Sciatica

1
Sciatica

• Kelley McDonald
• Evaluation 1
• 2/18/08

2
Sciatica

• Pain along sciatic nerve. 2
• Irritation along any part of the sacral plexus,
  sciatic nerve trunk, or peripheral nerve
  branches. 2
• Irritation of peripheral nerve endings may cause
  pain reflex. 2
• Two lesions commonly to blame
• Sacroiliac region 2
• Level of the piriformis muscle where nerve trunk
  emerges through sciatic notch 2
• Can be classified into four levels of severity 3

3
Classifications

• Sciatica Only3
• No sensory/ muscle weakness
• Modify activity, develop rehab/prevention program
  
• An increase in pain would require re-evaluation.
• Sciatica with Soft Signs3
• Some sensory changes
• No or mild reflex change
• Normal muscle strength
• Normal bowel/bladder function
• Remove for 6 to 12 weeks

4
Classifications Contd.

• Sciatica with Hard Signs3
• Sensory/reflex changes
• Muscle weakness due to repeated, chronic, or
  acute condition
• Normal bowel/bladder functions
• Remove 12 to 24 weeks
• Sciatica with Severe Signs3
• Sensory/reflex changes
• Muscle weakness
• Altered bladder function
• Immediate surgical decompression

5
Sciatica Facts

• Can be caused by
• Herniated intervertebral disk 4
• Osteoarthritis of lower spine 4
• Pregnant uterus 4
• Dislocation of hip 4
• Improper injections of buttocks 4
• Sitting on hard surfaces for extended periods 4
• Males can develop sciatica from constantly
  sitting on wallet carried in hip pocket. 4

6
Causes

• Cysts 1
• Nerve may be injured. 1
• Spinal Stenosis 1
• Inflammation of nerve root 1
• Scar tissue 1
• SI joint dysfunction 1
• L disc herniation 1
• May be in connection with infection or
  inflammatory disease. 2
• May be caused by mechanical factor of compression
  or tension. 2
• Herniated disc 3
• Annular tear 3
• Myogenic/ Muscle-related disease 3
• Facet joint arthropathy 3

7
Signs Symptoms

• High steppage 1
• Inability to stand on toes or heels 1
• Sensory difficulties throughout the foot 1
• Muscle atrophy and/or weakness 1
• Burning or hyperesthesia is sacral and/or gluteus
  area 1
• Medial rotation with hip extension makes worse 1
• Radiating pain 1
• NCV tests slow 1
• Pain extending down post. thigh and low leg to
  sole of foot and along lat. aspect of low leg 2
• Pain when sitting/leaning forward 3

8
Signs Symptoms Contd.

• Morning pain 3
• Arthritic pain (changes in weather aggravate) 3
• Straight leg raising test aggravates 3
• Pain into buttock/thigh region 3
• Pain during IR of thigh/ spinal extension 3

9
Special Test

• Straight leg raising test5
• Pt. is lying supine. AT lifts leg while
  supporting foot at calcaneous. Knee should remain
  straight. The angle the leg can be raised will
  vary but normal range is 80. If pain is present
  during leg raise, then you must determine if pain
  is because of hamstring tightness or if it is
  actually the sciatic nerve.
• () Sign Pain
• Indication Reproduce back and leg pain so cause
  can be determined.

10
Special Tests

• Well Leg Straight Leg Raising Test/ Opposite Leg/
  Positive Cross Leg Straight Leg Raising Test5
• Pt. lies supine while raising uninvolved leg. Pt.
  will experience pain in involved side.
• () Sign Pain
• Indication Evidence of space-occupying lesion
  such as a herniated disc in lumbar area.

11
Special Tests

• Hoover Test 5
• Have pt. perform in conjunction to straight leg
  raising test.
• Pt. laying supine. As pt. tries to raise leg, cup
  calcaneus of opposite leg.
• () Sign Pt. pushed down on cupped heal as they
  try to raise leg.
• Indication To see if pt. is genuinely trying to
  perform test or just malingering.

12
Special Tests

• Kernig Test/ Brudzinski-Kernig Test
• Pt. positioned supine, hands behind head in
  cupped position. Pt. should flex head onto chest.
  While raises the extended leg actively by flexing
  hip until pain is present. Pt. should then flex
  knee and if pain disappears, test is positive. 1
• () Sign pain 1
• Indication Meningeal irritation, nerve root
  involvement, or possible irritation of dural
  coverings of nerve root. 5

13
Special Test

• Bowstring Test 1
• Perform SLR test, then flex K slightly to reduce
  symptoms. If thumb or finger pressure is applied
  to popliteal area, pain is present.
• () Sign Pain
• Indication Tension/pressure on sciatic nerve and
  modification for SLR test

14
Resources

• 1. Yvettes PowerPoint
• 2. Kendall, F. P., McCreary, E. K., Provance, P.
  G., Rodgers, M. M., Romani, W. A. (2005).
  Mucles Testing and Function with Posture and
  Pain 5th Edition. Baltimore, MD Lippincott
  Williams Wilkins.
• 3. Anderson, M. K., Hall, S. J., Martin, M.
  (2005). Foundations of Athletic Training
  Prevention, Assessment, and Management.
  Philadelphia, PA Lippincott Williams Wilkins.
• 4. Saladin, K. S. (2007). Anatomy Physiology
  The Unity of Form and Function. New York, NY
  McGraw-Hill.
• 5. Hoppenfeld, S. (1976). Physical Examination of
  the Spine Extremities. Upper Saddle River, NJ
  Prentince Hall.