Sciatica is a general term used to describe the pain and discomfort caused by an impingement of the sciatic nerve. It is usually felt as pain radiating from the buttocks down the back of the leg. The pain can be sharp, shooting or burning. It can be constant or come in waves or shock-like zingers. Sitting, standing up, walking or sudden movements can worsen the pain. The condition can start gradually and worsen over time if not adequately addressed. Sciatic issues are quite common. They are also frequently misdiagnosed and mistreated.
When people come to me with sciatic symptoms the first thing I do is determine the exact location of the discomfort. As the sciatic nerve is the longest nerve in the body, traveling from the sacrum bone all the way to the big toe, it can become impinged, or inflamed by a variety of factors.
While most sciatic issues are either predominantly in the gluteal area or in the back of the hamstring or both, it can exist in other locations as well. There can be involvement through the knee, calf and foot. Some people who get sciatic pain can only sit or only stand. Some have to sleep with a big pillow under their knee. All in all, sciatic issues come in all shapes and sizes and can be rather mysterious in their expression.
In my assessment I start in the upper area and move down to the lower regions, from the hip to the toe. As a rule, the further away from the spine the symptoms are, the more likely the problem originates with muscular entrapment of the nerve rather than a lower back spinal impingement. In the AMA perspective, if you have discomfort or radiating anything, especially in your leg, then they believe it has to be a byproduct of the initial exit of the nerve in the lower back from the sacrum. My experience tells me this is not the case.
Another unique feature of sciatic problems is that they can be brought on by opposite behaviors or actions. For example, athletic individuals who are serious bike riders deal with this issue a lot, as do hardcore runners. These individuals often have strong, tight muscle, which can lead to muscular impingement of the nerve.
On the other end of the spectrum are more sedentary individuals for whom too much sitting is at the root of the problem. But it’s not simply sitting that’s problematic; it’s sitting incorrectly that is the culprit. The more we sit incorrectly, the tighter the gluteal muscles get. They are very powerful when they get tight and don’t like to release. As the sciatic nerve exits the sacrum it goes right through those muscles and they put pressure directly on the nerve.
And it works the other way too. If the nerve starts to get overactive, aggravated or tense due to emotional or psychological stress, then the muscles will contract, forming a negative feedback loop between the nerves being hypertonic and the muscles being hyper-contracting. They work together to add to the problem (or to add to the solution). In reality, the nerves and muscles are very entangled. It’s not like an anatomical picture where you see the nerve clean and clear.
So in one perspective, you have athletic individuals who have musculature that starts to entrap the nerve. Then you have sedentary people with a nervous system that creates tension in the musculature and the tonality of their muscles just grip their nerves. It can be uncomfortable.
In general, I think people are confused about nerve involvement. There is often concern that the nerve is damaged. Yet, of the hundreds of sciatic cases I have worked on only a small percentage had lasting nerve damage. For the large majority, it was a matter of releasing the muscles around the nerve and joints in order to free the impingement.
There are the occasional cases that are caused by bone spurs or a disc pushing on the nerve as it originates in the lower back. Again the answer lies in freeing up the nerve. These cases take more time and are more challenging to resolve but the basic solution remains the same. No impingement on the nerve, no pain, no problem.
At Dorfman Kinesiology our primary tools to remedy sciatic related problems are therapeutic massage, self-massage, biomechanic realignment and stretching. For starters, take 3 minutes to check out my video on the Best Way to Sit and then do what it says. Correct sitting posture is key to the health of the sciatic nerve.
In my next article I will detail specific steps you can take to address sciatic pain and discomfort, as well as how to prevent future problems. In the meanwhile, sit up straight and relax. With this attention to your body and mind, sciatic issues can begin to unwind and you will feel better forever.