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As a health care provider, I often feel that the term sciatica is commonly used and perhaps somewhat misunderstood. However, overall there truly is a condition known as sciatica, so let’s get to the “bottom” of it!

Lumbar Spinal nerves

Simply stated, there are 31 pair of spinal nerves that travel the course of our spinal cord. The sciatic nerve arises from the levels of L4-S3 in your low back. The sciatic nerve exits from the spinal cord at the level of your sacrum, travels through a bony notch in your pelvis (the sciatic notch) and innervates the muscles in your buttock as well as the back side of your leg. It is the largest nerve in the body.

Sciatic nerve2

Treatment

In order to reduce the horrible pain in the buttock, tingling down the leg and/or numbness through your hamstring one must determine the location of the nerve entrapment. The reason one feels the aggravating and sometimes completely debilitating irritant is dependent on its source of compression. Nerves, unlike muscles, do not like to be stretched. In fact, they really like to glide similar to dental floss through your teeth. The nerves send information to our legs as a water hose distributes water flow. If the hose is pinched or tangled, the amount of flow decreases at the terminal end. In order to fix the flow of water, you must fix the entanglement, not just stretch the opening where the water comes out. Make sense?

Through a thorough musculoskeletal exam, a licensed physical therapist can assist in the diagnosis and discovery of the place of nerve entrapment. Possible causes of entrapment may be any of the following or a combination of them all: a problem in the spine such as a disc bulge or a narrowing of the spinal canal, a tight muscle in the buttock or hamstring, or more rarely complications from a surgery or other abnormality.

It is important to discover the area of entrapment to properly treat the condition. The good news is that with proper physical therapy the pressure can be reversed.

Take Home Message

Seek help to determine the cause of your symptoms. It is important to have a proper diagnosis as not all sciatica is the same! In some cases, specific movements can be taught to reduce the irritant, provide for healing and restoration of the tissue and structures. Do not let the symptoms continue, the sooner the pressure is relieved, the better chance there is for full and healthy recovery!

Lumbosacral RadiculopathyAndrew W. Tarulli, MDa,b,Elizabeth M. Raynor, MDNeurol Clin 25 (2007) 387–405

http://www.instituteforchronicpain.org/treating-common-pain/what-is-pain-management/therapeutic-neuroscience-education

Image use: Author(s): KDS4444. Sciatic nerve2.jpg from Wikimedia Commons. License: CC-BY-SA 4.0

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