Understanding Low Back Pain and Sciatica

A physical examination by one of our therapists will help us determine if the patient is experiencing radicular low back pain—meaning pain that radiates to other extremities from an inflamed or compressed nerve root—or radiculopathy—meaning nerve root pain that has resulted in neurological deficits such as impaired reflexes, numbness, and/or muscle weakness. Sciatica, which specifically refers to pain, numbness, weakness, or tingling in the leg caused by injury to or pressure on the sciatic nerve, is one of the most common types of radiculopathy.

Patients experiencing radicular pain versus radiculopathy should be treated significantly differently. Low back pain with radicular pain is less medically sensitive, so we’re not necessarily worried about patients losing complete function of their nerves. Whereas with radiculopathy, depending on how fast the loss of function is happening, the patient may or may not be a candidate for surgery or things like injections.

Being that the treatments for these symptoms can vary so significantly, we cannot emphasize enough how important it is to conduct a thorough physical examination and neurological screening to ensure we have a complete understanding of the condition and can address it properly—whether that means treatment through physical therapy or referring our patients out to a specialist.

A thorough exam will help determine different contributing factors or causes of pain. For example, could the cause be a disc issue in the lumbar spine putting pressure on the nerve or degenerative changes of the bony structures around the nerve? Could it be piriformis syndrome¹ or deep gluteal syndrome²? Tarsal tunnel syndrome³? A diabetic polyneuropathy⁴ or some sort of polyneuropathy? These conditions could all be the cause of a patient’s low back pain, and determining the condition is very important to determine what type of medical intervention is appropriate. Treating someone with piriformis syndrome like they have polyneuropathy may lead to unnecessary interventions, examinations, testing, imaging or even surgery when they’re not needed.

That all said, under the right conditions, radicular low back pain, radiculopathy, and sciatica can be treated with and benefit from physical therapy with the right treatment plan. (Emphasis on the “right” treatment plan, as certain exercises or improperly executed exercises can be unsafe and potentially cause neurological loss.)

Reference:

1. Piriformis syndrome is a condition in which the piriformis muscle, located deep in the buttock, spasms, pressing on and irritating the sciatic nerve and causing buttock pain.
2. Deep gluteal syndrome is characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space.
3. Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
4. Polyneuropathy means that many nerves in different parts of the body are involved.