<span style="font-weight: 400;">You get a new client, they complete the ParQ and they say they have sciatica…..what do you do?</span>

&nbsp;
<ol>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">Ask if they have been diagnosed by an AHP? </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">If not …..ask how did they come to that decision?</span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">If they researched their symptoms themselves online then maybe we should still refer them to their GP/Physio, as this could be an incorrect ‘diagnosis’? </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">*Check if they have been cleared to exercise by an AHP? </span></li>
 	<li style="font-weight: 400;" aria-level="1"><span style="font-weight: 400;">*Ask for a letter of clearance to exercise from an AHP….with guidance? </span></li>
</ol>
&nbsp;

<span style="font-weight: 400;">Do you recognise any, or maybe some or even all, of these situations…?</span>

&nbsp;

<span style="font-weight: 400;">Maybe you have had sciatica &amp; improved your own symptoms with movements &amp; exercise? </span>

&nbsp;

<span style="font-weight: 400;">However this series is aimed at helping PTs looking to help each client who presents with symptoms deemed as sciatica.</span>

&nbsp;

<span style="font-weight: 400;">Here is what we feel is an appropriate system of approach to what PT’s can, and also should NOT do, in these cases…..</span>

&nbsp;

<span style="font-weight: 400;">&#x2705; This first episode will explore the definitions, symptoms, causes &amp; anatomy of sciatica</span>

&nbsp;

<span style="font-weight: 400;">&#x2705; In episode 2 we will start looking at tests we might or shouldn't use with someone with sciatica </span>

&nbsp;

<span style="font-weight: 400;">&#x2705; Finally episode 3 will be about ideas on how to train a client with sciatica (*if cleared to do so by an AHP)</span>

&nbsp;

<img class="aligncenter wp-image-27749" src="https://biomechanicseducation.com/wp-content/uploads/2021/05/shutterstock_1648667119-scaled-1.jpg" alt="" width="437" height="291" />
<h2></h2>
<h2></h2>
&nbsp;

&nbsp;
<h2><b>Definitions &amp; Symptoms of Sciatica</b></h2>
&nbsp;

<span style="font-weight: 400;">Searching the internet you will likely find definitions like….</span>

<i><span style="font-weight: 400;">Pain that radiates along the anatomy of the sciatic nerve, usually asymmetrically in the lower back, hips, buttocks &amp; back of leg </span></i>

&nbsp;

<span style="font-weight: 400;">The problem is there are a multitude of causes (&amp; combinations of causes) of sciatica that can present these symptoms, which is why we should develop a multidisciplinary team that includes AHPs that we can rely on to evaluate our clients &amp; advise us on how to progress </span>

&nbsp;

<span style="font-weight: 400;">AHP’s have different skills &amp; training to be be able to assess for more sinister causes </span>

&nbsp;

<i><span style="font-weight: 400;">Many synonyms for sciatica appear in the literature, such as lumbosacral radicular syndrome, ischias, nerve root pain, and nerve root entrapment.</span></i>

&nbsp;
<h2><b>What other definitions are there..?</b></h2>
&nbsp;

<span style="font-weight: 400;">&#x1f4a5;Acute sciatica. Acute sciatica is a recent onset, 4 to 8-week duration of sciatic nerve pain. ... </span>

<span style="font-weight: 400;">&#x1f4a5;Chronic sciatica. ... more than 8 weeks. </span>

<span style="font-weight: 400;">&#x1f4a5;Alternating sciatica. ... moves from one leg to the other </span>

<span style="font-weight: 400;">&#x1f4a5;Bilateral sciatica...felt in both legs simultaneously</span>

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27753" src="https://biomechanicseducation.com/wp-content/uploads/2021/05/Screenshot-2021-05-18-at-10.58.01-1.png" alt="" width="538" height="335" />

&nbsp;

&nbsp;
<h2><b>Causes of Sciatica</b></h2>
&nbsp;

<span style="font-weight: 400;">Note; Sciatica; it is not a medical diagnosis but </span><span style="font-weight: 400;">more a descriptive term </span>

&nbsp;

<i><span style="font-weight: 400;">In one study it was shown that about 90% of cases sciatica are caused by a herniated disc with nerve root compression, but lumbar stenoses and (less often) tumours are possible causes.</span></i>

&nbsp;

<span style="font-weight: 400;">However other medical conditions that may cause sciatica include:</span>

&nbsp;

<span style="font-weight: 400;">Lumbar degenerative disc disease, general degenerative changes in vertebrae or discs</span>

<span style="font-weight: 400;">Spondylolisthesis</span>

<span style="font-weight: 400;">Muscle spasm and/or inflammation of the lumbar and/or pelvic muscles</span>

