Lumbo-sciatica

What is lumbar sciatica?

This refers to the presence of lower back pain along with pain that radiates down the leg. The pain usually travels along the path of the sciatic nerve, either behind or on the outside of the leg.

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What is the sciatic nerve?

It is the largest nerve in the body. It starts in the lower back and goes down through the buttock and the back of the thigh. Behind the knee, it splits into several smaller nerves that go down to the toes. The sciatic nerve allows us to feel a large part of our leg and is responsible for sending the electrical signals to several muscles in the leg so that we can move.

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What are the symptoms of lumbosciatica?

The main symptoms are:

• Pain in the lower back and pain in the leg.
• The pain in the leg is often felt in the buttock, the back of the thigh, the calf, and the foot. However, you may only have pain in one of these areas.
• There may be burning, numbness, or tingling in the leg.

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When the pain goes down into the groin, the front of the thigh, or the leg, it is referred to as lumbar-cruralgia. The pain is not felt along the path of the sciatic nerve, but rather along that of the femoral nerve. It is less common, but just as possible. See the lumbar-cruralgia section.

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In general, there are two «types of lumbosciatica»:

• «Lumbosciatica with symptoms in lumbar flexion (rounded back)»
• «Lumbosciatica with symptoms in lumbar extension (arched back)»

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Here are the positions or movements that increase pain depending on the type of lumbosciatica:

For lumbosciatica with symptoms in lumbar flexion (rounded back), the pain is increased by one or more of the following:

• Sitting for long periods
• Driving for a long time
• Bending over
• Putting on socks, pants, underwear, shoes
• Sneezing or coughing

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For lumbosciatica with symptoms in lumbar extension (arched back), the pain is increased by one or more of the following:

• Walking for a long time (worse if walking slowly, better if walking faster)
• Standing for a long time (grocery shopping, cooking, waiting in line, or watching a show while standing still)
• Lying on your stomach or on your back with your legs extended
• Reaching to put objects on high shelves, such as in kitchen cabinets

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«It is possible to have both types of lumbosciatica at the same time and therefore have symptoms that fall into both categories. However, one category is often worse.»

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What are the serious symptoms of lumbosciatica to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis of one or both legs
• Significant or even complete loss of sensation in one or both legs
• Recent loss of balance when walking
• Significant and new incoordination
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

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Serious symptoms are only present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves.

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What are the causes of lumbosciatica?

Lumbosciatica can be caused by different things. Sometimes, the pain appears without any trigger. Other times, the pain is caused by a specific event.

Here are some examples of possible causes:

• Overloading the back compared to what you are used to. For example:
  
  • Doing spring or fall cleaning
  • Gardening all weekend
  • Driving for 10 hours in a single day
• Decreased level of physical activity (if you have become less active than before, you may develop lower back pain)
• New job, new sport, or new activity that works your back in a new way
• Car accident, fall, or sudden awkward movement

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How is lumbosciatica diagnosed?

The diagnosis is made based on the history of symptoms and the clinical examination.
It is important to know that medical imaging (X-ray, magnetic resonance imaging, etc.) is not relevant in 99% of cases of lumbosciatica.

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When to consult a physiotherapist for lumbosciatica?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for lumbosciatica?

Your physiotherapist will perform an assessment to determine your limitations and the cause of the lumbosciatica. To do this, they will assess the following elements:

• The mobility of your spine
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize the joints in your back and your sciatic nerve to reduce pain and improve movement
• Will give you specific exercises to do at home to address the cause of the problem and reduce pain.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements

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What to do at home for lumbosciatica?

Stop doing movements that cause too much pain temporarily, and then gradually start doing them again.
Do not remain completely still for long periods, as you will potentially be stiffer and in more pain afterward.

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Here are some tips that may help depending on the type of lumbosciatica:

For lumbosciatica with symptoms in lumbar flexion (rounded back):

• Limit the time spent sitting (get up every 20 minutes to walk a little).
• When you are sitting, straighten your lower back a little by sticking your buttocks out. Place a rolled-up towel in your lower back to remind you to sit up straighter.
• Go for frequent walks for a duration that is comfortable. Running might even be good for you (it depends on the person).
• In the car, sit well back in the seat and tilt the backrest slightly backward. Move the seat slightly closer to the steering wheel.
• Stick your buttocks out slightly to lean forward.
• When the pain is present, spend a few minutes on your stomach or on your back with your legs extended. This should relieve you.

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For lumbosciatica with symptoms in lumbar extension (hollow back):

• Limit the time spent standing (sit down every 20 minutes while the pain decreases).
• If you are standing still, place one foot in front of the other and make small weight transfers forward and backward.
• When cooking, place one foot inside the cabinet in front of you.
• When the pain is present, spend a few minutes lying on your side with a pillow between your knees. This should relieve you.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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If you are a runner, refer to the blog article on running (link to come) for concrete tips for running.

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Did you know?

• 90% of lower back pain episodes heal in 6 to 12 weeks
• 50% of lower back pain episodes heal in 1-2 weeks

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To learn more...

You can listen to the podcast "Parle-moi de santé" produced by one of our physiotherapists, Alexis Gougeon. Episode #7 discusses the topic of lower back pain.

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Episode #7 lower back pain

Find the episode on YouTube :

Click below to listen to episodes on podcast platforms:

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Sources

• Alexander CE, Varacallo M. Lumbosacral Radiculopathy. InStatPearls [Internet] 2019 Mar 23. StatPearls Publishing.

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