By Nick Mazzone, PT, DPT, CSCS
What is Sciatica?
Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body. The spinal nerves that become irritated are typically those that eventually come together to form the sciatic nerve (from spinal level L4 to S3). Sciatica is not a permanent condition and does not typically require surgical intervention.
What causes sciatica?
These symptoms are typically caused by excess pressure on a nerve after it exits the lumbar spine (lower spine). This pressure can come from a herniated disc, arthritis in the lumbar region, and other conditions in which the space that the spinal nerve travels becomes compressed or shrinks.
How can physical therapy help improve this condition?
This condition is relieved by decompressing the region in which these spinal nerves travel. This can be achieved through a specific mobility and strengthening program that includes postural education and awareness training. These specific exercises will depend on the location at which the nerve is being irritated. Generally speaking, in order to decrease pressure in the lumbar region of the spine, you must be mobile in not only the lumbar spine but the thoracic region (mid back) and hips. This will help take pressure off the low back by allowing a more even distribution of movement. Think about it this way: If you are lacking proper mobility in your thoracic spine, your lumbar spine will have to make up for this lack of mobility. This can lead to increased stress and strain in this area. The same idea works for the hips.
Postural training is important in helping to decrease pain and inflammation in the low back. The pelvis and lower spine are anatomically connected (the lower spine actually sits in the pelvis), and therefore movement between the two will be interrelated. The position of the pelvis will dictate the posture in our lumbar spine during all activities (including at rest!). Depending on where the nerve irritation is occurring, this positioning of the pelvis will either increase or decrease pressure on the nerve. If the irritation is occurring at the point where the nerve exits the spinal canal (at the nerve root), extension of the lumbar spine should help alleviate the pressure by “opening” the region where the spinal nerves exit, while flexion of the lumbar spine may increase pressure due to “closing” of the region. Refer to the picture above for a visual of this phenomenon. “Lordosis” is known as lumbar spine extension, while “flat” spine refers to a flexed spine. The picture below demonstrates these movements.
Check out this video that demonstrates a simple mobility exercise for the sciatic nerve to help alleviate your symptoms of sciatica:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Main photo of sciatica pain in leg retrieved from https://www.magnilife.com/blog/5-effective-ways-for-dealing-with-sciatica-pain/
Photo of irritated nerve retrieved from http://arizonapaintreatmentcenters.com/from-dr-craig-peterson-mva-sciatica
Photo of lumbar flexion and extension retrieved from https://b-reddy.org/making-pull-ups-and-burpees-more-shoulder-and-lower-back-friendly/
Photo of pelvis position and lumbar spine retrieved from https://body-motion.co.uk/injuries/postural-pain/improve-your-sitting-posture/