<span style="font-weight: 400;">Sacroiliac joint dysfunction</span>

<span style="font-weight: 400;">Rarely, tumors, blood clots, or other conditions in the lower spine may cause sciatica.</span>

&nbsp;

<span style="font-weight: 400;">The term sciatica is used because it describes the radiculopathy that occurs when one or more of the nerves that make up the large sciatic nerve are irritated or pinched. </span>

&nbsp;

<span style="font-weight: 400;">Most cases of sciatica will get better with time and conservative (nonsurgical) care. However, some sciatica symptoms such as progressive weakness, loss of leg sensation and incontinence may indicate a potentially serious injury to the sciatic nerve and surgery may be warranted.</span>

&nbsp;

&nbsp;

<img class="aligncenter wp-image-27750" src="https://biomechanicseducation.com/wp-content/uploads/2021/05/shutterstock_312582254-1-scaled-1.jpg" alt="" width="409" height="511" />

&nbsp;

&nbsp;
<h2><b>Anatomy of the Sciatic Nerve</b></h2>
&nbsp;

<span style="font-weight: 400;">Looking at our practical anatomy series where we explore general pelvic anatomy HERE </span>

&nbsp;

<span style="font-weight: 400;">The sciatic nerve is the largest section of the nervous system which is a continuum throughout the body. The sciatic portion can be around 2cm thick and is most famous when it comes to the rest of the nervous system because of its common irritation. </span>

&nbsp;

<span style="font-weight: 400;">Starting from the L4-S3 then the lumbosacral plexus (</span><i><span style="font-weight: 400;">plexus means an intricate network) </span></i><span style="font-weight: 400;">it emerges from the piriformis, usually inferiorly, but can be present in a variety of orientations. </span>

<span style="font-weight: 400;">Via the gluteal region it travels posterior to the gemellus twins, obturator internus, quadratus femoris and then passes by bicep femoris. Next behind the hamstrings &amp; the beautiful adductor magnus. </span>

<span style="font-weight: 400;">It innervates (supplies with nerves) the calf, the anterior and lateral lower leg and some foot muscles. </span>

&nbsp;
<h2><b>Variations of the anatomy of the Sciatic Nerve</b></h2>
&nbsp;

<span style="font-weight: 400;">The evidence suggests there are around 16% of us that have a variation from the ‘normal’ or most commonly expected presentation of sciatica nerve anatomy. </span>

<span style="font-weight: 400;">Some variations are thought to increase the risk of developing sciatica pain due to impingement, entrapment, or irritation of the nerve root.</span>

<span style="font-weight: 400;">In one study (Lewis et al, 2016) it was found that 89% of the cadavers anatomy analysed were of a ‘normal’ anatomic presentation. This is where the sciatic nerve divides above the piriformis muscle with one section passing through piriformis and the second portion passing below the muscle. </span>

<span style="font-weight: 400;">However variations found different sciatic nerve presentations where it passed over the piriformis or simply through the centre.</span>

<span style="font-weight: 400;">So what?</span>

&nbsp;

<span style="font-weight: 400;">Well its thought that some anatomic variants have not only higher risk but also reduced response to treatments or interventions. </span>

&nbsp;

<span style="font-weight: 400;">Ultimately no one sciatica patient is the same</span>

<span style="font-weight: 400;">No one intervention cures all </span>

<span style="font-weight: 400;">Clinicians may know more about the anatomy of our client’s sciatica based on tests or questions they may have been able to do than we realise. </span>

&nbsp;

<span style="font-weight: 400;">So lets connect and develop our multidisciplinary team to include our clients AHP’s or AHP’s who are willing to work WITH us…</span>

&nbsp;
<h1><span style="font-weight: 400;">Next time</span></h1>
<span style="font-weight: 400;">In Episode 2 we will start looking at tests we might or shouldn't use with someone with sciatica </span>
<h2><span style="font-weight: 400;">Can we test our client’s with this condition in mind?</span></h2>
&nbsp;

<hr />

&nbsp;
<h1><a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">Would you like to learn how to assess your clients Pelvic &amp; Spine Biomechanics?</a></h1>
&nbsp;

<img class="aligncenter wp-image-24100" src="https://biomechanicseducation.com/wp-content/uploads/2020/09/DSC01482-scaled-1.jpg" alt="" width="423" height="282" />

