Sciatica is a form of lower back pain caused by compression or irritation of the sciatic nerve, which runs from the lower back through the back of each leg. It causes pain, numbness, or tingling in the back of the thighs and legs. Sciatica is commonly caused by herniated discs in the spine pressing on the sciatic nerve and can also be due to spinal stenosis, spondylosis, or piriformis syndrome. Diagnosis is based on symptoms and physical exam maneuvers like the straight leg raise test. Treatment involves pain medication, physical therapy, injections, or surgery depending on severity. Preventive measures include maintaining good posture and back health through exercise and proper lifting techniques.

1. Sciatica
Dechasa Imiru (MSc PT)
Physiotherapy Department
Institutes of Health
Jimma University
11/29/2023 1
Sciatica

2. 
What is their D ifference

Sciatica?

R adiculopathy?

R adicular P ain?
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Brainstorming
Sciatica

3. 
Review the location of sciatic nerve

Describe the definition of sciatica

Explain the causes of sciatica

Discuss the clinical features of sciatica

Describe the diagnostic procedures

Discuss the possible treatments and advices of
prevention
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Learning Objectives
Sciatica

4. 
It is the largest and longest nerve in the body.

It is arising from the lumbosacral plexus (L4 - S3).

It passes from the pelvis through the greater sciatic
notch and extends down the posterior aspect of the
thigh

It is actually composed of two nerves

Tibial and common fibular nerve (Peroneal nerve)
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What is sciatic nerve?
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5. 11/29/2023 5
Sciatica

6. 
In the low er thigh/ above the back of the knee the
sciatic nerve again divided in to tw o.

T he peroneal nerve travellaterally (side w ays)along
the outer aspect of the knee to upper foot.

T he tibialnerve continues to traveldow nw ard tow ard
the feet and innervate the heeland sole of the foot.
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C ont…
Sciatica

7. 11/29/2023 7
Sciatic nerve low er division
Sciatica

8. 
Sciatica is a form of low back pain that
runs dow n through buttocks and in one or
both legs.

It causes pain,numbness,or tingling in the
back of the thighs and legs.

Why it a form of LBP ??
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What is sciatica?
Sciatica

9. 
Sciatica refers to radiating pain along the
course of the sciatic nerve from the lower back
or buttock to one or both legs or an
associated lumbosacral nerve root.

A common mistake is referring to any low
back pain or radicular leg pain as sciatica
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Sciatica… ..
Sciatica

10. 
sciatica is a specific type of radicular pain that involves
the sciatic nerve

while radiculopathy is a broader term referring to the
compression or irritation of nerve roots in the spine.

Radicular pain is a more general term that describes
pain originating from nerve roots, which can occur in
various areas of the body.
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N B
Sciatica

11. 
Annual incidence of 1% to 5%

Lifetime incidence reported between 10% to
40%

No gender predominance

Peak incidence occurs in patients in their fourth
decade

Rarely occurs before age 20 (unless traumatic)
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Epidemiology
Sciatica

12. 
Anything that causes irritation (compression) along the
course of the nerve can cause sciatica.

The most common causes are:-
1) Over use of your back
◦ lifting too heavy object or
◦ Doing work that uses your back much more than you are used to
2) Injury to your back
◦ falling, or having something hit your back
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H ow does sciatica occur?
Sciatica

13. 
A posterior dislocation of the hip joint

A herniated disc

Pressure from the uterus during pregnancy

An improperly administered injection

Temporary compression of the sciatic nerve
as a person sits on a hard surface
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Other causes could be
Sciatica

14. 
Infections

Tumors

Spondylosis and spondylolisthesis

Spinal stenosis

Paget’s disease which gradually softens bones in the
spine, legs, so that they become curved.

Osteoporosis

Piriformis syndrome
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C ont …
Sciatica

15. 
The hallmark symptom of sciatica is pain that radiates
from the lower back down the back of the leg

Sensory impairment/disturbance, numbness, tingling/
burning sensations in the legs or numbness

Sometimes the muscles are weak

Rarely, there is a loss of bowel or bladder control.
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C linicalP resentation
Sciatica

16. 
The pain may vary in intensity, ranging from a mild
ache to sharp, shooting pain.

Reflex impairment

Gait dysfunction

Coughing, sneezing, twisting , lumbar flexion or
prolonged sitting or standing can often exacerbate the
symptoms.
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C ont.… .
Sciatica

17. 
Sciatica symptoms of paresthesias or dysesthesias in the
lower extremity can differ, depending on which nerve is
affected

L4: When the L4 nerve is compressed or irritated, the
patient feels pain, tingling and numbness in the thigh.

