posture education.
If you seek out physical therapy, your physical therapist will be able to differentiate from all of the different causes of your pain. Physical therapy will give you a better understanding of posture education and training postural muscles. Physical therapy will also be able to give you clues and show you when you are in an incorrect posture. Beginning physical therapy as soon as any pain or numbness is felt is imperative in order to get the best and fastest results. For more information on physical therapy go to www.totalperformancept.com.
Above are just a few of the differential diagnoses that sciatica could present as, there are many more. It is no doubt that ‘sciatica’ has become an overused term when diagnosing back and leg pain and if you are presented with this diagnosis you should dig deeper to find out the real problem.
Call Total Performance Physical Therapy today to set up your appointment.