&nbsp;
<h2><a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">We have a few places left for our London 2 day workshop June Wed 9th &amp; Thur 19th.</a></h2>
&nbsp;
<ul>
 	<li>Do you have clients who struggle with range of movement in their squat?</li>
 	<li>Want to understand how you can assess the reason why their butt winks?</li>
 	<li>Wish you knew why their shoulders just wont allow them to press overhead?</li>
 	<li>Do you have clients who cannot maintain a straight spine during dead lifts?</li>
 	<li>Do you have clients afraid to do certain exercises because of their physical limitations or even pain?</li>
 	<li>Would you like to see their movement improve before your very eyes?</li>
 	<li>Maybe YOU want to improve your own ability to move?</li>
</ul>
Learn how to:

•Assess where limitations are coming from with a simple evidence based screening programme<span class="Apple-converted-space"> </span>

•Learn the relevant techniques that improve movement &amp; function of the pelvis &amp; spine

<strong>Pelvic Biomechanics</strong> - In this section we look at evidence based manual assessments for the pelvis, including how to identify sub-clinical muscle spasm, the difference between structural v’s functional leg length discrepancy and a system of exercise application to improve pelvic function in your clients.<span class="Apple-converted-space"> </span>
<ul>
 	<li>Leg Length Discrepancy <span class="Apple-converted-space"> </span></li>
 	<li>Downings Sign</li>
 	<li>4 Sign</li>
 	<li>Modified Thomas Test<span class="Apple-converted-space"> </span></li>
 	<li>Gillets</li>
 	<li>Relevant iMoveFreely® exercises &amp; application</li>
</ul>
<strong>Spine Biomechanics</strong> - In this section we will show you how to asses &amp; correct thoracic rotation. This stunning screen can literally be a game changer in so many ways.
<ul>
 	<li>Quadratus Lumborum</li>
 	<li>Sciatic Nerve<span class="Apple-converted-space"> </span></li>
 	<li>Spinal Flexion</li>
 	<li>Spinal Extension</li>
 	<li>Lateral Flexion</li>
 	<li>Thoracic Rotation mobility</li>
 	<li>Relevant iMoveFreely® exercises &amp; application</li>
</ul>
<strong>Spine Biomechanics Cont/d</strong>.. The Stability &amp; Control phase of training takes us to a deeper level in understanding ‘core training’ with a 3 Step assessment system.

<strong>Step 1 - These Basic Core Capacity Progression Tests</strong> will help you gain a better understand of whether your client is even ready for core training.<span class="Apple-converted-space"> </span>

<strong>Step 2 - Core Ratios Testing</strong> is such a cool and evidence based way to determining risk.

<strong>Step 3 - Finally Functional Stability Testing</strong> is essential to understand limitations from Aberrant lumbar motion, spinal hinging (kneeling and squatting) and cross pelvic syndromes.<span class="Apple-converted-space"> </span>

All of the above comes with a restorative periodised exercise programmes strategy from the iMoveFreely® programme.<span class="Apple-converted-space"> </span>

&nbsp;
<h1><a href="https://www.biomechanicseducation.com/product/pelvis-spine-biomechanics-3-day-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener">&gt;&gt;CLICK HERE TO BOOK HERE NOW&lt;&lt;</a></h1>

<hr />

&nbsp;

<strong>References:</strong>

<span style="font-weight: 400;">British Medical Journal (2007) Diagnosis and treatment of sciatica. </span><a href="https://www.bmj.com/content/334/7607/1313"><span style="font-weight: 400;">https://www.bmj.com/content/334/7607/1313</span></a><span style="font-weight: 400;"> - Accessed 18/05/21</span>

<span style="font-weight: 400;">Lewis, S. et al (2016) Anatomical variations of the sciatic nerve, in relation to the piriformis muscle. </span><span style="font-weight: 400;">Elsevier</span><span style="font-weight: 400;">. Vol 5, pp.15-19</span>

<span style="font-weight: 400;">Mayo Clinic (date unknown) Sciatica </span><a href="https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435"><span style="font-weight: 400;">https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435</span></a><span style="font-weight: 400;"> - Accessed 18/05/21</span>

<span style="font-weight: 400;">NHS (2020) Sciatica </span><a href="https://www.nhs.uk/conditions/sciatica/"><span style="font-weight: 400;">https://www.nhs.uk/conditions/sciatica/</span></a><span style="font-weight: 400;"> -  Accessed 18/05/21</span>

<span style="font-weight: 400;">Spine Health (2019) What you need to know about sciatica </span><a href="https://www.spine-health.com/conditions/sciatica/what-you-need-know-about-sciatica?source=pop-block"><span style="font-weight: 400;">https://www.spine-health.com/conditions/sciatica/what-you-need-know-about-sciatica?source=pop-block</span></a><span style="font-weight: 400;"> - Accessed 18/05/21</span>

&nbsp;