The patient also feels weak when straightening the leg and
may have a diminished knee jerk reflex.
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C ant… .
Sciatica

18. L5: When the L5 nerve is compressed or irritated, the pain,
tingling and numbness may extend to the foot and big toes.
S1: When the S1 nerve is compressed or irritated, the patient
feels pain, tingling and numbness on the outer part of the foot.
The patient also experiences weakness when elevating the heel
off the ground and standing on tiptoes.
The ankle jerk reflex may be diminished
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C ont.…
Sciatica

19. 11/29/2023 19
Sciatica

20. 
Herniated lumbosacral disc

Cauda Equina syndrome

Muscle spasm

Nerve root impingement

Epidural abscess

Epidural hematoma

Tumor

Potts Disease, also known as spinal tuberculosis

Piriformis syndrome
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D ifferentialD iagnosis
Sciatica

21. 
Sciatica is a clinical diagnosis

Careful history about the symptoms and examination of
back and limbs.

On history: absence of spinal cord lesion and cauda
equina lesion need to be confirmed.

Lab tests or x-rays, a CT scan, or an MRI might be
necessary
11/29/2023 21
H ow is it diagnosed?
Sciatica

22. 
To confirm that the pain is being caused by the sciatic
nerve.
Positive result:

If SLR causes pain or makes pain worse, as it is an
indication that pain is being caused by the sciatic nerve.
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Straight leg raise test/SLR
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23. 11/29/2023 23
SLR test
The SLR is considered
positive when it evokes
radiating pain along the
course of the sciatic nerve
and below the knee
between 30 and 70
degrees of hip flexion.
Sciatica

24. 
Bragard test is a modification of the SLR, where ankle
dorsiflexion is applied at the end of the SLR.
Dorsiflexion reduces the SLR angle at which the test is
positive and can be used to differentiate neural symptoms
from musculoskeletal symptoms.
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Bragard test
Sciatica

25. 11/29/2023 25
Bragard test
Sciatica

26. 
Also known as the popliteal compression test or posterior
tibial nerve stretch sign.

The patient can be examined in a supine position.

The examiner flexes the knee and applies pressure on the
popliteal fossa, evoking sciatica.

The pain would be reproduced by a quick snap on the
posterior tibial nerve in the popliteal fossa.
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Bow string test
Sciatica

27. 
Cauda equina, cord lesion, infection of the spine, or
cancer

Numbness on saddle area, and loss of bladder and/or
bowel control – cauda equina syndrome

Feeling of weakness in both side leg and foot and bilateral
numbness and tingling – cord lesion
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Warning signs/red flags
Sciatica

28. 
Over 50 years of age and have never had any previous
back pain may have a history of cancer.

Symptoms of fever, chills or unexplained weight loss and
had a recent bacterial infection, such as a UTI (urinary
tract infection)
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C ont …
Sciatica

29. 
Make sure that the client is free from a single red flags
before you admit!!

Safety is first always, make a rule
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N B:
Sciatica

30. 
Depending on symptoms, you may refer to GP

If it is necessary to have further tests.

These may include:
◦ Blood test to rule out infections
◦ X-ray
◦ Computerized tomography (CT) scan or
◦ magnetic resonance imaging (MRI) scan
11/29/2023 30
C ont …
Sciatica

31. 
Short Form-36 bodily pain (SF-36 BP)

Oswestry disability index

Roland-Morris disability index

VAS-score

TUG
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Outcome M easures
Sciatica

32. 
Most cases of sciatica can be treated at home with pain
killers and advice.

Medicines for pain and inflammation, such as ibuprofen
and naproxen.

Advice the pt to use ice massage or deep heat.

If usual medicine and advice doesn’t get better
physiotherapy helps the patient
11/29/2023 32
Treating sciatica
Sciatica

33. 
It is important to remain as physically
active as possible.

Bed rest may provide some temporary pain
relief, prolonged bed rest is unnecessary.

Recommended exercises include walking
and gentle stretching exercises.
11/29/2023 33
Exercise
Sciatica

34. 
M any people find that using
either hot or cold compression
packs helps to reduce pain.
11/29/2023 34
C ompression packs
Sciatica

35. 
Regular exercise to strengthen the muscles that support
your back.

Exercise stimulates the production of endorphins,
which are natural painkilling chemicals.

