Physical Therapy for Sciatica

Physical Therapy for Sciatica in Seattle

What Is Sciatica? 

Where is the sciatic nerve? The sciatic nerve is the largest nerve in the body, arising from the spine at levels  L4, L5, S1, S2 and S3.  Sciatica refers to irritation of this large nerve at the level of the spine; sciatica is a type of lumbar radiculopathy that can cause pain into the leg and foot.  The sciatic nerve exits the spine level deep in the buttock, runs down the back part of the thigh, it splits at the knee, runs through the calf and into the bottom and sides of the foot.  Sciatica refers to pain that is felt in the leg. 

What does sciatica feel like?

Often, sciatica symptoms will feel like pain in the leg.  The pain can feel deep, sharp, shooting, or aching in nature.  The part of the leg that hurts will differ based on the level of the spine that is affected.  For example, if there is pressure at L4, this can cause pain across the front of the thigh and sometimes into the inside of the lower leg.  The L5 nerve root can refer pain to the buttock, outside of the thigh, outside of the lower leg, across the foot and into the big toe.  S1 can refer pain down the back of the thigh and into the back of the calf and into the outside part of the foot.

What Causes Sciatica?

There are a number of sciatic nerve pain causes, here are a few:

  • Herniated disc –  A herniated disc is when the contents of the disc push out, causing direct pressure on the nerve root or a chemical irritation of the nerve root.  Pressure or irritation of the nerve root can be felt along the pathway of the nerve causing pain into the leg.  This is most common in people in their 20’s to late 40’s.  
  • Lumbar stenosis – This is a narrowing of the spinal canal or openings to the side where nerves exit. Although this can impact younger people, it is most common in those over 60.  
  • Spondylolisthesis – Misalignment of the vertebrae or a slipping of one vertebrae on another.  A physical therapist can do some hands on testing to determine if there is too much motion at a certain level of the spine.
  • Muscle spasm – a strong contraction of a muscle in response to an injury, a strain, or overuse.  This can hold the spine in a way that compresses the nerve as it exits.  
  • Spinal mass – Malignant or benign tumors can put pressure on nerves exiting the spine.  
  • Infection/spinal epidural abscess – Other signs of infection may be present – such as fever, redness, malaise. If you think you may have an infection you should see your doctor before coming to PT.

Physical therapy can address sciatica with a musculoskeletal origin, such as  herniated disc, stenosis, spondylolisthesis and muscle spasm.  There are other causes of sciatic that are not appropriately addressed by a PT.  An evaluation with a physical therapist can help to determine if symptoms are musculoskeletal in nature and appropriate for physical therapy.  It is important to go to physical therapy for sciatica in order to get an accurate diagnosis and a treatment plan that is tailored to you.

Do I need an MRI or X-Rays for sciatica?

Probably not, or at least not right away.  A good physical therapy evaluation should be helpful in determining the cause of symptoms.  MRIs are very good in picking up any little “fault” in our spine or surrounding tissue but those findings are very often of little to no relevance clinically, meaning they won’t change what is done in the clinic.  Since MRI is so good at picking up any normal age-related change, it is common for patients or practitioners to focus their treatment on that finding even though it may not be the source of a person’s pain and symptoms. It is very common for there to be positive MRI findings in people who don’t show any symptoms while at the same time it is also very common for there to be no significant findings in a person who shows sciatic symptoms.  A famous 2014 study looked at MRIs of 3,110 people aged 20-80 both with and without back pain.  The study showed that up to 96% of people had disc degeneration!  This is not to say never get an MRI; sometimes an MRI or other imaging may be appropriate in the presence of other symptoms or worsening symptoms, but ultimately it is a decision between you and your doctor, physical therapists do not order MRIs or other imaging.     

Seeking Care For Sciatic Nerve Pain Relief

If you are asking the following questions, it may be time to see a physical therapist:

  • How long does sciatica last?
  • Why is my sciatica not going away?
  • How do I get my sciatic nerve to stop hurting?

To ensure a thorough diagnosis of any injury or to get personalized help with developing an individualized treatment plan,  please  schedule an appointment at our Seattle-based clinic – Union Physical Therapy.  At Union Physical Therapy our therapists have advanced training in assessment and treatment for conditions of the spine.  We will tailor your treatment to you. 

Union Physical Therapy also has a large care network, including physicians and other practitioners.  Your therapist can help to make a recommendation if it is necessary to check in with a doctor for additional medical management.  

See our blog on Physical Therapy Exercises For Sciatica

About the co-authors:

Jon Sparks, PT, DPT, CSCS is a physical therapist at Union PT in Seattle. He is experienced in treating acute and chronic industrial injuries, postoperative rehabilitation and orthopedic injuries. He enjoys staying up-to-date with evidence-based treatments.  Outside the clinic Jon is thoroughly obsessed with rock climbing.  When not climbing, he enjoys traveling, exploring new restaurants and snowboarding.

Amanda Benson, PT, DPT, CMPT, OCS has been treating patients in the Seattle area since 2005.  She has advanced training in manual therapy and in orthopedics.  When Amanda isn’t treating people with back pain you can find her riding her bike or spending time with her family.