Sciatica is a term that refers to pain of the sciatic nerve, the largest nerve in the body. This nerve extends from the lower back through the pelvis, buttocks, and down into both legs. It is a mixed nerve, meaning it allows for both movement and sensation.

This nerve plays an important role in mobility, enabling movements such as walking and running. However, for many different reasons the sciatic nerve can become irritated or compressed, which causes pain known as sciatica. 

Sciatica, while being a term used to describe a specific symptom, is also known by other names or descriptors, which may include the following:

• Sciatic neuralgia: This is another term for sciatica that emphasizes an issue with the nerve itself—which results in pain that is often described as a sharp, shooting, or stabbing. This pain follows the path of the nerve.
• Lumbar radiculopathy: The sciatic nerve has five different nerve roots, two of which are in the lumbar region. Nerve roots are the locations where a nerve branches off from the central nervous system and spinal cord. This form of sciatica refers to radiculopathy (injury, damage or compression to these specific nerve roots) and pain that occurs in the lower back. 
• Sciatic neuropathy: Refers to damage of the sciatic nerve that results in pain, numbness, tingling, swelling and oftentimes muscle weakness.

While these terms may have slightly different meanings, they are often used interchangeably, and all in some way refer to pain of the sciatic nerve.

Typically, “sciatica” is pain that is directly caused by dysfunction or damage of the sciatic nerve itself. However, the term is commonly used to describe other conditions related to sciatica or nerves connected to it. 

Additionally, while sciatica generally refers to pain, the term is often used to refer to many other related symptoms, such as the following:

• Mild pain, shooting pain, or pain that radiates to the lower back, buttocks, and down the leg—possibly continuing into the feet and toes. Some individuals may also experience pelvic discomfort.
• Pain that occurs after sitting or standing, or with movement such as lifting or bending the legs. Pain may also occur with coughing or sneezing.
• Tingling, or a sensation of pins and needles.
• In severe cases, numbness or weakness.

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Sciatica, generally speaking, is caused by compression or irritation of the sciatic nerve. However, there are many conditions or situations that cause compression, pressure, or irritation on the nerve. Some common causes include:

Herniated discs: A herniated disc refers to the slippage or protrusion of a spinal disc, which is a cushion-like structure located between each vertebrae in the spine. They are gel-like on the inside and fibrous on the outside. They can naturally change shape to allow for movement, but may also push into spaces occupied by nerves—creating irritation and pain.

Degenerative disc disease: This is another condition affecting the spinal discs. As mentioned above, these spinal discs can change shape, which allows them to absorb shock from movement. These discs naturally wear away with age, from constant movement and other forces. When this happens, the nearby vertebrae can rub against each other and cause nerve irritation or compression.

Pelvic floor dysfunction: Overactive, tight pelvic floor muscles can cause compression or pelvic misalignment that may irritate the sciatic nerve.

Sacroiliac joint dysfunction: The sciatic nerve passes through the pelvis, and is located very close to the sacroiliac joints. Problems with these joints, such as inflammation or poor alignment, can affect the sciatic nerve and cause symptoms. 

Pregnancy and postpartum: The changes an individual experiences during pregnancy or postpartum can create pressure and stress on the pelvis—such as the increase in volume within the pelvis from a growing baby and placenta, as well the shifting of the body’s structures. These factors can cause the sciatic nerve to be compressed. 

Injuries: Injuries resulting in broken bones at the hip or pelvis can cause damage to or put pressure on the sciatic nerve. These injuries can either directly impact the sciatic nerve, or indirectly cause problems through misalignment or pelvic floor dysfunction. 

Scars or adhesions: Previous surgeries to the back, pelvis, or abdominals, such as a hip replacement, may create scar restrictions that can irritate the sciatic nerve.

Spinal stenosis: A condition where the space around the spine narrows, which can put pressure on nearby nerves.

Spondylolisthesis: Occurs when one of the vertebrae of the spine slips forward and out of place compared to the one below. While minor slippage doesn’t always have symptoms, more severe cases can press onto the sciatic nerve.

Cauda equina syndrome: A rare medical emergency that occurs when the nerve roots at the bottom of your spinal cord are compressed, which can be caused by a herniated disc or an injury.

