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How to Assess Sciatica

Body CompositionPeople often have pain without injury or accident.  They don’t know why they have it and often forget when or how it started.  Pain behind the leg is often referred to by lay people as sciatica, but what is it really?  The sciatic nerve is formed from a group of nerves that exit the side of the spine and are rootlets off the spinal cord.  They join together to form the sciatic nerve which lies deep under the buttock, posterior thigh, and calf muscles and extend into the foot.  This is the power supply to the leg bringing it vital electrical information.  People who have  damage to this nerve may have pain, numbness, or tingling partially or fully down the leg and into the foot and toes.  If the nerve is severed, it would render you unable to move the leg or feel sensation such as hot, cold, or pressure.

People with sciatic pain generally complain that it is worse with sitting or standing more than 20 minutes.   Patients often avoid twisting, bending, and lifting due to increased pain.  People often wake several times per night due to increased low back or leg pain and may have trouble returning to sleep due to pain.  They may report increased pain with coughing or sneezing.  They may be stiff in the morning for 20 minutes, then loosen up with activity.

To complicate matters, there is a little muscle called the piriformis.  It is a hip external rotator and lies deep within the buttock.  This muscle often becomes very tight and painful when you have chronic and severe low back pain.  Because the piriformis lies directly over the sciatic nerve, when tight it may mimic true sciatica.  Piriformis syndrome may cause people to have leg pain, however the pain does not extend into the foot.  It is important to assess the cause of the leg pain to ensure proper treatment.

Often patients like to ask their doctor for an MRI so they know for sure what the problem is.  Most skilled physicians, chiropractors or physical therapists will be able to perform a simple exam to determine the cause of your leg pain without need for an MRI.  Treatment may consist of joint mobilization or manipulation depending upon the practitioner from whom you seek treatment.  As the soft tissue always tightens up around the injured area, this should be treated too.  Patient education is extremely important:  ice 30 minutes several times per day, avoid the positions or activities that increase the pain and change positions often.

Mary Boyd, MS, PT is the owner of Mountain View Physical Therapy.  Contact her at 290-5575 for more information about sciatica.

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