Sciatic Nerve Pain – Case Study # 1: Leila

sciatic nerve painSciatic Nerve Pain: Case Study #1 – Leila

Leila came to my office complaining of lower back pain, shooting pain from the low back and left buttocks down into the leg, pins and needles and numbness in her left leg all the way down to her toes, and severe muscle cramps behind her knee and in her calf.  Her cramps were severe at night.  She reported suddenly waking up one morning with these symptoms, and she was in a lot of pain when I saw her.  Leila is a 54 year old stay at home mom, who does daycare out of her home as well as computer related work from her home office.

Leila limped into my office, as she could barely put any weight on her left leg.  After taking the history, I proceeded with my assessment.  She had difficulty bending forwards and backwards.  Her back was painful when pressure was applied.  She had difficulty moving around and getting up, especially after being seated for a long time.  Her hamstrings were relatively flexible, although tighter on the left.  Her piriformis (a muscle deep under the gluts in the buttocks) was very tight and almost in spasm.  A large knot had developed in her calf.  Her entire leg was numb.  Twisting movements were painful to the left side.

She was experiencing acute sciatic nerve pain, and it was very debilitating for her.  Normally quite active, Leila was unable to walk to participate in any of her hobbies, such as table tennis and volleyball.

This was the second time she had experienced sciatic nerve pain.  However, this time was much more severe and did not seem to resolve quickly and on its own like her first sciatica episode a year earlier.

Anyway she continued to see me for treatment approximately twice per week, where we would work on loosening tight muscles that might have been putting pressure on her sciatic nerve, stretching, home exercises, modalities, and other techniques.  I also showed her various positions that she could lie in that would help to take the pressure off her low back and ease the sciatic nerve pains temporarily.  Unfortunately Leila has a very low pain tolerance which made it difficult for me to work the muscles as deep as I needed.

Her low back responded well to treatment, and in a few days her low back pain was gone.  However, the pain in her buttocks and all the way down the leg was still there.  As her muscles in that region were very tight, this led me to believe that her piriformis muscle was a likely compressive source of her sciatic nerve pain.

Her pain, numbness,  and night cramps continue to decrease but are still there.  Her sciatica still flares up at times and has not completely resolved.  She has had this condition for about a month and a half now, and she has lost strength in many muscles as a result.

The next step in therapy for her is to work on core strengthening and posture.

Sciatic Nerve Pain – What is it?

What is Sciatica?

What is Sciatic Nerve Pain , or Sciatica?

Sciatica is a fairly common condition that refers to pain that originates in the sciatic nerve and often causes pain in the low back, buttocks, and down the leg.  This can range from mild to severe, intermittent or constant, chronic or acute.  Acute refers to the initial stages, and chronic refers to the later stages.  The pain follows the path of the sciatic nerve from the low back down the leg, and more commonly affects only one side.  Sciatica is not a condition in itself, but rather a set of symptoms that occur as a result of inflammation or irritation of the sciatic nerve – hence the term “sciatica.”

Sciatic nerve pain is very common and can affect people of all ages, however it is more prevalent as people reach their late thirties or beyond.  It affects both men and women.  When severe the pain can be quite crippling, making it difficult to walk, sit for long periods, go up stairs, or basically carry out a normal day.  It can also be quite a nuisance at times.   In the worst of cases, surgery may be required to correct the structural or mechanical cause of your symptoms.  Please note that surgery for sciatic nerve pain is rare and is usually due to a congenital defect,  structural abnormality, or trauma.  However, despite the possible severity of the symptoms (especially during the early or acute phase of sciatica), sciatic nerve pain is not usually a serious problem and in most cases will resolve with time and/or physiotherapy.

The word “sciatica” is a general term used to describe pain or a set of symptoms associated with irritation or inflammation of the sciatic nerve.   The medical community differentiates between two types of sciatica to help clarify the cause or origin ailment.  There are two different types of sciatica: true sciatica, or false sciatica.  True sciatica is caused by compression of the actual spinal nerve root in the lumbar spine or low back.  The main cause of this is a herniated disc, or a disc “bulge,” in the spine.  False sciatica, by contrast, is caused by compression peripheral to the spinal nerve root.  Please refer to the anatomy section of this website for a better explanation of nerve roots within the spinal cord and how they can be compressed.  Regardless of which type you have, the pain caused by true and false sciatica is identical.

Inflammation or irritation of the sciatic nerve, whether termed true or false sciatica, can be attributed to a number of causes, such as a disc herniation, piriformis syndrome, spinal stenosis, and many others.  It can happen gradually, suddenly, or develop after the original presenting injury or condition.   For example, you may initially have low back pain, and if left untreated you may start to notice some tingling or shooing pains down your leg.  Due to the multiple causes of sciatica, treatment may vary depending on the cause.   Your physiotherapist will help you determine the cause and course of treatment.