Physical therapy for sciatica must target either the facet joint or the intervertebral disc at a problem spinal level. Sciatica leg pain can present in a myriad different ways: from 'a pulled string' to jangling flashes of pain as if two live electrical wires are touching. Treatment for sciatica may cause the pain to worsen temporarily before it gets better.
1. A deep-seated cramping pain in the leg, with a positive SLR
(Pressure on the spinal nerve root from acutely bulging intervertebral disc - disc prolapse)
2. A jangling pain in the leg like electrical impulses. SLR is often negative
(Chemical scalding of the disc nucleus disgorged onto the spinal nerve - disc fenestration)
3. Gnawing leg pain, often with pins & needles, numbness, altered sensations
(Acute inflammation and swelling of a facet joint)
4. A dullish leg pain like a pulled muscle, often brought on by sitting
(Chronic facet inflammation and nerve root tethering from adhesions)
The 'movement hinges' of each spinal segment consist of the intervertebral disc and the paired facet joints. The disc takes most of the load through the segment, whereas the facet joints restrain movement. To be effective, physical therapy for sciatica must address both these structures - and the spinal nerve running between the two.
Both facet joints and discs swell and become lumpy with common–or–garden degenerative processes. Discs bulge when they lose fluid although facet joints, with their more abundant blood supply, have a stronger inflammatory response. Either one can affect the nerve root which exits the spine between them. But here's the good news! The good blood supply of the facets means that sciatica pain treatment can be quick and effective here.
A tensely swollen intervertebral disc can stretch
and inflame the nearby nerve root
And angrily inflamed facet joint capsule is a potent cause of nerve root irritation
You can read more about this sciatica treatment video here
The highly sophisticated nerve supply of a facet joint lets you know about the inflammation and trapped swelling. Discomfort is often felt as referred, or phantom, pain in the parts of the leg that share the same nerve supply. Indeed, the leg is a map of different areas where pain is referred from the different spinal levels.
Referred pain is different to pain cause by direct inflammation of the nerve itself. This is known as 'neuritis' or radicular pain and will manifest as a limited 'straight leg raise' (SLR). Most people with sciatica can move their leg freely (although their hamstrings is tight). So they have 'referred pain sciatica' rather than 'true sciatica'.
The heightened inflammatory reaction of the facet joints can cause weeping of the joint capsule. With lack of movement (caused by pain and fear) the oozing fluid can 'organise' into a stringy matted mass of living junk called adhesions. Adhesions are much more common in backs than everybody thinks - and their clogging of the spinal machinery causes havoc!
Adhesions are living junk tissue. They are like undergrowth and weeds invading a pristine forest
The (yellow) nerve on the right has withered or atrophied through being choked by adhesions. Adhesions are difficult to get rid of but they will reabsorb if they are made to move and stretch with normal movement. This is where the Ma Roller comes into its own. BUT you can only use this device in chronic and sub-chronic cases. To be confident in knowing the difference, you need to download the video above 'Easy Yoga Stretches for Sciatica Relief'.
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Read more about Sarah Key's 7 Best Sciatica Stretching Exercises
Read more about Sciatica Back Pain
Read more about How To Do Your Own Exercises for Relieving Sciatica
Read more about Sciatica Symptoms and Treatment
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