What is sciatica, and how do I fix it?
Sciatica is quite literally a pain in the butt, and I've had the firsthand experience of treating numerous patients with these symptoms. Currently, I am addressing my own bout of sciatica. In the following sections, you'll find an overview of this condition, its typical symptoms, common causes, and conservative treatment options. If you know someone grappling with sciatica, feel free to share this information with them.
What is Sciatica?
Sciatica is a term used to describe a set of symptoms caused by compression or irritation of the sciatic nerve. The sciatic nerve is the longest nerve in the body. It begins in the lower back courses behind the hips, and down each leg. When this nerve is under pressure or irritated, it can lead to a variety of uncomfortable symptoms.
The hallmark of these symptoms is pain that radiates along the path of the nerve, typically from the lower back through the buttock and down the back of one leg. This pain can vary widely, from a mild ache to sharp, burning sensations or even electric shock-like jolts. In addition to pain, individuals with sciatica may experience numbness, tingling, or weakness in the affected leg.
Common Symptoms
The root cause of your sciatica may vary but it all stems from a compression or irritation of the sciatic nerve. Some common causes are:
It depends. There isn't one magic fix for sciatica as there are many root causes of sciatica and individuals respond to various treatments differently. Below you will find helpful treatments you may discuss with your doctor of physical therapy or perform on your own to fix your sciatica symptoms. Find a positional preference. Often with sciatica, there are positions that make the referred pain worse and better. Limiting movements that make the pain worse and encouraging frequent movements that make the pain better is a great first step toward healing.
References
Sciatica is a term used to describe a set of symptoms caused by compression or irritation of the sciatic nerve. The sciatic nerve is the longest nerve in the body. It begins in the lower back courses behind the hips, and down each leg. When this nerve is under pressure or irritated, it can lead to a variety of uncomfortable symptoms.
The hallmark of these symptoms is pain that radiates along the path of the nerve, typically from the lower back through the buttock and down the back of one leg. This pain can vary widely, from a mild ache to sharp, burning sensations or even electric shock-like jolts. In addition to pain, individuals with sciatica may experience numbness, tingling, or weakness in the affected leg.
Common Symptoms
- Lower back pain
- Pain that radiates down one leg which may extend to the buttock, back of the thigh, and can go all the way to the calf or the foot
- Numbness and Tingling
- Weakness
- Worsening pain with certain movements such as prolonged sitting, bending and lifting, and even coughing and sneezing
The root cause of your sciatica may vary but it all stems from a compression or irritation of the sciatic nerve. Some common causes are:
- Herniated Disc: This is one of the most frequent causes of sciatica. The spinal discs act as cushions between vertebrae, and if the soft inner material of a disc protrudes or leaks out, it can compress the adjacent nerve roots, including the sciatic nerve.
- Spinal Stenosis: Narrowing of the spinal canal (spinal stenosis) can exert pressure on the nerves, including the sciatic nerve. This narrowing can be a result of aging or conditions like osteoarthritis.
- Piriformis Syndrome: The sciatic nerve can be irritated or compressed as it passes under or through the piriformis muscle in the buttock. This muscle spasm or tightness can lead to sciatic nerve irritation.
- Sacroiliac Joint Dysfunction: Dysfunction or inflammation of the sacroiliac joint, which connects the sacrum (bottom of the spine) to the pelvis, can irritate the nearby sciatic nerve.
- Degenerative Disc Disease: As the spinal discs age, they can lose fluid and become less flexible. This degeneration can lead to changes in the spine that may contribute to sciatic nerve compression.
- Trauma or Injury: Injuries to the spine, such as fractures or dislocations, can cause compression of the sciatic nerve, resulting in sciatica.
- Tumors: Rarely, tumors in the spine or nearby structures can compress the sciatic nerve, leading to sciatica.
- Pregnancy: Pressure on the sciatic nerve can occur during pregnancy due to changes in the body, such as weight gain and altered posture.
- Muscle Imbalances: Imbalances in the muscles surrounding the spine and pelvis can contribute to sciatica. Weakness or tightness in certain muscles may affect the alignment of the spine and put pressure on the sciatic nerve.
It depends. There isn't one magic fix for sciatica as there are many root causes of sciatica and individuals respond to various treatments differently. Below you will find helpful treatments you may discuss with your doctor of physical therapy or perform on your own to fix your sciatica symptoms. Find a positional preference. Often with sciatica, there are positions that make the referred pain worse and better. Limiting movements that make the pain worse and encouraging frequent movements that make the pain better is a great first step toward healing.
- Nerve glides (neural flossing) exercises involve gently gliding and mobilizing a nerve to improve its ability to move within its surrounding tissues
- Traction: this involves creating separation between the joints surrounding the nerve. This could be done manually or with a mechanical traction device or inversion table.
- Joint mobilization and manipulation: these aim to improve the range of motion, reduce stiffness, desensitize the nervous system, and promote better alignment of the vertebrae.
- Soft tissue mobilization - massage or other techniques to improve blood flow and decrease tension within the nervous system and muscles.
- Dry needling: addressing trigger points in soft tissues as well as near the nerve to desensitize the nervous system
- Stretching: focusing on the piriformis muscle, but also the hip flexors, hamstrings
- Core strengthening: excessive compression can happen when we are not stabilizing well. Becoming better at activating and using your core can help fix a major root cause of this condition.
- Education and posture training: education should focus on avoiding positions that cause referred pain promoting centralization of symptoms. Little postural changes such as a towel roll strategically placed at the lower back when you drive can be a huge help in managing symptoms and preventing reoccurrence of pain.
Davis D, Maini K, Vasudevan A. Sciatica. 2022 May 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29939685.
Sciatica - Diagnosis and treatment - Mayo Clinic. (2019). Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/sciatica/diagnosis-treatment/drc-20377441
Sciatica - Diagnosis and treatment - Mayo Clinic. (2019). Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/sciatica/diagnosis-treatment/drc-20377441
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