SCIATICA – A pain in the butt!

By Jeanine Robotti, Physical Therapist and Clinic Director.

Causes, Symptoms, and Physical Therapy for Sciatica

Sciatica, also referred to as lumbar radiculopathy, is a common term to describe several symptoms related to lumbar nerve root irritation. The most common symptom is pain radiating down the back of the thigh and into the lower leg. Low back pain may or may not be present. Often this only affects one side, resulting in an ‘asymmetrical pain pattern’. The pain can range from mild to severe, and often develops as a result of a herniated disk, a bone spur on the spine, or narrowing of the spine (stenosis) causing compression on the sciatic nerve root as it exits the spine. Hormonal factors like pregnancy or hormone replacement during menopause, or steroids taken by athletes, and psychosomatic issues, such as family stress, anxiety, and depression, can also contribute to the onset and/or aggravation of sciatica in some cases.

The sciatic nerve starts at the spinal cord and travels through your buttocks before it branches down each leg. It is the body’s longest nerve. It has a direct effect on the ability to control the muscles in the hip, thigh, lower leg and feet and is responsible for sensation as well. Therefore, sciatica may cause numbness, tingling and muscle weakness in the lower extremity. The most common activities of daily life, like sitting, walking, standing, bending and lifting, are commonly affected if you experience sciatica.

Pain in the buttock and leg can have other possible causes. The most common cause not stemming directly from the lumbar spine is a compression of the sciatic nerve as it passes near the piriformis muscle in the buttocks. At this point, the sciatic nerve is about the thickness of the thumb and can pass above, through or below this muscle. The piriformis is a powerful hip external rotator and if the piriformis irritates the nerve, it can cause sciatica symptoms.

The good news is that sciatica is most often relieved through conservative methods within a relatively short period of time when patients consult physical therapists who are experts at examining and performing physical therapy for sciatica. Each sciatica case is as different as every person is unique. Some patients experience excruciating pain and others have just mild symptoms. Early intervention with a skilled physical therapist can quickly help relieve symptoms and get one on the path to recovery.

Below is a concise guide to help you further understand sciatica and some physical therapy stretches for sciatica that your physical therapist will guide you through.

What are the symptoms of Sciatica?

  • Low Back Pain (LBP) or buttock pain that travels down one leg is the typical first symptom. The pain can have different qualities: dull or sharp, pulling, or “burning”. The quality and quantity of pain may change from burning to dull, and from constant to relating to specific times of the day or specific activities.
  • Neurological issues: numbness or “pins and needles” (tingling) sensation and altered reflexes.
  • Note that the disappearance of pain is not always a good sign. It may mean a nerve is heavily compressed and fully dysfunctional.
  • Muscle weakness and muscle rigidity or cramps.
  • Your symptoms may worsen when you get up or down from sitting, get out of bed, bend over, lift objects, twist, cough or sneeze.

What are some causes of Sciatica?

Sciatic nerve compression may be caused by:

  • A herniated disk: commonly called ‘ruptured’ or ‘slipped’ disk – in which the center gel-like substance of an intervertebral disk protrudes through a tear in its outer ring called the annulus. This substance puts pressure on the spinal nerve roots located very close to the disk. Acute back injuries, as well as slow degenerative processes, can cause herniated discs.
  • Spinal Stenosis: the narrowing of the spinal canal through which the nerves travel, commonly associated with advanced age.
  • Inflammation of nearby anatomical structures can cause compression on the sciatic nerve. Some examples are bone or muscle injuries that cause misalignment of the vertebral bodies; tumors pressing on the nerve; infections, or digestion issues.
  • Pregnancy: During pregnancy, a hormone called relaxin is produced which relaxes the ligaments in the pelvis to prepare the body for childbirth. This laxity can cause excessive movement which then irritates the nerves in the lumbar, sacral and buttocks regions.

There are many other factors that increase the risk of being diagnosed with sciatica, which affects all ages and sexes. People who lead an active lifestyle are less likely to develop sciatica than those who lead a sedentary lifestyle. Too much sitting and not enough healthy exercise can increase this risk. Even athletes need to balance their routines with proper stretching and passive modalities, such as massage, to avoid back pain associated with sciatica. These risk factors include:

  • Age: spine degeneration between the ages of 30 and 60 can cause herniated disks, bone spurs, and hip joint dysfunction.
  • Obesity: excess adipose tissue causes a strain on the lumbar spine resulting in mechanical stress on the vertebrae which can ultimately result in degenerative changes.
  • Diabetes is also a common contributor.
  • Smoking decreases blood flow to the spine and its related nerves affecting overall spinal health.

Proper Diagnosis of Sciatica is Essential

As there are many disorders that can cause sciatica, the physical therapist’s first step is to analyze what is causing your pain. Forming a diagnosis involves an in-depth review of your medical history and a physical and neurological examination. Putting yourself in the hands of a physical therapist early in this process is key to correct diagnosis and swift treatment success.

