About the Back

Physical Therapy for Sciatica

Physical therapy for sciatica must target either the facet joint or the intervertebral disc at a problem spinal level. Sciatica leg pain can present in a myriad different ways: from 'a pulled string' to jangling flashes of pain as if two live electrical wires are touching. Treatment for sciatica may cause the pain to worsen temporarily before it gets better.

The Different Forms of Sciatica Can Indicate Different Structurs Affected

1. A deep-seated cramping pain in the leg, with a positive SLR
(Pressure on the spinal nerve root from acutely bulging intervertebral disc - disc prolapse)

2. A jangling pain in the leg like electrical impulses. SLR is often negative
(Chemical scalding of the disc nucleus disgorged onto the spinal nerve - disc fenestration)

3. Gnawing leg pain, often with pins & needles, numbness, altered sensations
(Acute inflammation and swelling of a facet joint)

4. A dullish leg pain like a pulled muscle, often brought on by sitting
(Chronic facet inflammation and nerve root tethering from adhesions)

What Causes Sciatica?

The 'movement hinges' of each spinal segment consist of the intervertebral disc and the paired facet joints. The disc takes most of the load through the segment, whereas the facet joints restrain movement. To be effective, physical therapy for sciatica must address both these structures - and the spinal nerve running between the two.

Both facet joints and discs swell and become lumpy with common–or–garden degenerative processes. Discs bulge when they lose fluid although facet joints, with their more abundant blood supply, have a stronger inflammatory response. Either one can affect the nerve root which exits the spine between them. But here's the good news! The good blood supply of the facets means that sciatica pain treatment can be quick and effective here.

Sciatica is Often a Referred Pain

The highly sophisticated nerve supply of a facet joint lets you know about the inflammation and trapped swelling. Discomfort is often felt as referred, or phantom, pain in the parts of the leg that share the same nerve supply. Indeed, the leg is a map of different areas where pain is referred from the different spinal levels.

Referred pain is different to pain cause by direct inflammation of the nerve itself. This is known as 'neuritis' or radicular pain and will manifest as a limited 'straight leg raise' (SLR). Most people with sciatica can move their leg freely (although their hamstrings are tight). So they have 'referred pain sciatica' rather than 'true sciatica'.

Some Related Pages for Sciatica During Pregnancy

Nerve Tethering by Adhesions is a Common Cause of Sciatica

The heightened inflammatory reaction of the facet joints can cause weeping of the joint capsule. With lack of movement (caused by pain and fear) the oozing fluid can 'organise' into a stringy matted mass of living junk called adhesions. Adhesions are much more common in backs than everybody thinks - and their clogging of the spinal machinery causes havoc!

[Image]: Adhesions are living junk tissue. They are like undergrowth and weeds invading a pristine forest.

The (yellow) nerve on the right has withered or atrophied through being choked by adhesions. Adhesions are difficult to get rid of but they will reabsorb if they are made to move and stretch with normal movement.

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