Sciatica
Lower back pain is one of the most common problems I come across as a physical therapist. Walking on two legs is a feat that is difficult to overcome, it has benefits, however there are also tradeoffs with back pain being one of them. The silver lining is that many of us tend to create this issue in similar ways, and fairly simple solutions do exist. The sciatic nerve is a structure that can be compromised in situations where low back pain arises and may require some additional finesse when managing symptoms.
The sciatic nerve is a bundle of nerves that all converge to form one large nerve traveling from your lower back down to different regions of your leg. It splits multiple times as it travels toward your foot, resulting in a highly efficient mechanism to control your muscles and deliver sensations from the outside world. The catch is that if it is compressed somewhere along that pathway, symptoms may be provoked anywhere it travels, not just at the compression site. The extent of the pressure is a large determinant in how effective physical therapy can be at managing the issue.
Pressure can be caused by a disc injury in the spine, or it can be caused by musculature on the periphery. A disc contains connective tissue and a gel-like fluid that aids in attenuating forces. If we apply enough pressure to that connective tissue over time, it can begin to lose its integrity and allow that gel to migrate toward a nerve traveling down your leg and eventually creating symptoms. This often times begins as an accentuation of the curve in your lower back generating the required pressure to create the situation described above.
Musculature can also compress nerve tissue as it makes its way from your spine to the destination. This is where the classic “piriformis syndrome” gets diagnosed. As we find success in moving, we trend toward certain patterns over time. These patterns are often useful and effective, however can lead to overutilization and potentially problems. If a set of muscles becomes accustomed to being active over a long-time horizon, they can start to have difficulty turning off. Repeated activation may compress spaces around structures like the sciatic nerve possibly resulting in pain.
Sciatica is another one of those diagnoses that gets thrown around without real consideration of what it means. There are a number of ways to irritate neural tissue like the sciatic nerve, however there are also many solutions to altering the circumstances that led to the problem.
Austin Ulrich, Physical Therapist
