Low Back Pain with Radiating Pain/Sciatica

Nerves may be the source of your pain rather than the joints, muscles or tendons in the area. A physical therapist may diagnose this as your cause of pain by ruling out local dysfunction and ruling in nerve irritation with tests such as a straight leg raise or slump test. These tests utilize the concept that muscles/tendons only traverse 1-2 joints whereas nerves can be tensioned all the way from head to toe. This differentiation is important because while muscles may respond well to aggressive stretching, nerves may get flared up by this treatment.

Sciatic nerve tension may be due to entrapment at the level of the spine or anywhere along its path as it can get "trapped" at many interfaces from the hip to the knee and down to the ankle. Depending on the severity and irritability of the nerve, multiple joint or single joint movement may be used to tension or glide the nerve. Nerve glides are less aggressive and involve increasing tension at one joint while decreasing tension at another, with the goal of "flossing" the nerve back and forth. Nerve tensioners, or stretching, should be used with caution and would include tensioning across multiple joints. These are useful in less symptomatic cases with persistent, low-level symptoms.

Other ways to assist in improving neural tension include improving the pliability of the muscles and mobility of the joints at the common entrapment sites, usually starting at the spine, moving to the piriformis and hamstrings, then into the calf and shin. This may be accomplished through manual therapy, self-massage, joint mobility exercises and stretching. Core stability training, lower extremity strengthening, postural and movement retraining as well as activity modifications should also be considered to address other impairments that may be contributing to the overall presentation.