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A Pain in the Derriere. by Krista Leake PT, DPT, ATC What is sciatica? Sciatica is a general term that refers to pain or symptoms that occur along the sciatic nerve. The sciatic nerve is a large nerve and in fact it is the largest nerve in the body. Multiple nerve roots branch out of the lower spine and come together to form a sciatic nerve on each side of the body. This nerve passes behind each hip, down the buttock and back of each leg to the foot and finally the big toe. Causes of pain along the sciatic nerve. Sciatica is caused by anything that can irritate the sciatic nerve from where the nerve roots come out of the spine or lower in the buttock. Sciatica may be caused by the nerve getting pinched between

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the vertebrae of the spine, or the space in which the nerve lies becomes narrowed by an overgrowth of bone in the vertebrae or by swelling due to trauma or a strain in the area. It also may occur if a disc is pushing on the nerve. Rarely is the cause anything serious. Changes in your body are just one factor in your pain. When it is an acute pain, it is better related to the tissues, but in some people the pain remains and becomes long term pain. This type of pain is rarely related to damage and is more related to changes in the nervous system and the way the body interprets pain. The central nervous system becomes more sensitive and gets more pain with less provocation. The good news is that you can get out of pain with no changes to your structure. Symptoms of sciatica. Sciatica pain can be felt anywhere along the path of the nerve. Typically, sciatica is only felt on one side and the classic symptom is pain that radiates from the low back to the buttock and down the back of the leg. It also may extend into the foot or toes. This pain can vary widely from severe debilitating pain to a mild ache or tingling and numbness. Sometimes it can feel like a jolt or electric shock sensation. It can be worse with coughing or sneezing and prolonged sitting can aggravate symptoms. Some people also experience muscle weakness. What can I do about it? The good news is that mild sciatica usually improves gradually and goes away with time. Physical therapy is a mainstay in treating pain from sciatica. A combination of strengthening, stretching, hands on work by the therapist, and aerobic conditioning are central components to improving pain and function. It seems odd that when you are in pain to be told that resuming and adding activities is important for recovery, but some form of low impact aerobic activity such as walking, swimming, or pool therapy is recommended since this activity improves blood flow to the area and encourages the exchange of fluids and nutrients for healing. Many exercises can help strengthen all the surrounding tissue and improve function. The exercises will depend on the underlying medical condition causing the sciatica pain and the physical therapist will design a specific program just for you. By adding different types of physical or work stress, the body will be allowed to slowly to adapt and over time turn down the pain alarm and you will start to feel better. Start slowly and build up tolerance and resiliency to get back to feeling good. You are inherently strong and stable and exercise, physical activity, and things that make you stronger can be helpful for pain. What about rest? If the pain is severe, it is often difficulty to move, but resting more than a day or two is not recommended. Prolonged inactivity and rest can increase pain and lead to deconditioning. Simply resting and avoiding activity can make sensitivity to pain worse and contribute to prolonged pain. Regular and a gradual increase in activity are important to reduce the pain and have not been shown to cause any tissue damage even if the movement is painful. You need to start stressing the body again to build up tolerance to aggravating activities. Rarely is surgery indicated to treat sciatica but seek immediate treatment if sciatica is associated with severe leg weakness or trouble controlling bowels or bladder or the pain follows a traumatic injury such as a car accident or major fall. Sciatica can make life difficult and may prevent you from exercising, sleeping well, or even tying your shoes. Let us help you get relief. Call us today at 434.200.7600.

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