Core stability and flexibility exercise

Teaching how to improve your posture and reduce any
future strain on your back.
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Exercise and physiotherapy
Sciatica

36. 
For chronic pain that is caused by sciatica

The way we feel is partly dependent on the way we think
about things.

Research has shown that

People who train themselves to react differently to their
pain

Using relaxation techniques and maintaining a positive
attitude, show a decrease in the levels of pain that they
experience.
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C ognitive behavioraltherapy (C BT )
Sciatica

37. 
Discectomy – where the part of the herniated disc
pressing on your nerve is removed

Fusion surgery – if a vertebra has slipped out of place,
it may be possible to fuse it into place using by metal
rods

Laminectomy – a procedure often used to treat spinal
stenosis, this removes or trim the arch of a vertebra to
relieve the pressure on the nerves.
11/29/2023 37
Surgery
Sciatica

38. 
While not all causes of sciatica can be prevented

Measures you can take to reduce the risk of developing it.
Maintaining a healthy weight
Practicing good posture,
Using proper lifting techniques,
Engaging in regular exercise
Avoiding prolonged sitting or standing in one position
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P revention
Sciatica

39. Weight

Being overweight can put extra strain and pressure on
your back.
11/29/2023 39
P reventing sciatica
Sciatica

40. 
One of the biggest causes of back injury, particularly at
work place.

Step 1) Think before you lift

Can you manage the lift?

Are there any handling aids you can use?
11/29/2023 40
Lifting and handling
Sciatica

41. 
Step 2) Start in a good position
◦ Your feet should be apart with one leg slightly forward to
maintain balance
◦ When lifting, let your legs take the strain – bend your back,
knees and hips slightly but donot stoop
◦ Tighten your stomach muscles
◦ Do not straighten your legs before lifting as you may strain
your back on the way up
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Lifting and handling
Sciatica

42. 
Step 3) Keep the load close to your waist
◦ keep the load as close to your body for as long as possible with the
heaviest end nearest to you

Step 4) Avoid twisting your back or leaning sideways
◦ Especially when your back is bent
◦ Turning by moving your feet is better than lifting and twisting at
the same time
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C ont …
Sciatica

43. 
Know your limits – there is a big difference between
what you can lift and what you can safely lift.
- If in doubt, get help

Push, do not pull – if you have to move a heavy object
across the floor, it is better to push it rather than pull it

Distribute the weight evenly – if you are carrying
shopping bags or luggage, try to distribute the weight
evenly on both sides of your body.
11/29/2023 43
C ont …
Sciatica

44. 
How you sit, stand and lie down can have an important
effect on your back.
1) Standing posture

Stand upright, with your head facing forward and your
back straight

Balance your weight evenly on both feet and keep your
legs straight.
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P osture
Sciatica

45. 
You should be able sit upright with support of your back

Your knees and hips should be level and your feet
should be flat on the floor

Some people find it useful to use a small cushion or
rolled-up towel to support the small of the back

If you use a keyboard, make sure that your forearms are
horizontal and your elbows are at right angles
11/29/2023 45
2 Sitting posture
Sciatica

46. 
Make sure that your lower back is properly supported

Correctly positioning your wing mirrors will prevent you
from having to twist around.

Foot controls should be straight in front of your feet

If driving long distances, take regular breaks so that you can
stretch your legs
11/29/2023 46
D riving
Sciatica

47. 
Your mattress should be firm enough to support your
body while supporting the weight of your shoulders
and buttocks, keeping your spine straight.
11/29/2023 47
Sleeping
Sciatica

48. 
D o you take of your self???
11/29/2023 48
H ow can Itake care of myself?
Sciatica

49. 
Lose w eight if you are
overw eight.

D o regular aerobic exercise to
keep your back and abdominal
muscles in shape (this can be as
simple as w alking)

Learn to lift properly

Lean to maintain good posture
11/29/2023 49
H ow can Ihelp prevent sciatica?
Sciatica

50. 
The key to sciatica is patient education

The majority of cases of sciatica are best managed
conservatively

Bed rest should be limited

Regular exercise is essential

Surgery should only be undertaken when conservative
methods have failed

Patients should be encouraged to lose weight, stop
smoking
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Summary
Sciatica

51. Q uestions?
C omments?
T hank you!!
11/29/2023 51
Sciatica