Diagnostic testing may be required for a proper diagnosis. These include X-ray, MRI, CT scan and/or electrodiagnostic tests (electromyography or EMG and nerve conduction velocity or NCV).

Cauda Equina Syndrome (CES) – A Red Flag!

There is a bundle of nerve roots called the cauda equina at the lower end of the spine (Latin for “horse’s tail”). This nerve bundle is responsible for sending sensory and motor nerve signals to your brain for the organs in your pelvic region.

Unusual pressure on these nerve roots creates a condition called cauda equina syndrome (CES). It changes the control you have over your bladder, legs, and other body parts. It is of crucial importance to not leave it untreated as it can lead to serious long-term complications.
This disorder often develops quickly and requires immediate medical attention.

Symptoms of this disorder include:

  • Saddle Anesthesia: loss or reduction of sensation around perineum, buttocks, and groin.
  • An inability to control your bladder or bowels, which can result in incontinence or retention of feces.
  • Sexual dysfunction (impotence).
  • Intense lower back pain.
  • Weakness, pain, or a loss of sensation in one or both legs.
  • Loss of reflexes in your lower limbs.


Before you are seen by a physical therapist for treatment, your doctor may prescribe medication, especially in the acute pain stage. Your physician and physical therapist will then collaborate to create the best treatment strategy for your unique condition.

Common types of drugs include:

  • Anti-inflammatory drugs
  • Muscle relaxants
  • Epidural steroidal injection
  • Trigger point injections

Physical therapy for sciatica may be your first line of defense when seeking treatment. The physical therapists at Physio Logic will often prescribe complementary services to help address a patient’s condition. These services include chiropractic, spinal decompression, acupuncture, pain management, and medical massage therapy. All of these affiliated therapies play unique roles in decreasing muscular and nerve pain, increasing flexibility, restoring function and returning a patient to a pain-free lifestyle. Often there may be systemic conditions or comorbidities that increase a patient’s risk for sciatica. In those cases, a physical therapist may refer the patient to a functional medicine expert or clinical nutritionist to address those risk factors through lifestyle changes and healthier life choices.

The good news is that in the majority of cases, people with sciatica do not require surgery. Unfortunately, it may be necessary for rare cases of very severe forms of sciatica, as in cauda equina syndrome. For everyone else, the best therapy is to seek out skilled physical therapists who will create an individualized treatment plan for you and take advantage of the many non-surgical approaches available — massage, chiropractic, trigger point therapy, acupuncture, and pilates, to name a few. Through physical therapy for sciatica and other complementary treatments, your physical therapist will educate you on how to avoid future relapses and return you to a pain-free lifestyle stronger than before.

Physical Therapy Stretches for Sciatica

For those suffering from mild sciatica pain, here are a few gentle stretches to help relieve your discomfort. Be sure to hold each stretch for 20-40 seconds and perform the stretches on both sides. Be sure to stretch the less affected side first as that will ensure a better outcome on the more painful side.

  1. Single knee to chest- lying on your back with knees bent, feet flat on the mat, or legs extended if possible. With both hands bring one knee into your chest for a comfortable low back and gluteus maximus stretch.
  2. Knee to opposite shoulder- lying on back as above. Using your opposite hand, bring your knee across your body towards your shoulder to stretch the gluteus medius and minimus muscles on the side of your hip.
  3. Both knees to chest- lying on back as above. Bring both knees into your chest.
  4. Modified pigeon stretch- lying on back with knees bent, feet flat on the mat. Place one ankle above the opposite knee and bring both legs up toward your chest. This will stretch the external rotators of the hip including the piriformis muscle. Try to keep your spine in neutral by not rolling your hips off the mat or flattening your low back to the mat.
  5. Hamstring stretch with strap- lying on back with legs extended or knees bent, feet flat on the mat. Using a stretch strap, belt or towel, place your foot in the loop and gently bring your leg towards your head. At first, keep the knee slightly bent. This will stretch the upper hamstring by your sit bone. Then release the stretch and straighten the knee to continue the stretch down the back of the leg. Keep your low back from flattening on the mat to isolate the hamstring muscle.
  6. TV watching position- lie on your stomach with your legs rolled in (toes facing in). Prop yourself up on your elbows keeping the rest of your body relaxed.
  7. Hip/quad stretch- start kneeling up tall and step forward with one foot. Bring your hips forward until you feel a stretch in the front of the back hip. Be sure your front knee is over or behind your ankle to not stress your knee. Lift your chest and your arm on the side of the back leg to enhance the hip flexor stretch.

If you’re in the New York City area and looking for a physical therapist that can treat your Sciatica, give us a call now or contact us by filling out the form below.

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