Maven Sports Medicine effectively combines our high standard of orthopedic rehabilitation practice with our clear understanding of elite fitness and sports performance. Maven’s Doctors of Physical Therapy have decades of combined practice experience in orthopedic rehabilitation, sports strength/conditioning, fitness, and athletic training. Our dedication to providing excellent evidence-based care to all our active and athletic patients remains consistent.

Diagnosis:

Sciatica can be diagnosed by a thorough examination from a medical clinician and your medical history.

A patient may say one of the following during the evaluation:

• "I began experiencing pain, burning, numbness, and/or tingling sensations that travel into my thigh after sitting for an hour or two."
• "When I bent over I feel a burning/shooting pain in my buttock."
• ""I am feeling increased tightness in my hamstrings."
  
  
  After your history is taken, your spinal active range of motion will be measured. You will be asked to bend forward, backward, sideward, and to rotate to see if any of these motions reproduce your symptoms. Usually, bending backward reproduces painful symptoms down the leg(s). Other tests will be performed to confirm the diagnosis.

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Treatment of Sciatica

There are many different treatments for sciatica once the source of the pain is determined.

Conservative treatment would consist of:

• Physical therapy
  • Lumbar stabilization (also known as core strengthening) exercises are appropriate for chronic low back pain; however, they are not indicated for acute herniated disc or acute low back pain. Our focus on instructing patients on these special exercises is to help them to actively engage the deepest layer of the abdominal muscles known as the transversus abdominus.
    
    This muscle wraps around the sides of your trunk beneath the ribcage and becomes continuous with the multifidi muscles, which are muscles ("many fingers") attached to each segment of your lumbar spine. When the transversus abdominus contracts, it causes the multifidi to contract, thus creating a natural corset, keeping your spine in a stable position during movement. You may see many of the lumbar stabilization exercises Maven uses in Pilates mat work classes and some yoga positions.
  • Soft-tissue mobilization or massage techniques are indicated for symptomatic muscle spasms or soreness associated with muscle guarding that often occurs in your back and hip muscles as a result of sciatica. There is no evidence that soft-tissue mobilization directly affects sciatica symptoms, however it may temporarily ease some of your discomfort.
  • Posture re-education is critical in keeping your back generally safe, especially if you perform activities that increase the load on your spine.
• NSAID’s (Naprosyn, Naproxen, Celebrex, Ibuprofen) - are usually ingested orally. They may be effective for short term, acute episodes of limb pain or numbness associated with nerve root compression. Contrary to patient belief, NSAID’s do not "mask" pain. They actually can have a positive effect on the irritated and inflamed nerve and disc. Many patients with sciatica also present with muscle spasms in the muscles of the low back and/or the buttock. As result, muscle relaxants (Skelaxin, Flexeril) may also be indicated.
• Epidural injection- consists of injecting a steroid (cortisone derivative) and an anesthetic into the region where the inflamed nerve root is positioned. Patients may receive up to 3 injections within a given year. The most accurate method of epidural injection, which has become the standard, is using fluoroscopy. From our experiences with patients who have received epidural injections, far more patients have benefited from the fluoroscopy approach vs. the non-fluoroscopic approach.
• Spinal manipulation (or spinal "adjustment" or thrust) is a manual technique that is performed by physical therapists and chiropractors for back pain treatment. If your sciatic pain is a result of a disc herniation, spinal manipulation should NOT be used in the treatment as it can be potentially harmful to the inflamed nerve root(s) and lead to more permanent disabilities or functional limitations. Your physical therapist will determine whether spinal manipulation will benefit your condition during the initial evaluation.