Sciatica
A common condition, sciatica is characterized by pain radiating along the path of the sciatic nerve, which extends from the lower back through the buttocks and down the back or side of each leg. It may be associated with numbness, tingling, burning, or weakness in the leg. It often occurs when the nerve is compressed, irritated, or inflamed, leading to discomfort that can range from mild to debilitating.
What causes Sciatica?
Sciatica can result from various conditions that place pressure on or irritate the sciatic nerve, including:
- Herniated discs: a slipped or bulging disc in the lumbar spine
- Spinal stenosis: a narrowing of the spinal canal
- Piriformis syndrome or other muscle-induced entrapment: spasms or tightness in the piriformis muscle or inferior gamellus
- Degenerative disc disease and disc tears: wear and tear on the spinal discs over time can cause exposure of internal disc contents to nerves passing by, leading to chemical irritation of the nerves
- Trauma or injury: direct impact to the lower back or pelvis
- Ischial femoral impingement: too narrow of a space behind the back of the hip and the sits bone (ischium) can pinch the sciatic nerve as it travels out of the pelvis and into the hamstring region
- Sacroiliac joint (SIJ) mediated “pseudosciatica”: pain from the sacroiliac joint (SIJ) can sometimes radiate into the buttocks and down the back of the leg, closely resembling sciatic nerve pain; additionally, the piriformis muscle—which partially attaches to the SIJ—can become irritated or tight, potentially compressing the sciatic nerve and leading to true sciatica (piriformis syndrome).
- This connection means that SIJ dysfunction can both mimic and contribute to sciatic nerve-related pain.
Understanding the root cause of a patient’s sciatica is a necessary part of the diagnostic processes, allowing us to tailor preventive and therapeutic strategies to meet each individual’s needs.
Symptoms of Sciatica
Although symptoms vary depending on the severity and cause of a patient’s sciatica, they commonly include:
- Sharp, shooting pain in the lower back, buttocks, or legs
- Numbness or tingling sensations in the legs or feet
- Throbbing, aching, or the feeling of extreme tightness in the buttock or down the leg
- Weakness in the affected leg
- Pain that worsens with prolonged sitting, standing, or sudden movements
As these symptoms can significantly impact daily activities and overall well-being, seeking professional care is vital to prevent further complications.
Diagnosing Sciatica
Diagnosing typically begins with a thorough medical evaluation which includes the following steps:
- Taking a complete patient history to understand symptoms, lifestyle, and any previous injuries
- Conducting a thorough physical examination to assess likely lumbar or hip involvement, thorough neurological exam, and areas of discomfort
- Nerve conduction studies (NCS) and electromyography (EMG) to assess nerve and muscle activity to pinpoint the location and extent of nerve damage
- The potential use of advanced imaging techniques such as MRI to evaluate for lumbar or hip nerve compression, or structural issues that may be contributing to the condition
- The possibility of musculoskeletal ultrasound to help:
- diagnose or rule out piriformis entrapment
- diagnose or rule out ischial femoral impingement (congestion in the sub gluteal region where the nerve exits the back of the hip)
- identify surrounding fascia thickening around the nerve
Understanding the underlying causes of a given patient’s sciatica is essential for effective treatment and relief.
Nonsurgical Treatment for Sciatica
The Orthohealing Center administers the advanced, nonsurgical treatments listed below to target the root causes of sciatica and promote a natural healing environment.
- Platelet-rich plasma (PRP) therapy: the patient’s own platelets are used to reduce inflammation and stimulate tissue repair
- Platelet lysate or alpha 2 macroglobulin (A2M): these processes use the patient’s own growth factors and proteins to reduce inflammation and stimulate tissue repair
- MFAT: the stroma fibers and mesenchymal stem cells present in fat are used to support the health and reduce symptoms associated with damaged tissue and nerve
- Softwave therapy: this noninvasive technology is effective at reducing myofascial pain and muscle tension that could be compressing the nerve
- Class V laser therapy: this noninvasive technology promotes an anti-inflammatory environment, improves blood flow, and reduces pain mediators
- Neufit: this noninvasive active modality can release tension in the affected tight muscles and stimulate nearby weak muscles
- this can activate and reestablish muscle balance and reduce any contributing overuse to the muscle spasm
- Nerve hydrodissection therapy: a minimally invasive technique that uses fluid to separate and relieve compressed nerves
- Trigger point injections: injections directed into tight muscle to release knots in the piriformis or inferior gamellus
- Therapeutic Botox injections: for muscles that have responded only temporarily to trigger points, Botox may offer more long-term relief
- physical therapy post-procedure is essential to “reset” the muscle and elongate it while in a more relaxed state
These cutting-edge therapies are tailored to each patient’s unique condition, offering the possibility of lasting relief and improved quality of life without the risks associated with surgery.
