Sciatica: If My Leg Hurts, Is It My Back?
By Alan Williams, PT, OTR/L, ATC, CSCS
Remember the children’s song that goes, “The hip bone’s connected to the leg bone! The leg bone’s connected to the knee bone!” and so on? While it’s really just a silly tune designed to help teach youngsters the names of basic body parts, the song does make a very good point. Every single part of the human body is connected to every other part, whether through muscles and tendons or nerves and blood vessels. Nothing works independently. When you experience pain in a certain body part – say for example, your leg – convention usually tells us that the problem must lie within the leg itself, but that is not always the case. When trying to find a cause for leg pain, it’s worth checking out what else is connected to the “leg bone.”
Sciatic neuritis (also called sciatica) is the term for inflammation of the sciatic nerve and its accompanying symptoms. The longest nerve in your body, the sciatic nerve begins at five different root points, runs down your spinal column to your hips, and then splits, traveling down the back of each leg. Because it is so long, there are many places where this nerve can become irritated or compressed. This results in numbness, muscle weakness, and pain that can range from a mild ache to an excruciating, searing sensation. The pain can present in the low back or at any point along the sciatic nerve in the leg, though usually only one leg is affected. It is often experienced as “referred” pain, meaning it has spread from the point of origin.
In rare cases, sciatica includes loss of bladder/bowel control, indicating a serious condition called cauda equina syndrome. Persons experiencing these symptoms should seek immediate emergency medical care.
Sciatica has many possible causes, though it is most commonly due to compression of the sciatic nerve roots – such as the lumbar (lower back) nerves and sacral (pelvic) nerves. This compression can be due to an enlarged or herniated vertebral disc, bone spurs, trauma or injury, increased pressure from pregnancy, normal degenerative changes associated with aging, or even a tumor.
Conversely, sciatica can also be “self-inflicted” when a person’s habits cause the nerve to be compressed. This can happen through long periods of improperly balanced sitting (such as when slouching, sitting on your feet, or sitting on a wallet in your back pocket), jobs or hobbies that require excessive bending and twisting, or wearing heavy belts for long periods of time (as in certain professions like construction or law enforcement). Also, diabetics and the obese are at greater risk of developing sciatica due to the already increased stress load on their nervous system.
Because the treatment for sciatica depends greatly on determining its source, it’s advisable to consult your physical therapist or doctor regarding your symptoms. They will work to indentify or rule out any medical causes; if your sciatica is self-inflicted, they will help you to modify your habits and activities accordingly. Once the cause is addressed, most sciatic pain can be managed through gentle stretching, ice and/or heat to reduce inflammation, and strengthening and balance exercises. Your physical therapist or doctor will be able to give you specifics in these areas.
With the right treatment, most people can recover fully from their sciatic symptoms; however, sciatica that is not addressed may become worse over time, possibly requiring surgery. There is even a chance the condition and accompanying nerve damage may become permanent. For this reason, it is important to see your physical therapist or doctor early in the onset of your symptoms.
While not every cause of sciatica is preventable, proper posture, regular exercise, and taking breaks every hour when sitting for long periods of time will go a long way to helping you stay sciatica-free. Remember, anything you can do to keep one part of your body healthy will surely benefit the whole – it’s all connected, after all.
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