Most of us at some point of time may have experienced numbness or tingling sensations due to sleeping foot/leg, which goes off after few steps on the floor. This is mainly due to temporary compression of sciatic nerve. But the condition can get quite debilitating if the compression is prolonged for few weeks to month.
Sciatica is more of a symptom than a condition, caused due to sciatic nerve compression. The nerve can be compressed at the spinal level or below along its course.
Sciatic nerve is the thickest nerve in the body. It is the terminal branch of lumbo- sacral plexus.
It is formed by the ventral rami of L4, L5, S1, S2 and S3 nerve roots. The nerve is divided into two parts called the tibial part and the peroneal part.
Tibial part is formed by the ventral division of ventral rami of L4, L5, S1, S2 and S3.
Peroneal part is formed by the dorsal division of ventral rami of L4, L5, S1 and S2.
Sciatic nerve arises in the pelvis, passing through the greater sciatic notch below the piriformis (at times through the Piriformis muscle) to enter gluteal region.
It lies deep to the gluteus maximus and crosses superior gamellus, obturator internus, inferior gamellus and quadratus femoris to enter back of the thigh. It curves around the greater trochanter to enter the lateral aspect of thigh.
In back of thigh it lies deep to biceps femoris superficial to adductor magnus.
It ends by dividing into its two terminal branches at the back of the thigh.
During its course it gives muscular, articular and terminal branches.
There are no branches in gluteal region, in the back of the thigh from the tibial part long head of biceps femoris, semitendinosis, semimembranosus and ischial part of adductor magnus are supplied while from the peroneal part short head of biceps femoris is supplied.
There are no branches in gluteal region and peroneal part of the nerve, in the back of thigh from the tibial part it gives single branch to hip joint.
The nerve terminates by dividing into common peroneal nerve and tibial nerve.
• Pain in leg
• radiating leg pain
• Numbness/ tingling
• Muscular weakness
• Gait dysfunction/ abnormal walking
• Sensory impairment
• Hot and cold alteration /burning sensation in the leg
• Reflex impairment
• Paresthesia/dysesthesia and oedema in lower extremity
• Symptoms may aggravate with increased intra-abdominal pressure (cough, constipation etc)
• PIVD (prolapsed inter-vertebral disc)
• Spinal stenosis
• Nerve entrapment (piriformis syndrome)
• Inflammatory conditions of spines/ malignancies
• Traumatic pathologies
Precautions and preventive measures are taught to the patient to reduce the episodes of severe pain. Proper posture, ergonomics and back care are taught to the patient. Patients need to be in active rest as being bed ridden has shown worse results.
Physiotherapist aims at reduction of pain by means of therapeutic modalities and manual techniques.
Chiropractic adjustments can be used in suitable candidates.
Nerve mobilization and dry needling helps relax the nerve. Exercises can be implemented depending on the basis of activities that aggravate or relieve patient’s pain.
Physiotherapist needs to emphasize on Core strengthening to enhance spinal stability.
If weakness is observed than lower limb strengthening and gait training also forms an important part of the rehabilitation programme.
Hope he have helped you understand your problem better.
At Pain Free Physiotherapy Clinic we have treated thousands of cases with sciatica problem. We have successfully identified the real cause in most of them and helped most of them live a pain free life