Understanding Sciatica: Causes, Symptoms, and Treatment
As a physical therapist, I see many patients struggling with "sciatica," a term that covers a range of conditions causing radiating pain from the lower back down the leg. This discomfort can travel through the gluteal area and reach all the way to the foot. Sciatica is not a single diagnosis but rather an umbrella term for conditions that compress or irritate the sciatic nerve. Here, I’ll break down three common causes—spinal stenosis, disc herniations, and deep gluteal syndrome—and discuss how each differs in symptoms and treatment.
One root cause of sciatica symptoms is spinal stenosis. This condition occurs when joint spaces within the spine narrow, which can put pressure on the spinal nerves. Patients with spinal stenosis often experience pain that radiates down the leg when the spine is in an extended posture, such as walking or standing for extended periods. An interesting hallmark sign of spinal stenosis is the relief of symptoms when bending forward—such as while pushing a grocery cart or leaning on a countertop. This is because flexing the spine opens up the narrowed spaces, reducing nerve compression. Spinal stenosis is more common in older adults, as the spine naturally changes with age. Physical therapy for spinal stenosis often includes exercises that promote a flexed position to relieve nerve pressure, along with strengthening and mobility work to maintain function without worsening symptoms.
Another potential cause of sciatica is a disc herniation. When a disc herniates, either physical disc material or chemical inflammation can result in the compression of a nearby nerve root. This compression can lead to radiating pain down the leg, often exacerbated by a flexed posture, such as sitting for long periods, bending forward, or twisting. One hallmark sign of a disc herniation is that activities that increase intra-abdominal pressure, like coughing or sneezing, can worsen the pain. The good news is that discs have a high capacity to heal independently. In fact, research shows that the majority of disc herniations can improve with conservative treatment and time, often showing significant healing within a few months. Physical therapy for disc herniations generally involves avoiding aggravating postures and using extension-based exercises to create space around the nerve root.
A less commonly discussed but frequent cause of sciatic-like symptoms is deep gluteal syndrome. Unlike the spinal causes of sciatica, deep gluteal syndrome is a local irritation of the sciatic nerve by muscles or other soft tissues within the gluteal area. This condition often causes discomfort that worsens with prolonged sitting or specific postures that irritate the nerve. Many patients experience tightness or a dull ache in the gluteal region and may feel some radiating discomfort down the leg. For deep gluteal syndrome, treatment generally includes soft tissue mobilization, targeted stretches to relieve pressure on the sciatic nerve, and exercises to improve hip and gluteal strength. Addressing these factors can reduce local irritation and alleviate symptoms over time.
Although these conditions can all cause sciatica-like symptoms, they each have distinct triggers and respond to different treatments. This is why identifying the root cause is so essential; what may work for one patient could potentially worsen symptoms for another. While many sciatica cases resolve within 4-6 weeks, seeking the expertise of a physical therapist can make a world of difference in managing symptoms, improving recovery time, and addressing the underlying cause. Whether it’s spinal stenosis, a disc herniation, or deep gluteal syndrome, we can help guide you through the best exercises, lifestyle modifications, and pain relief techniques to put you on a path to lasting comfort.
If you’re experiencing radiating leg pain, consider consulting a physical therapist to identify the source and start a targeted treatment plan that works for you.
