#20: Sciatica: Diagnosis and Treatment Strategies

Rehab Science with Tom Walters

Sciatica is a umbrella term that refers to pain and/or altered sensation (numbness, tingling, heaviness) that travels into the sciatic nerve distribution or that of one of the lumbosacral nerve roots that makes up the sciatic nerve (L4-S3).

Sciatica is caused by an irritation or inflammation of the sciatic nerve or one of the nerve roots that forms the sciatic nerve. It is often seen with disc bulges and herniations and spinal stenosis. Sciatica can also be caused by spondylolisthesis and, in rare cases, spinal tumors.

Sciatica has a lifetime incidence of 10-40%, so many of us will experience this issue at some point in our lifetime.

Sciatica is diagnosed via clinical testing such as the straight leg raise and slump tests and a description of symptoms that fits with the sciatic nerve’s motor and sensory distributions.

Sciatica is typically aggravated with lumbar flexion (bending forward), rotation or twisting of the spine and coughing.

Treatment typically involves initially reducing acute symptoms with ice and heat, NSAIDs, avoiding provocative positions and activities (usually lumbar flexion) and muscle relaxants, in some cases.

Rehab revolves around behavior modification, short courses of spinal mobilization and/or manipulation, nerve mobilizations and therapeutic exercises that target the hip and trunk with a primary emphasis on reducing neural irritation (centralization). Usually, mobility exercises help most initially and then strengthening exercises are added later.

Most cases resolve in 4-6 weeks. If symptoms don’t improve after 6-8 weeks or there is a progressive loss of motor function (muscular weakness), then imaging may be helpful to rule out more severe disc bulges or herniations and other potential tissue causes.

Clinicians should lookout for red flags such as progressive LE weakness, loss of bowel or bladder function, saddle paresthesia as these can point to acute neurological deficits.

Here are links to YouTube videos that can help if you are experiencing sciatica right now.

Sciatic Nerve Mobilization Exercises

Low Back Disc Herniation Exercises

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