Your sciatic nerve is the longest nerve in your body, emerging from the vertebra in your low back and descending through the buttocks and backs of your upper legs. Just above the knee, the nerve separates into branches, traveling all the way to the feet and toes.
The sciatic nerve can become impinged or entrapped anywhere along its path, but entrapment most commonly occurs near the spine itself, or at the site of the periformis muscle, located deep within the buttocks. Pain symptoms that occur anywhere along the sciatic nerve are referred to as sciatica.
Sciatica symptoms can range from a mild nuisance to an excruciating pain that cannot be ignored.
Common symptoms include
Pain in the low back, usually to one side or other of the spine
Pain in the buttocks or back of the leg
Pain in the hip
Numbness, burning or tingling in the leg, feet or toes
Weakness in the leg or foot
Shooting pain in the low back or buttocks
Pain that worsens with sitting and standing, and lessens when lying down
Pain is usually felt on one side of the body, but it can affect both sides in some instances.
Sciatica Pain Causes
A number of things can initiate a bout of sciatica, including trauma, muscle strain while lifting heavy objects, and overuse from sports or exercise. Degenerative conditions of the spine related to aging can increase the risk of sciatica, as can being out of shape or overweight.
The most common underlying causes of sciatic nerve pain include:
Herniated disc in the lumbar spine
Entrapment beneath the piriformis, a short band of muscle deep within the buttocks
Spinal stenosis, where the spinal passage narrows from wear and tear, compressing part of the nerve
Slipped disc (spondylolisthesis)
Sciatica often resolves itself with rest and self-care. However, sometimes sciatica pain relief requires professional intervention.
Diagnosis of Sciatica
Diagnosis of sciatica begins with a clinical exam. Your care provider may ask you to perform activities that may cause pain to worsen, like walking on your toes or heels, performing leg raises while lying down, or rising from a squat. An EMG may be ordered to measure impulses along the sciatic nerve.
At NYDNR, we use real-time diagnostic ultrasound to view the sciatic nerve along its entire pathway. Ultrasound imaging enables us to view the nerves and surrounding structures while the patient is in motion, making it a superior diagnostic tool to Xray or MRI. Quick and accurate imaging on-site at our clinic means we can begin treatment immediately, without having to outsource or wait for imaging results.
Sciatica Pain Treatment
Traditional treatment approaches often focus on sciatica pain management, but fail to get to the source of pain and correct it. Muscle relaxants, pain medications, and steroid injections are common traditional treatments. Surgery is sometimes considered in severe cases.
At NYDNR, we take a holistic, non-invasive and drug-free approach to sciatic pain treatment. Our team of back pain experts understands the interconnectedness of the structures that affect the sciatic nerve.
Treatment approaches at NYDNR may include:
Physical Therapy for Sciatica
Depending on the location and nature of sciatica, certain exercises can help relieve pain. Sciatic nerve flossing exercises may help to release the nerve so it can glide more smoothly. Pelvic stability exercises can help relieve disc pressure on the nerve.
Our chiropractic team uses a variety of treatments to help ease sciatica pain. Heat and cold, spinal manipulation and ultrasound may all be incorporated into a treatment plan.
At NYDNR, treatment for sciatica is individualized for each patient. We pride ourselves on accurate diagnosis and innovative treatment methods that go beyond pain relief to restoring full function, so you can get back to your active pain-free life.
Dr.Kalika has revolutionized low back pain and sciatica care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology. The NYDNRehab motion and gait analysis lab is the only private lab in the US to feature research-grade technologies found only in the world’s top research labs, and made available to patients in our private clinic. Dr.Kalika’s modern approach to low back and sciatica pain has put him on the radar of some of the world’s top pro athletes and professional ballet dancers.
Sciatic nerve pain is characterized by sharp pain in the lower spinal region that may radiate into the gluteal muscle and continue down the leg, causing pain, numbness, tingling and weakness. It is caused by compression or entrapment of the sciatic nerve, which is one of the largest and longest nerves in your body. Roots of the sciatic nerve exit the spinal column from the vertebral junctions L-4/L-5 and L-5/S-1, where they conjoin and descend to innervate the muscles of your legs, feet and toes.
When unimpeded, the sciatic nerve glides freely as the body moves, providing a conduit for messages and sensory feedback, to and from the brain. Because of its location in the pelvic region, where the transfer of large force loads between the upper and lower body take place, the sciatic nerve may become compressed or entrapped from other structures, including muscles, tendons, bones and ligaments. It may also be injured from over-stretching, which may occur from sports or yoga.
Sciatica Symptoms
Symptoms of sciatic nerve pain include:
Unrelenting sharp searing pain, usually on one side of the body, next to the lower spine and into the buttock
Pain that along the path of the sciatic nerve, which travels from the low back, along the back of the leg, and all the way to the foot and toes
Pain that gets worse with sitting and standing
Prickling sensations along the leg
Numbness or weakness in the leg, foot and/or toes
Causes of Sciatic Nerve Pain
Sciatica pain has several potential origins, including:
A protruding or herniated disc the places pressure on the nerve root
Spinal stenosis, usually due to aging, where the spinal canal narrows, reducing space for the nerve to glide
Compression or entrapment by a too-tight periformis muscle
Inflammation of strained back muscles that compresses the nerve
Trauma from sports, a fall, or an accident
Over-stretching of the nerve, causig painful irritation
Pressure from a cyst or tumor
Other less common causes
Irritation of the sacroilliac joint can mimic symptoms of sciatica, but it does not involve the sciatic nerve.
Diagnosis of Sciatic Nerve Pain
Diagnosis takes into account the patient’s medical history, clinical profile and location of the symptoms. MRI may be prescribed to identify and confirm sciatica, but is not always reliable, and over reliance on MRI may result in treating the wrong cause of pain.
At NYDNR, we use diagnostic ultrasound to visualize the sciatic nerve, spinal discs, hips and pelvis, to identify the exact location and origin of sciatic nerve pain. We may also perform nerve conduction and electromyography tests, which are conducted in our office. Clinical experience is our most effective tool for diagnosing and treating sciatic nerve pain.
Physical Therapy for Sciatica
Most sciatic nerve pain can be resolved with conservative treatment. Treatment approaches for sciatic nerve pain largely depend on where the sciatic nerve is affected. Treatment should not only be directed at relieving pain and correcting structural damage, but at treating whatever dysfunction led to the structural damage in the first place.
At NYDNR, we provide individualized treatment based on the specific needs of each patient. A combination of treatment methods may be used, including:
Neurodynamic treatment to release nerve pressure and enable the nerve to glide freely
ESWT (extracorporeal shockwave therapy) to reduce inflammation and stimulate regeneration of nerve tissue
Gait retraining to eliminate over-activation of the periformis muscle
DNS (dynamic neuromuscular stabilization) to restore dynamic lumbopelvic alignment
Manual therapies to ease pressure and restore functional alignment
Our goal is to relieve sciatic nerve pain and eliminate its source, to restore optimal function and improve physical performance.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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Dr. Mikhail Bernshteyn
Dr. Christina Pekar
Dr. Michelle Agyakwah
Mariam Kodsy
