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Two common questions are:
- “Can Sciatica cause knee pain?”
- “Can Sciatica cause foot pain?”
The answer to both questions is… yes. However, you need to be cautious. It’s common for us to hear the sound of hooves and think ZEBRAS, instead of horses.
In many cases, knee pain and foot pain are just that, nothing more. Before you take a deep dive down the rabbit hole let’s take a look at what Sciatica actually is.
Sciatica: What Is It?
Sciatica is a term used to describe pain anywhere along the Sciatic nerve. This pain is often secondary to a combination of compression and inflammation of the nerve.
The most common site of injury tends to take place at the lower back. Inflammation at the lower back with or without compression of the nerve (often by a bulging disc or herniated disc) can result in pain. Piriformis Syndrome is also commonly blamed for Sciatic nerve pain.
Common complaints include pain in the buttock, thigh (hamstrings and Iliotibial Band) and calf. In some cases pain may be felt in the bottom of the foot and toes. The location of your pain is not necessarily where the nerve was injured. Recall that the most common site of injury is at the lower back secondary to disc injury.
Characteristics of Sciatica
Before you start blaming your foot or knee pain on Sciatica let’s take a look at some of the common characteristics of Sciatica pain.
- Pain is commonly described as a shooting, burning, stinging or numbing sensation in one or both legs.
- Pain is sometimes felt with sneezing, coughing and straining.
- People will commonly report increased pain with sitting and lifting. Especially in a slumped (rounded) back posture.
- Pain is often worse when first getting out of bed in the morning.
- In some cases, weakness or numbness in one or both of your limbs may appear. Weakness in the ankle or leg may cause your foot to drag or slap the ground while walking. This would be a reason to see a Medical Doctor more urgently, preferably an Orthopedic Physician (you may need to ask your Primary Care Doctor for a referral).
- Two common postural compensations include a flared out foot at the effected leg (“duck foot”) and a lateral shift at the spine (see picture below). Turning the foot outward helps to decrease tension on the nerve, which helps with pain resolution. Lateral shifts at the spine are often secondary to disc injury.
Tests For Sciatica
Two common tests for Sciatica include The Straight Leg Raise Test and The Slump Test. Reproduction of pain with these tests indicates increased likelihood that pain at your knee or foot is from Sciatica. I would recommend you have these tests done by a medical provider that is familiar with treating Sciatica. To get an accurate diagnosis and the right treatment you need a complete evaluation.
It is important to note that frequent, re-occurring bouts of plantar-fasciitis, hamstring strains and Baker’s Cysts are often attributed to poorly managed Sciatica. If you continue to run into these diagnoses and have a history of Sciatica and/or back pain there may be a correlation.
Now, if your symptoms do not seem consistent with the descriptions above (“Sciatica Characteristics”) you likely do not have Sciatica. That is great news! Obviously you are still stuck with the knee or foot pain… sorry.
Knee and foot pain can have a host of different causes. If you are adamant on attempting to relieve pain on your own, your best bet is to gradually work on restoring flexibility and strength at the knee or ankle. The inability to fully bend or straighten the knee and stiffness at the ankle joint are often common sources of pain at the knee and foot.
A great first step is to…
- Address any trigger points (tender points) in the muscles surrounding your foot and knee.
For knee pain this might include foam rolling the quadriceps, glutes, hamstrings and calfs. For foot pain you want to focus on rolling a lacrosse ball or tennis ball on the bottom of the foot and calf muscles. Start with gentle pressure and spend 1-2 minutes in each muscle group.
If You Suspect Sciatica
Seeing a Physical Therapist or Orthopedic Physician is a great first step. In many cases, physicians will not prescribe medications or medical imaging until you have tried a conservative treatment approach first. So I would lean toward Physical Therapy first.
Because Sciatica is often a result of inflammation at the nerve the goal is to help promote a positive environment for healing. In order to do that we need to eliminate postures and movements that may be causing compression and strain to the Sciatic nerve.
If you recall, Sciatica is often triggered by pressure on the nerve from a disc in your back. Avoiding slumped (rounded) back postures and minimizing sitting is key for reducing stress on the nerve. Stretching the nerve can also cause a spike in pain if done early on. We go into more detail in this article.
If we suspect Sciatica our “go to exercises” are discussed in the videos below.
Medication can be helpful for resolving un-relenting inflammation that is causing pain, but you need to consult with your Physician first.
Now, I am all for holistic. Break out the turmeric and while you are at it remove all the processed sugars from your diet. On top of that, stop doing the things that are causing pain (as mentioned above)!
We all want the quick fix. We think we can just sweep the pain under the rug. Taking medication while you continue to irritate your nerve with poor posture and movement is like rubbing icy hot on your face right before you punch yourself.
If you need to resort to medication please consult with your physician first.
Non-Steroidal Ant-inflammatory Drugs (i.e Ibuprofen and Advil) may prove to be beneficial for reducing pain that is secondary to the inflammatory response. However, anti-inflammatories don’t work for everyone. Anti-inflammatories are helpful for resolving inflammation at joints, muscles, ligaments and tendons, but they have a hard time penetrating through nerves.
Corticosteroids (i.e. Prednisone) may prove to be more effective for resolving inflammation of the nerve. In some cases, a local corticosteroid injections (epidural) can be performed in regions suspected of injury. Typically at the low back (lumbar spine).
Can Sciatica cause knee pain or foot pain? The answer is yes. That is because irritation of the Sciatic nerve (despite the site of irritation) can cause pain anywhere along the Sciatic nerve.
Sciatica pain is often described more as a deep ache, burning or shooting pain. It is often triggered by sitting, lifting, sneezing and coughing. Symptoms also tend to be worse in the morning when first getting out of bed.
The most common site of compression and irritation of the Sciatic nerve is at the lower back secondary to a disc herniation or bulge. In order to resolve pain we need to adopt postures that minimize stress at the back. Exercises will also be more geared toward resolving pressure on the nerve local to the back. Medications for resolving persistent inflammation can also be helpful.
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