Physical therapy is a very effective form of treatment and management for sciatica. In cases where the cause is not by a permanent change or damage to the body, physical therapy can help get you back in optimal health, reduce your pain, and prevent future complications.

In other cases such as degenerative disc disease where the damage cannot necessarily be reversed, physical therapy can still be a very beneficial form of management to reduce the effects of your condition, prevent future damage, and lower the risk of worsening symptoms.

As discussed before, sciatica can have a variety of causes ranging from spinal problems to issues originating in the pelvis. Due to this, your condition may require a blend of orthopedic and pelvic floor focused treatments to best address the root cause.

The providers at Hive Therapy and Wellness proudly provide holistic treatment that considers all aspects of your needs, in order to best relieve your symptoms and set you up for success in the future, too. This includes treatment such as the following:

Pain Management

One of the first treatments you may think of for sciatica is pain relief—physical therapists can provide this with a range of treatments such as thermotherapy, electrical stimulation, manual therapy, cupping, dry needling, and more.

They are skilled in providing in-office treatments for pain, as well as teaching you ways to manage pain at home. For individuals with pelvic dysfunctions, pain relief techniques can include external or internal manual therapies that target tight muscle tissue or trigger points.

Spinal Manipulation

Another example of treatment for sciatica is spinal manipulation or joint mobilization. The sciatic nerve is often compressed or irritated by misalignment and other spinal problems.

If your unique needs are not contraindicated by this treatment, your physical therapist may integrate it into your treatment plan in order to reduce pressure on your sciatic nerve.

Spinal or pelvic misalignment can be caused by many things, such as poor posture, the effects of pregnancy, or pelvic floor dysfunction. Therefore, your physical therapist will be sure to address any harmful postures or stressors that may be contributing to your misalignment and sciatica pain.

They’ll be sure to examine your hips, lower back, abdominals, and pelvic floor to check for muscle imbalance and or dysfunction, and incorporate necessary treatments to address these problems.

Pelvic Floor Training

If your physical therapist determines that you have pelvic floor dysfunction, they’ll integrate treatments like neuromuscular re-education and biofeedback into your care plan.

These treatments will help you regain awareness and control of these important muscles, as well as allow you to practice strengthening techniques and relaxation. All of these treatments will allow better pelvic floor mobility and function, which will reduce irritation of the sciatic nerve.

Exercise and Stretching

Rest assured that Hive’s providers take a well-rounded approach to your care, which always includes preventative health. Not only will they relieve your symptoms through treatment, but they’ll also teach you preventative strategies to avoid future dysfunction.

One way to encourage optimal long-term health and lower your risk of sciatic pain is with a thorough exercise and stretching routine.

Physical therapists are experts in anatomy and physical health of the body—meaning they can create the best exercise plan for your needs. This can involve strengthening of the core, back, and lower body muscles, improving your posture, and utilizing stretching or yoga to improve flexibility and balance.

This can help reduce the risk of sciatic nerve compression, reduce pain, and improve overall mobility.

Education

Another important form of preventative health your physical therapist will incorporate into your care plan is education. They can teach you about the potential causes of your sciatica pain, what postures or activities may worsen it, and how to manage your pain at home.

If you perform sports or a job that may affect your risk of pain, they can teach you proper form for lifting, bending, and other daily activities to help lessen the effects on your body.

This is especially useful for jobs that involve long periods of sitting or frequent heavy lifting. They may even make suggestions to improve the ergonomics of your environment, if applicable.

With education on body mechanics, proper form, stretches to maintain mobility, and an exercise program to help you stay in shape, you’ll be better equipped to prevent and manage sciatica pain!

As for treatment in the clinic, your Hive physical therapist will create a comprehensive treatment plan that is determined by your unique condition and individual needs. The treatments commonly used for sciatica at Hive Therapy and Wellness include the following:

• Dry Needling
• Cupping
• Manual Therapy 
• Spinal Manipulation 
• Electrical Muscle Stimulation
• Tissue Scraping 
• Exercise Prescription
• Behavioral Modifications
• Therapeutic Modalities
• Neuromuscular Re-education
• Biofeedback
• Therapeutic Activity