with Jason Lau, Doctor of Physical Therapy
Question: I get pain from my right buttocks down to the back of my leg… I think it is sciatica. What should I do?
Answer: Imagine your car’s check engine light turns on. What does that tell you? It tells you something with your car’s engine needs to be addressed. It does not tell you what the specific problem is, only that there is something that needs to be fixed. The diagnosis of sciatica is very much like your check engine light. With the diagnosis of sciatica, we know the sciatic nerve is irritated or injured, but the cause is not determined. Therefore the response to sciatica can be different for different people.
What we do know from the diagnosis is that the sciatic nerve is involved. It would be useful to take a little time to review the function of the nerves. The nerves are the wiring in our body. Much like wiring that connects a computer to a keyboard, our nerves connect our brain to our physical bodies. When you want to lift a laundry basket, the lifting command starts in the brain and is sent through the nerves to your muscles. Thus, the nerves are an integral part of your strength. The nerve also sends incoming messages from the physical body to the brain. When you put your hand under a cold shower to check the temperature, the sensation of the cold is received by your skin, traveling through the nerves and ultimately arriving at the brain. Besides temperature, the nerves communicate other sensations such as pressure and pain. In general, motor commands are sent out from the brain, and sensation messages are sent into the brain via the nerves.
With all that said, when we have an injury involving a nerve, we can have symptoms that include weakness, numbness, tingling, and pain. You know that feeling you get when you have sat too long and your foot starts to tingle or go numb? That is actually caused by the compression of your nerve and not necessarily by a lack of circulation, as many people think. It just so happens that the sitting position that is compressing the nerve is most likely compressing the blood vessel that is running along side the nerve.
If you think you have sciatica but hesitate to see a medical professional, here are a few things you can try that can help:
Core strengthening - Everyone with back related issues can benefit from having a stronger core. This is the most commonly overlooked tip, but it is the most important. Strengthening provides long-term gains.
Stretching - Most people who have sciatica have muscle tightness in the buttocks, piriformis, and low back. Stretching can reduce the tightness that may be putting pressure on the nerve.
Soft tissue mobilization (massage) - Use a tennis ball, lacrosse ball, or foam roller to loosen up the tightness in the muscles of the buttocks and low back.
When it comes to sciatica, we know the sciatic nerve is involved. There are many possible causes for sciatica. There can be structural origins, such as spinal stenosis; soft tissue origins, such as muscle tightness, inflammation, lack of nerve mobility; and sometimes issues can be joint-related, as with misalignments or immobility. If you have tried the above tips and find 0% improvement, or you just want to get better faster, then you should consider seeing your doctor or physical therapist to determine the exact cause and best course of action for improvement.
Submit your questions for future PT Perspective columns to Jason Lau, Doctor of Physical Therapy at firstname.lastname@example.org