Is it really sciatica? How do we treat it?

Sciatica is one of the most common symptoms that we see in the office. So what is sciatica? Mayo Clinic defines sciatica as pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the buttocks and down each leg.

So let’s get into even more detail of what is the sciatic nerve. The sciatic nerve is a connection of six nerves that come out of the low back and connect together, roughly in the middle of the gluteal muscles. There are multiple branches that come off the sciatic nerve that sends the innervation aka the electrical signal of the nervous system throughout the entire leg.

Usually true sciatica is causes by some type of irritation of the nerve itself. The pirirformis is the muscle that gets the most hate for causing sciatica, but it can be any of the muscles of the posterior hip/ thighs region causing compression to the nerve and giving the sciatica symptoms. What we feel is more common at our office is the “sciatica“ symptoms are coming from a spot before the six nerves joined together and create the sciatic nerve. These symptoms can stem from stenosis or narrowing of the hole where the nerve comes out, a disc herniation / slip disk or even poorly moving lumbar spine joints.

So if it's not truly sciatica, what is it? We think the answer is lumbar radiculopathy. This is probably the most common symptom that we see in our office. We like to define Lumbar radiculopathy is any pain that is experienced in the leg from the hip all the way to the bottom of the foot that the pathology happen before the sciatic nerve starts. But in reality, the treatment all starts off with the same assessment, Mckenzie Therapy Assessment

So what do we do to assess and treat sciatica and lumbar radiculopathy? In our office we use principles of McKenzie therapy where we try to find what is a directional preference of movement. We have our patient move/stretch in multiple directions/ planes of motion. It could be doing press ups, back bends, forward fold or side glides. It can be any motion that improves range of motion, decreases pain or centralizes pain. If we can find a way to move the body to take pressure off the nerve, the symptoms tend to get better whether it's true sciatica or lumbar radiculopathy.