By: Jerry Moczerniuk PT, DPT
In this practice, there are patients who come in with the complaint of “sciatica”. Often times that term is considered to be a condition or diagnosis, when in fact it is a cluster of symptoms associated with a specific pattern of neural dysfunction or entrapment referring symptoms to the lower body.
Causes of pain, weakness, and abnormal sensation in the legs vary, however in instances when leg pain occurs without a direct injury, lumbar spine disease must be considered, and properly evaluated. It is also important to understand that low back disease does not always present with actual pain in the low back.
The term sciatica broadly refers to symptoms of numbness, tingling, weakness, and pain occurring in the pathway of the sciatic nerve. Sciatic nerve (the widest and longest nerve in the human body), begins at the lumbar spine, it then thickens in the region of the buttocks, and later branches down the back of the leg to supply the muscles and skin of most of the leg.
Sciatica in majority of instances is a symptom of some form of low back disease. Recent studies indicate that up to 90% of sciatica symptoms are caused by a bulging or herniated disc in the lumbar spine. Other causes include degenerative disc disease, lumbar stenosis, spondylolisthesis, and piriformis syndrome. In the most common case of a bulging or herniated disc, the disc matter may compress against the nerve exiting a particular level of the lumbar spine, causing irritation and inflammation of that nerve. Such irritation and inflammation may cause worsening symptoms in the leg (numbness, tingling, weakness, pain). Duration of symptoms has been shown to affect outcomes. As prolonged nerve compression may result in long term deficits, and may respond less favorably to conservative and surgical intervention.
Research has shown effectiveness of physical therapy interventions in treatment of all of the above mentioned conditions. Physical Therapy should not however simply treat sciatica and leg pain, as treatment will differ greatly based on the cause of the symptoms. In fact, symptoms may worsen if the exact cause is not properly established. A comprehensive evaluation must therefore be performed in order to establish an appropriate, individualized plan of care.
A skilled physical therapist is capable of accurately identifying the cause of symptoms through comprehensive history taking and physical examination. Once an accurate cause has been established, conservative Physical Therapy treatment may be initiated to decrease symptoms, facilitate return to normal function and improve quality of life.
Physical Therapy treatment may consist of modalities to control pain and swelling, specific exercises in directional preference, stabilization exercises, hands on techniques to improve joint mobility and decrease spasm, activity modification strategies and postural re-education to decrease symptoms and facilitate healing.
Dr. Moczerniuk is a Doctor of Physical Therapy, member of American Physical Therapy Association, and a Clinical Director at db Orthopedic Physical Therapy of Manalapan LLC, located at 120 Craig Rd. Suite 2. Dr. Moczerniuk can be reached at 732-462-2162 or via e-mail at Jerry@dborthopt.com. You can also find out more about our practice at dborthopt.com
