What is sciatica? whats it usually caused by?
- Pain along sciatic nerve- lower back, through hips & buttocks and down each leg.
- usually caused by herniated disc or spinal sternosis, Spondyloliesthesis & OA pressure on the disc
Anatomy of sciatic nerve- pathway 4
largest nerve in humans
- originates ventral rami of spinal nerves L4 to S3 & contain fibres from anterior and posterior divisions of lumbosacral plexus
- nerve fibres form single nerve leave pelvis through greater sciatic foramen
- goes down posterior thigh
- before popliteal fossa divides into 2 branches- tibial nerve and common peroneal nerve
functions of sciatic nerve 2
motor functions- eg. hip adduction, plantarflexion
sensory fiunctions- eg. sole of foot, web between 1st and 2nd toes
sciatic nerve supply
undivided
- hamstrings
- adductor magnus
tibial branch
- L5-S3
common peroneal
- L4-S2
dangers of sciatica 3
- if not treated- permanent damage
- more dangerous for diabetic as more susceptible to nerve damage
- can lead to CES damaging the nerve root
testing for sciatica
- Straight leg test- neuro pain in lower back and leg between 30-70° hip flexion- L4-S1 nerve root
- Slump test
- Myotomes L4- ankle dorsiflexion or get to walk on tip toes, L5- big toe extension, S1- ankle plantar flexion
- reflexes - Patella L3-L4, Achilles L5-S1
non invasive technique 3
- NSAIDs
- Opioids
- Corticosteroids
exercises 5
- pelvic tilt
- knee to chest
- lower trunk rotations
- bird dogs mgill- strengthen abdominal muscles stabilise lower back
- Mckenzie
imaging for sciatica
Scans arent normally needed
X-ray- see if there’s bone overgrowth compressing on nerve root
MRI- imaging to show disc compression and nerve
symptoms of sciatica 6
bottom and back of legs through to feet and toes feel
- tingling
- weakness - myotomes
- numbness- dermatomes
- pain- stabbing
- positive SLR or slump test
- altered reflexes- patella & achilles
- potential foot drop
L4, L5, S1 reactions sciatica
L4: pain, tingling and numbness in the thigh. weak when straightening the leg and may have a diminished knee jerk reflex.
L5: pain, tingling and numbness may extend to the foot and big toes.
S1: pain, tingling and numbness on the outer part of the foot. weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.
