Sciatica with or without low back pain is usually self-limited and has no serious underlying pathology, but anyone who has had it can attest to the misery it causes.

So, just what is ‘sciatica’? Basically, it’s a term used to refer to pain that occurs in the buttocks and leg as far as the foot from compression on the sciatic nerve.
The term is rather non-specific because there are multiple structures in the lumbar spine itself that can irritate the nerve, but it can also be injured as it passes through the buttock tissues typically with a direct blow to the area as during a fall.

Let’s take a look at some of the most common causes of this pain in the butt as the physical therapy treatment varies greatly based on the root cause.

One of the most common culprits is what is incorrectly referred to as a ‘slipped disk’.
Herniated disks (aka HNP) occur when a defect or tear of the outer protective ring surrounding the disk bulges into the space occupied by the nerve in the spinal canal placing excessive pressure on the nerves. An HNP can be caused by a specific injury – usually lifting, bending, or twisting or from the wear and tear of poor posture and habits.

Conversely, a spine with degenerative disk disease (DDD)/ degenerative arthritis can result in sciatica for different reasons.  If the lumbar disk wears out, it loses the cushioning action of a normal healthy disk.  This now results in a ’bone-on-bone’ situation and because bone forms according to the stresses placed upon it, bone spurs form. These spurs further narrow the available space in the spine and thus compress the nerve.

Because Idaho is a direct access state (meaning that you may consult a physical therapist without a physician’s referral), patients usually come to me without X-rays or an MRI meaning that it’s up to me to determine what might be causing the sciatica.  This is done by taking a thorough history to determine which activities increase or alleviate the symptoms, as well as the use of functional movement assessment (FMS).

I chose to compare two very different causes of sciatica to help illustrate why sciatica needs to be evaluated on a case-by-case basis before it can be properly treated.

Though PT can’t reverse these signs of aging, I can determine if there are other factors at play that have tipped the scales and are causing sciatica. Some common culprits are glute/ core weakness, shortened/tight muscles, or joint stiffness. My clients are blown away when my assessment reveals a limitation resulting from a decade-old injury that they’d completely forgotten about. Because we as humans just ‘keep on keeping on’, unresolved imbalances from injuries lurk and eventually place an undue load on other structures: joints, discs, tendons, etc.

Although there are a variety of ways to treat the symptoms (ice/heat/ massage/ anti-inflammatories), I hope that you’ll choose to treat the problem. The trails, rivers, and slopes are calling…

Kim Mazik, PT is a graduate of Ohio State University with 25+ years experience as a physical therapist. She has had extensive training as an orthopedic therapist assuring accurate diagnosis and treatment of musculo-skeletal pain and dysfunction. Her approach is holistic and eclectic; blending joint manipulation, massage therapy, Functional Movement Assessment, yoga, Pilates as well as other therapeutic exercise with an emphasis on educating clients, thus empowering them to manage their symptoms outside the clinic.