Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.

The two most common causes of sciatica, would be a disc herniation and piriformis syndrome.  

Anatomy of the Piriformis muscle and syndrome

Stretching

Orthopedic Tests

Straight leg raise (SLR) test. This test includes the patient lying on his/her back and lifting one leg at a time with the other leg flat or bent at the knee. A pain encountered while lifting the affected leg usually indicates sciatica.

Hip Quadrant Test

Testing for: joint capsule tightness or hip pathology

Procedure:

  • Patient is supine
  • Therapist Flexes and adducts the patient’s affected hip, until there is some resistance
  • Therapist maintain the resistance and moves the patient’s hip through an arc into abduction

Positive Sign: pain, early leathery end feel, crepitus in the movement

Pace Abduction Test

Testing for: the strength of the piriformis muscle

Procedure:

  • Patient is seated, with their hips flexed 90 ° and their knees together
  • Therapist places both hands on the lateral side of the knees , holding them together
  • Patient attempts to move their knees apart while the therapist resists

Positive Sign: piriformis weakness if the patient cannot move their knees apart. Pain is present in the area of the piriformis indicates piriformis trigger points

Piriformis Length Test

Assessing For: the length of the piriformis muscle

Procedure:

  • Patient is prone with their knees close together
  • Patient flexes both their knees to 90°
  • Slowly separate the lower legs away from the midline, while keeping the knees together (the internal rotation of the femur stretches both piriformis muscles)
  • The normal internal rotation would be (45°-50°) from the midline

Positive Sign: short piriformis muscle is indicated if the internal rotation is less than 45°

Posterior SI Joint Provocation

Testing for: SI joint dysfunction

Procedure:

  • Patient is sidelying on the unaffected side
  • Therapist brings affected hip into flexion
  • Therapist places one hand on the patient’s ASIS on the affected side, and therapist other hand on the ischial tuberosity on the same side
  • Therapist attempts to posteriorly rotate the patient’s affected pelvis

Positive Sign: pain around the SI joint indicates SI joint dysfunction

SI joint Gapping Test

Purpose: to assess the integrity of the anterior ligaments of the SI joints

Procedure:

  • Patient is supine
  • Therapist applies a lateral and inferior pressure to the medial sides of the patient’s Anterior Superior Iliac Spines. (Therapist crosses their arm in order to push easier)

Positive Sign: anterior ligament sprain if there is Unilateral Gluteal or Posterior Leg

Straight Leg Raise

Purpose: To determine the cause of low back pain

Procedure:

  • Patient is supine.
  • Place their affected leg in adduction and internal rotation
  • Raise the affected leg by grasping it around the heel and flexing the hip (their affected knee should be extended).
  • Flex the hip until the patient feels pain (usually around 70-80 degrees of flexion)
  • Slowly lower the leg until no pain is felt by the patient.
  • Dorsiflex the patient’s affected foot (this stretches their sciatic nerve)

Positive Signs:

Hamstring Tightness – pain in the back of their thigh and knee during hip flexion

Lumbar or SI Joint Dysfunction – pain in the low back after 70 degrees of hip flexion only (no foot dorsiflexion)

Sciatic Nerve Involvement – pain down the leg during passive dorsiflexion

Space Occupying Lesion or Disc Herniation – pain down their opposite leg ( the one that is not raised