Sciatica:The Other S Word Everybody Dread, Part II
In this post, I' d like to discuss the most common possible causes of sciatica. I could not reinforced the utmost importance of a CLEAR DIAGNOSIS in understanding and treating sciatica APPROPRIATELY. Knowing what structures are involved, which movements worsen or alleviate your symptoms is obviously necessary. You can't fix a problem without knowing where it is coming from...
But before this, I need to go back to Richard, my patient I mentioned in part I.
Like many people who presents to their family doctor these days with complaint of lower back pain or sciatica, Richard was told the following: "You strained your back and need to rest for a few days, applied heat to your lower back and take these prescription pain pills. You should feel better within the next ten days. If you don’t see any improvement, come see me again and we will do an MRI".
I have so many problems with this response. None of what was offered to Richard is really helping him actively fixing his problem and addressing the cause for his back pain. Richard seek the help of his doctor hoping to fix his back and get on with his life as soon as possible.
Pain pills are a band-aid, a highly addictive one at that ( 1 in 5 person prescribed narcotics will demonstrate some level of dependence, some with long lasting addiction).
Heat should also not be used in acute phases of an injury as you are only maintaining the inflammation process the injury started. Use ice instead...on your back. And if you are experiencing pain in your leg, it is a waste of time to ice your leg since the problem comes from your spine.
Bedrest and excessive rest is also one of the worst thing you can do: it is not proactive, it does not help your spine and body move, which they need to stay healthy. Instead, it makes you stiffer and weaker, making moving even harder when you try to resume normal activities.
Richard is not alone and none of these options really help get better... for the long haul. Most back pain will cease within 6 weeks with or without treatment( but who would want to be incapacitated for that long?)
By finding out from a skilled PT what causes your sciatica, you can immediately learn the proper positioning, movement, exercise, stretch, and what not to do or avoid to heal properly. It is crucial to receive such help to prevent recurrent episode of sciatic/ lower back pain and to be ready to manage it properly if you experience it again
Check my free e-book for more tips on what to do when your lower back hurts.
The most common causes for experiencing sciatica are:
-herniated disc ( but please do not believe a "bulging" disc is always a source of pain. Actually it is most often not and most times benign... but that will the subject of a future post) pressing /pushing on a nerve root
-degenerative or arthritic changes: could be Degenerative Joint Disease/ DJD, Degenerative Disc Disease/ DDD, Stenosis (narrowing of the spinal canal, or the space between vertebrae where the nerve roots exit on each side of the spine), basically just wear and tear of the spine, where joints between vertebrae and discs get compressed together, creating a narrowing and sometimes pushing against a nerve root, sending pain down your buttock, thigh, leg and/or foot
-pelvis / sacroiliac joint problem, where your spine meets your hip, can also often mimic sciatica symptoms.
What are typical symptoms:
-with a herniated disc, people generally have pain bending forward, sneezing, twisting, coughing and they experience a sharp pain running down the back of their leg...sometimes all the way into their foot. Often, these patients are active, 35 and younger.
-with degenerative changes, people are more likely over 50 years of age, experience relief with sitting while standing, bending backward and walking exacerbate their symptoms
-when the sacroiliac joint is involved, the symptoms and presentation can be very varied, making it much trickier to diagnose. I have treated patients sent by their doctor for acute knee pain when in fact the culprit was their SI joint referring pain mostly to their knee. Look for the video in my next post to find out if your pain is coming from your sacroiliac joint.
Remember that human bodies comes in a many varieties and anatomical differences could mean that people experience different symptoms in a multitude of ways.
If you have any additional questions about sciatica and / or why your back is hurting, or questions regarding the following video, Don't hesitate to reach out to us at Butheau Physiotherapy by calling 4252814171 or emailing
If you've been struggling with sciatica our back pain and don't know if physical therapy is the best option to help you recover, check out our 20mn free phone consultation: www.butheauphysio.com/phoneconsultation.html
8/31/2018 11:30:04 am
It's important to know different types of causes of back pain so you can treat it. It's good to know that excessive rest is actually not good for back pain. It can make it harder for your spine to build up strength, like you said.
11/12/2021 04:32:31 pm
Like you, the response from Richard's doctor makes me crazy. The typical western medicine strategy of numbing the pain until it "goes away" doesn't help it to "go away" at all! And, therefore, it will come back again. And that's why people are convinced that sciatica is a forever condition when it doesn't have to be!
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Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.