One of my middle aged female patients with a history of high blood pressure mentioned her right hip hurts. She said it felt like lead with pain and burning sensations.

When heaviness is the primary symptom of leg problems, or of relatively high severity, the cause is usually a dysfunction of the vascular system such as Lymphedema, Varicose Veins or Chronic Venous Insufficiency. This should be evaluated first if you suspect it may apply to you. If there is severe swelling in the leg there is possibly a blood clot in an artery or deep vein thrombosis.

If what you experience is pain that typically begins toward the hip region and travels down the affected leg, sometimes down to the foot, you most likely have sciatica.

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. Pain varies from annoying to disabling. The sensation ranges from tingling or burning to a deep, sharp shooting pain. The painful sensation often starts or worsens with movement, coughing, laughing, or sneezing.

You might experience pain in one region of the leg and numbness in another. Some may experience a weakening in the leg or foot accompanied by sciatica hip pain. The weakness may become so severe that mobility becomes difficult.

Herniated or slipped discs remain the most common contributing factor. The discs lie between each vertebra and consist of a tough exterior and a gel like interior to provide shock absorbing cushioning. If the outer covering of the disc ruptures, the gelatinous interior oozes through the disc and compresses the sciatic nerve.

Common causes of sciatica include: narrowing of the spinal canal in the lower back, degenerative disc disease and Spondylolisthesis (a condition in which one vertebra slips forward over another one.)

Physical therapy exercises incorporating strengthening and stretching are a central component of almost any sciatica treatment plan.

Treatment may include McKenzie-based mechanical diagnosis and therapy, muscle energy techniques, mobilizations, spinal stabilization and core strengthening exercises, nerve slides/glides, or traction. Often people will respond to moving in a certain direction. Some people with sciatica feel better with exercises moving in a backwards bending position, some in a bending forward position. Occasionally exercising in a neutral spine position is necessary. Sometimes we have a patient who responds best to rotating or shifting the hips sideways. The best therapy treatment for someone with sciatica varies greatly from person to person secondary to the many reasons the sciatica may be present.

At the Healing Center of Scottsdale, we offer a unique treatment program with the ATM2 device. ATM2 stands for Active Therapeutic Movement which is based off of Mulligan theory, a joint mobilization technique.

Jeff Juraska, PT

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