Sciatic Nerve Pain:  Top 10 Questions

Sciatica:  Do You Know the 3 Things a Nerve Requires? 

The sciatic nerve is a large nerve originating from the lower spine and spinal cord, running behind the leg. The main function of the nerve is to allow for normal feeling, reflexes and muscle function.

Nerves are physical tissues, similar to tendons, muscles and ligaments and have physical requirements. The three
main physical requirements a nerve has are:

  1. Space: Nerves in your body run through tunnels, muscles and around tendons. When space is taken away from a nerve (example – compression), the nerve may develop symptoms such as pins and needles, numbness, weakness and even eventually pain. If you compress the
    ulnar nerve next to your “funny bone,” you are bound to feel pins-and-needles in your fingers.
  2. Movement: New studies, using diagnostic ultrasound, have shown that nerves work similar to dental floss. When a someone straightens out his/her leg, the sciatic nerve will slide down the leg and when the leg is bent again, it slides back. When a therapist or physician pulls on your leg (straight leg raise), he/she is trying to assess how well the nerve can slide/glide and even how sensitive it is to the movement. When nerves don’t move well (tight muscles, small spaces, scar tissue, etc.), nerves may become a source of pain.
  3. Blood: Nerves LOVE blood! This ties in directly to the movement needed and described above. Approximately one quarter of all the blood in your body goes to the nervous system. When nerves are subjected to prolonged stretching, such as hamstring stretches or sitting in a car on a long road trip, they may cause some pain.

Physical therapy is a movement-based profession and when physical therapists examine and treat nerve injuries, one of their objectives would be to “give the nerve back what it wants” – space, movement and blood.  This may include exercise, manual stretching/movements, nerve glides, advice on positioning and more.

Nerve sensitivity: It is also important to note that when nerves are subjected to injury/irritation long enough, they become much more “sensitive.” Nerves can become sensitive to temperature, movement, pressure and even stress. The good news is that research has shown that when patients understand nerve pain, (thus reducing fear and use gentle movements to give a nerve back some blood) space and movement, the nerve sensitivity will decrease and thus pain over time will also decrease.

For more information – ask your Physical Therapist at Spine and Sport. (816) 279-7778

All rights reserved ISPI 2007 International Spine and Pain Institute
Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Top 10 Burning Questions about SCIATICA

  • What are the 3 most common causes for sciatica?
    • To answer this question, you must first understand what the nerve needs to stay healthy. Every nerve in your body needs 3 things to stay healthy.  Space, Movement,  and Blood.  Thus, to find the cause of your sciatica, we will investigate how much space and movement is available to the nerve by assessing the joints and muscles around the nerve.  The lumbar spine, the sacrum, and the hip must have adequate space and movement in order for the nerve to receive proper blood flow.  Thus, the 3 most common causes arise from limitations in space and movement to the lumbar spine, sacrum, or hip.  This may involve the bone’s alignment , position, or movement ; or it may involve the muscles being tight or weak in and around this area.
  • What is the #1 mistake that people make when treating sciatica?
    • The #1 mistake people make when treating sciatica is stretching too much. Nerves hate to be stretched.  Prolonged stretching depletes or inhibits blood flow to the nerve.  Thus, stretching can actually be disadvantageous to treating sciatica.
  • What type of exercises help sciatica the best?
    • The best type of exercises for sciatica are called neurodynamics. These exercises, sometimes called nerve flossing or nerve glides, help to pump blood into the nerve which is essential for healing and pain relief.  Nerve glides are the first priority in prescribing exercises.  However, in addition,  exercises are prescribed to create space at the limiting area.  This is individualized based upon the cause of your sciatica.  These exercises may involve the spine, sacrum, or hip to restore needed space.
  • How often do I need to do these exercises?
    • Initially when one is in pain, some type of movement needs to occur every hour to ensure adequate blood supply to heal. Thus, we have people do their nerve glides every hour that they are awake.  There are many ways this can be done, and it only  takes 30 -60 seconds at a time.  As one progresses, their exercises  progress and change as well.
  • How long will it take to go away?
    • Depending on the cause and the duration of your symptoms, this may vary. But if a therapist diagnoses the specific cause, we should expect to see progressive relief in 7-14 days with proper treatment.  This means improved management of the pain can be expected in 7-14 days.  While treating the actual cause, may take longer based upon postural habits and tendencies.
  • Do I need an MRI or x-ray?
    • Not initially.  If your sciatica treatment is not making progress after 2-3 weeks, then further diagnostics may be warranted such as an MRI or x-ray.  Ultimately, you need to see a  physical therapist who specializes in the treatment of sciatica, because there are some rare symptoms that may warrant an MRI right away.  Symptoms that include extreme weakness or foot drop; loss of control of your bowel or bladder; these symptoms may be a sign of something more serious  that would require immediate medical attention.
  • Do I need any special equipment to treat my sciatica?
    • Not necessarily. Your physical therapist will prescribe exercises  and treatment that you can do at home without any type of special equipment.  During therapy at the clinic, your therapist may prescribe a modality such as traction, ultrasound, or electrical stimulation to help with your treatment.
  • Should I use heat or ice?
    • Great question! Remember that one of the 3 things that nerves need is blood flow.  Thus, using heat will help open the blood vessels and increase blood flow.  So generally, heat is a good treatment strategy.  However, if your injury that is causing the sciatica is acute (meaning it just happened in the last 48 hrs) from a fall or trauma of some sort, then ice is used to help manage acute inflammation.
  • How do I get permanent relief and not just temporary relief so it doesn’t come back again?
    • To answer this question, one must understand the 3 phases of healing and realize that completing all 3 phases is essential to lasting results. Furthermore, the exercises change for each of these 3 phases.   All too often, sciatica is recurrent because treatment is never thoroughly finished.  The 3 phases involve 1) inflammation, 2) repair and regeneration, and 3) remodeling.   After the pain is relieved in the inflammation stage  using neurodynamics and modalities in physical therapy, it is vital that the cause of your sciatica is addressed with repositioning exercises and neuromuscular postural retraining.  Thus, your exercises change from neurodynamics, to repositioning, to mobility and stability exercises.  Completing a full treatment plan with both exercise and postural re-training will help ensure lasting relief from sciatica pain.
  • What is the best sleep position for sciatica?
    • Sleeping on your side is the recommended position. Using pillows to support your hips can be used between your knees.  Which side you sleep on may or may not matter based upon the exact cause of your sciatica and upon the integrity or quality of your mattress.   Your physical therapist can individualized a recommendation for you.