What is Sciatica?
The term Sciatica is a term we hear almost on daily basis in our New Patient Evaluations at our St. Petersburg, Sarasota, Tampa, and Orlando Regenexx Clinics. Sciatica is described as pain in the low back, buttock, or the leg – extending down the back of the leg, side of the leg, or even front of the shin or down into the foot. The cause of sciatica is often attributed to compression of the sciatic nerve, which is the largest and longest nerve in the body, by the piriformis muscle in the gluteal area.
Even though the piriformis muscle is often blamed for the cause of sciatic pain, there are many other areas this pain could be originating from, which will be discussed in this article as you read on. Some of the symptoms that are often described in the case of sciatica are:
- Mild tingling, dull ache, or burning sensation in the leg
- In some cases, the pain is severe enough to make a person unable to move
- Pain on one side/ down one leg
- Sharp pain in one part of the leg or hip and numbness in other parts
- Dull ache in the foot or heel
Differential Diagnoses for Sciatica
According to an epidemiological review, up to 40% of adults report having experienced sciatica in their lifetime. Additionally, some studies in this review reported a cure rate of more than 75%, but other studies report cure rates of less than 50% (1). The discrepancy in the healing rate may be, in part, due to the extended list of what we call the differential diagnosis, or the list of other conditions that could be causing pain similar to sciatica. The success rate in managing any orthopedic issue begins with an accurate diagnosis so that the appropriate course of action can be taken. A comprehensive list of differential diagnoses for sciatica may include:
- Herniated lumbosacral disc
- Spinal stenosis
- Muscle spasm
- Nerve root impingement
- Epidural abscess
- Epidural hematoma
- Tumor
- Potts Disease, also known as spinal tuberculosis
- Piriformis syndrome
In our clinical experience in regenerative orthopedics, the most prevalent cause of a set of symptoms that could be called sciatica from this list is pathology in the lumbar spine, like a herniated lumbar disc, spinal stenosis, or nerve root impingement.
More often than not, the pain is only felt in the buttocks, leg, calf, or foot when a patient is encountering nerve pain from a disc bulge or herniation in the back. It is less common for disc pain to be felt in the low back. This is one of the key reasons sciatica is a prevalent diagnosis – because the pain focused on rather than the cause.
What Can be Done for Sciatica?
In the case of our patients at Regenexx at New Regeneration Orthopedics coming in with leg pain, we perform a detailed orthopedic evaluation to assess the nature of the pain and find the root cause of the pain. Then, if the examination warrants it, a physician may order an MRI study of your spine to determine if there is pathology at the spinal level causing leg pain. If your sciatic-type pain is then determined to have an origin in the spine, a Regenexx physician may suggest a platelet rich plasma (PRP) or bone marrow concentrate (BMAC) procedure to support in the local recovery to the damaged and/or inflamed tissue in the spine.
Check out our outcomes data for 11,176 (and counting) cases treating the lumbar spine with regenerative orthopedics across the entire Regenexx registry network.
Additionally, if you have been diagnosed with a lumbar spine disc issue as the root cause of your referring leg pain, below are a few exercises that are successful in alleviating symptoms associated with lumbar disc bulges and referral pain down the leg.
*Note: These exercises are example recommendations, and you should always consult your physician before beginning any new fitness regimen.
Exercises for Sciatica
Hamstring Release with Ball
- Sit on a hard surface and put a tennis ball or a lacrosse ball underneath your hamstring/thigh area.
- Put some weight over the area and position your body to apply pressure over the ball.
- If you find a tender spot, keep the ball in position then extend and flex your knee.
- Perform this muscle release for two to five minutes, moving the ball up and down the hamstring every 30 seconds.
McKenzie Extension
- Lie on your stomach with your elbows on the floor and the chin tucked in or resting in your hands.
- Relax both your back and buttock muscles while you press up onto your elbows symmetrically so that you are in a gentle back-arched position.
- Your hips must remain touching the floor through the entire exercise.
- Hold at the top for two to three seconds, lower, and repeat the motion.
- For best results, perform 10 repetitions every waking hour.
- This exercise should not reproduce pain. Discontinue if you feel pain.
Glute Activation
- Lie supine with the leg to be exercised bent up and the foot on the ground.
- Slowly squeeze the buttock of the bent leg, so that your bottom lifts off the surface one or two inches only.
- Hold the squeeze for three to five seconds, release and then repeat 10 times.
Hip Flexor Activation
- Lie on your back with your knees bent and your back in neutral position.
- Engage your core by recruiting your pelvic floor and transverse abdominis, slightly flattening your spine onto the floor. Think *tuck the ribs down toward belt buckle and tilt your belt buckle up to your ribs*
- Maintain a steady abdominal breathing while you lift one leg up to 90 degrees at the hip keeping the knee bent.
- Keep your back and pelvis completely still at all times.
- Return slowly to the initial position and repeat with the other leg.
- Perform 10 repetitions on each leg.
Remember, if any of these movements reproduce your pain, discontinue them and consult a specialist before continuing any type of exercise or rehabilitation program.
We are Here to Help!
If sciatica or pain referring down your leg is affecting your life and keeping you from doing the things you love, our physicians at Regenexx in Tampa, St. Petersburg, Sarasota or Orlando are a great starting point to get a comprehensive evaluation. From there, it is our promise to give you an honest recommendation of the best course of action is to manage the source of your sciatic pain.
References:
- https://www.ncbi.nlm.nih.gov/books/NBK507908/
- physiotec.ca
