Sciatica

When it comes to leg pain, the common diagnosis utilized by medical professionals and Google MD is “sciatica”. This term is in reference to the sciatic nerve which traverses from the gluteal region down the back of the thigh to the knee. The term itself is an umbrella term for sciatic nerve inflammation. The origin of the sciatic nerve is actually the lumbar and sacral regions of the spinal cord (L4,L5,S1,S2,S3).

Inflammation or an injury to any of these spinal nerves as they exit the spinal column send pain signals that travel the length of the sciatic nerve and its branches all the way into the lower leg and even the foot. Common causes of compression to one or more of these nerve roots include: spinal stenosis - a narrowing of the canals as the nerves exit the lumbar spine, lumbar disc bulge or a herniation or a nerve root adherence to a previously injured structure that now limits the ability of the nerve to glide naturally.

Not all leg pain is a result of the sciatic nerve itself and not all pain in the leg is nerve pain. There are three types of pain associated with the lumbar region: nociceptive, somatic – referred and radicular pain. The definitions of these types of pain are not as important as their commonality. All three types of pain can be experienced in the lower back and leg with an injury to a specific structure.

There are structures related to the lumbar spine and pelvis which can evoke leg pain, that are not related to the nerves themselves. The nature of this somatic-referred pain differs from that of radicular pain, which is related to nerve inflammation. The lumbar spine ligamentous network, zygapophyseal joints (joints of the spinal column, the sacroiliac joint of the pelvis) and it’s dense supporting ligaments have empirically been proven to refer pain into different regions of the leg.

Dysfunction of specific muscles of the spine, pelvis and hip can all refer pain into the gluteal and thigh region when provoked. Hamstring strains and tendonitis, specifically where it originates at the pelvis, can be a source of pain. A less common, yet possible source of buttock and thigh pain is kidney pathology. When there is an injury to a kidney, the pain is referred into the back and pelvis.

The role of physical therapy, through a careful examination, is to determine the type and source of one’s leg pain and develop and specialized plan of care. Treatment for the spine itself includes manipulations and mobilizations. Dry needling can be employed to treat muscular and ligamentous dysfunction of the spine, pelvis, hip and thigh to decrease pain signals and trigger points. And there is no better medicine for the body than movement and exercise.