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It may begin like a small niggling ache in your buttock. You think perhaps you bumped it and it’s just a little bruise. Then, a shooting pain extends down the back of your leg and into your toes, causing a pinpricking numbness. Sitting is painful. Walking is worse. You limp, favoring one leg to avoid putting too much weight on the injured side. The lopsided compensation creates pressure on the opposite knee, and now it starts to throb.This domino effect is just one example of what can happen when sciatica pain is not treated.
This painful condition is related to an assault on the sciatic nerve, the largest nerve in the body. An impingement anywhere along the nerve can cause pain in one location, or more commonly the pain can radiate from the hip all the way down the back of the thigh and into the foot.
“Getting to the root of the impingement is how physical therapy can address the symptoms,” explains physical therapist Helen H. Setyan, DPT, UCLA Department of Rehabilitation Services. “Sources of the impingement can include disc herniation, structural misalignment, muscle spasms, poor muscle coordination, and incorrect body mechanics.”
WHAT YOU SHOULD KNOW
Sciatica is caused by an impingement of the sciatic nerve.
Physical therapy is an effective treatment.
Patients must participate in their own healing process.
Treating Acute Sciatica Pain
Sometimes, sciatica pain may clear on its own in a few weeks with at-home pain-relieving treatments. Heat and ice can both be helpful in addressing the acute (sudden) pain, as can nonsteroidal anti-inflammatory medications (e.g. aspirin, ibuprofen). Ice reduces swelling, which eases pressure. Heat increases circulation, which can help speed natural healing. Some people prefer one over the other, while others find relief in alternating heat and ice.
Heat patches can work well for longer-term warmth (several hours). But beware that some adhesive patches can be too strong and can damage thin skin when you remove the patch. An alternative is a belt with a pocket in which the patch can be placed. That avoids having to stick anything to the skin.
The Perils of Just Living With It
Sciatica pain that lingers for several weeks, is excruciating, or gets worse, needs to be treated. Be aware that most insurances, including Medicare, may require a referral from your primary care physician. Forgoing that step can be costly. And not seeking treatment can set you up for long-term chronic pain—leading to a desire for stronger pain relievers. A condition called hyperalgesia can occur with the use of opioid pain medications. The use of these powerful pain killers can actually cause some people to become more sensitive to painful stimuli than they otherwise would without opioids.
Extensive Evaluations Inform Treatment
According to Dr. Setyan, keys to treatment are extensive evaluation processes to determine the culprit of sciatica-associated symptoms, and continually evaluating patients throughout the course of care. Some of the tests physical therapists use include: movement analysis, postural assessments, strength and flexibility measurements, and sensory and nerve mobility tests. These assessments guide the treatment process. Manual therapy, posture and body mechanics training, strength and conditioning, and stress-reduction techniques are among the approaches used to treat sciatica.
Prevention Through Education
Proper body mechanics means knowing how to lift, push, pull, and move in accordance with correct body alignment. With injuries such as sciatica, patients can compensate with other body parts (such as favoring one side of the body), which can throw the body out of alignment. A physical therapist can help correct those misalignments, and teach patients how to use proper form. That, in turn, can reduce re-injury.
“My wish for my patients with sciatica is for them to be as educated about it as possible,” says Dr. Setyan. “Most often, they are misinformed and misguided on the proper management of the condition. They hear that diagnosis and think that they will have it forever. But physical therapy is effective, and symptoms can diminish.”
In addition, she emphasizes that physical therapy is a team approach to rehabilitation and wellness. The patient-therapist relationship is as important as the treatment. It’s a participatory process in which proper trust, communication and understanding all combine to get rid of a sciatica flare-up, and potentially reduce the risk of recurrence.