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physical therapy Bloomfield Hills MI
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Pinched Nerves/Sciatica

Sciatica is characterized by excruciating pain and paresthesias in the sciatic nerve distribution or associated lumbosacral nerve root and can severely impact the quality of life of those affected.1 It is not a medical condition but a symptom of a medical problem. The medical term for sciatica is lumbar radiculopathy. It is irritation, inflammation, pinching, or compression of a sciatic nerve root. Sciatica is typically only felt on one side of the body. Symptoms can include pain, weakness, numbness, or tingling in the leg.

What is the sciatic nerve?

The sciatic nerve comprises nerve roots from L4 to S3. With a diameter of up to 2 cm, the sciatic nerve is the body’s largest nerve.1 However, it isn’t just a single nerve but rather a bundle of nerves that comes from five nerve roots branching off your spinal cord. The sciatic nerve extends from the back of your pelvis down the back of your thigh down to your knee. You have two sciatic nerves – one on each side of your body.

What is Sciatica?

Sciatic most commonly occurs in people between 30 and 50 years old. The pain can be mild to severe and runs anywhere within the nerves connecting to the sciatic nerve. Symptoms can affect your lower back, hips, buttocks, or legs. Sciatic pain can even run further down, including your lower leg, foot, and toes. It just all depends on which nerve is affected.

What causes sciatica?

A herniated or bulging disc in your spine, typically at L4, L5, or S1, puts pressure on or irritates a lumbar nerve root: sciatica. It can also be caused by disc degeneration, where inflammatory proteins are released that irritate nearby nerve roots. These are only two causes of sciatica. Many other conditions cause sciatica, including obesity, arthritis, diabetes and a weak core.

Treatment of Sciatica

Patient Education2

  • Use hot or cold packs for comfort and to decrease inflammation
  • Avoid inciting activities or prolonged sitting or standing
  • Practice good, erect posture
  • Engage in exercises to increase core strength
  • Gently stretch the lumbar spine and hamstrings
  • Participate in regular light exercises such as walking, swimming, or aqua-therapy
  • Use of proper lifting techniques

Medical Therapies3, 4

  • A short course of oral nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Opioid and nonopioid analgesics
  • Muscle relaxants
  • Anticonvulsants for neurogenic pain
  • If oral NSAIDs are insufficient, oral corticosteroids may be beneficial
  • Localized corticosteroid injections
  • Spinal manipulation
  • Deep tissue massage may be helpful
  • Physical therapy consultation
  • Surgical evaluation and correction of any structural abnormalities such as disc herniation, epidural hematoma, epidural abscess, or tumor
  • Acupuncture5

Resources

  1. Davis D, Maini K, Taqi M, et al. Sciatica. [Updated 2024 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
  2. Wheeler AH. Diagnosis and management of low back pain and sciatica. Am Fam Physician. 1995 Oct;52(5):1333-41, 1347-8.
  3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007 Jun 23;334(7607):1313-7.
  4. Ostelo RW. Physiotherapy management of sciatica. J Physiother. 2020 Apr;66(2):83-88.
  5. Ji M, Wang X, Chen M, Shen Y, Zhang X, Yang J. The Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2015;2015:192808.