If you or someone you love has "sciatica" you are keenly aware of how devastating it can be.
Doing basic things like walking or sitting can become a monumental task simply too difficult to take on. It can truly sap the joy from life and leave you home alone in pain while everyone around you lives their life.
But what exactly is sciatica?
Most people misunderstand what sciatica is so knowing what to do about it is challenging. Once you have a more accurate understanding, you will be able to take the first steps in getting treatment.
First, and most important, Sciatica is not the problem.
Yup. You read that right.
Sciatica is not what is causing your pain. Rather, it is the description of your pain.
Let’s take a step back to get a clear picture.
The spinal cord goes down the back through the vertebrae (bones of the back).
At each level of the spine (i.e. L1, L2 etc.) the nerve branches out to communicate with a particular area of the body. Some of these nerves are for sensation, some are for muscle control…and some are for both.
The nerve roots from 5 levels of the spine (L4, L5, S1, S2, and S3 – each one named for the vertebrae above it) all combine to form one nerve…the Sciatic nerve.
The sciatic nerve is the largest and longest nerve in the body, about as thick as a mans thumb. Starting in the back it travels all the way down to the foot and branches off to various regions of the legs on its way.
Now back to our original point. Pain at any part of the body from where the sciatic nerve starts to where it ends could be called sciatica.
The problem is…that doesn’t tell you where the pain is COMING from…only where it is located.
To make this easier to understand, picture a garden hose. You turn the water on and water comes out the other end. Let’s say no water is coming out. Do you assume the hole is clogged? It may be…but more likely there is a kink in the hose somewhere between where it starts and ends and THAT is where the problem is. Unkink the hose and the water starts to flow again.
In the case of the sciatic nerve, if there is pressure on the nerve it can cause pain all the way down to the foot. That doesn’t mean you have a foot problem! The key is figuring out exactly where the root of the problem is (i.e. the kink in the hose) so you can treat the cause of the problem. Once you do that…the symptom of "sciatica" will go away.
That is why not all back pain is the same…and what worked for someone else may not be the thing that will work for you.
Because the sciatic nerve is so long there are many areas that can be the culprit and a thorough physical exam and history of your symptoms will help your physical therapist determine exactly where your pain is coming from so treatment can be tailored accordingly.
In the next few articles we will look at some of the more common causes of back pain and sciatica.