Sciatica seems to be a term that is loosely thrown at any pain going down the leg. In a blog I wrote titled,” Is Pain Going Down the Leg Sciatica or Something Else”, this issue is extensively explored and you may want to read that first. This blog will cover the causes of sciatica and what treatment of true sciatica should consist of. If you have been diagnosed with sciatica and want to learn more about your condition and what caused it, this blog is for you!
What is Sciatica?
The first step to knowing how to get rid of pain is to understand what is causing it. To fully understand the issue, it’s important to know some of the anatomy involved. The most obvious contributor to sciatica symptoms is the sciatic nerve, which I’m sure we are all aware of at this point. The sciatic nerve, shown in the image below, stems from the spinal levels L4-L5 and S1-S3 and runs down the backside of the femur (thigh bone).
Above the knee level, the sciatic nerve branches into the tibial and common fibular nerves continuing down the rest of the leg (shown below). Sciatica is defined as pain radiating along the sciatic nerve, and yes, that means down the entire backside of the leg not just parts of it.
The sciatic nerve supplies the muscles of the lower extremities including:
- Semimembranosus– inside of the thigh
- Semitendinosus–inside of the thigh
- Biceps femoris-outside and toward the backside of the thigh
- Adductors- inside of the thigh
- Magnus muscles
- Muscles of the lower leg and foot
True sciatica pain will go down the middle of the glutes, straight down the back of the leg all the way to the ankle. If your pain is going elsewhere, then you don’t have sciatica. If that’s your story then I encourage you to read the blog I mentioned in the intro.
Now that you have a good picture of the area we are dealing with, let’s dive into what is causing your sciatica symptoms and what to avoid in your day-to-day.
What Causes Sciatica?
Sciatica is pain along the sciatic nerve and is caused by a direct insult to this area. Pain down the leg, not necessarily along the sciatic nerve, can have many different causes that require different courses of treatment which is why it’s important to differentiate. Other conditions that can be causing your symptoms may include the following (and if you click on the highlighted words, you will see a video I have done on the very subject):
- Herniated disc in the lower back or lumbar spine
- Stenosis in the lumbar spine
- Piriformis Syndrome
- Sacroilliac (SI) joint dysfunction
- Lumbar Facet Syndrome
True sciatica is not a result of another condition, rather it results from a direct insult to the sciatic nerve. The most common cause of true sciatica is prolonged sitting with bad posture and bad ergonomics (and yes, sitting on your wallet is a direct insult to the sciatic nerve).
Sitting can compress the sciatic nerve if you are sitting at the edge of the chair. This is very common in someone who is on the shorter side and their work set-up is not ergonomically sound. If you are consistently over-stretching the nerve in a seated position this can also cause irritation of the nerve. Many times, the legs are extended for too long when sitting at your desk which causes over-stretching of the nerve and therefore sciatica. True sciatica is not as complicated as you may think and the same goes for treatment.
How to Relieve Sciatica
The very first thing you want to do is use this Ergonomic Checklist to evaluate your work set-up, which, given our current state of COVID, may be your own living room.
If the way you’re sitting or the chair you are using is contributing to your symptoms and left unaddressed, your symptoms will always continue to return. Once that is taken care of, treatment in my office will typically include:
The one thing you do NOT want to do is initially stretch your sciatic nerve when you’re already experiencing symptoms. Sciatica is an irritation of this nerve and stretching it even more following direct insult will only make matters worse.
Now, adjustment won’t fix the problem but it will help with the symptoms. If you’re wondering how that is exactly, check out this blog on Chiropractic and Health Benefits.
In addition to irritating your sciatic nerve, I am certain that your lifestyle has also negatively impacted your soft tissue in this area. In this case, functional rehab such as ART may be necessary to address any soft tissue dysfunction in and around this area.
Once symptoms have diminished, I strongly recommend to my patient’s sciatic nerve flossing as shown in the video below. If you are currently experiencing sciatica pain this is not something you want to do. If you have a history of sciatica symptoms, this is a great exercise to maintain a healthy level of stretchability in the soft tissue, and yes, your nerves are soft tissue.
How to Prevent Sciatica Pain From Returning
If your day-to-day requires a lot of sitting, please use this Ergonomic list to minimize the dysfunctional damage done, because our bodies are not designed to sit at a desk for 8+ hours a day, and pain and dysfunction are the end result.
If you wish to not only get out of pain but also stay out of pain you MUST address your postural deficiencies. Posture is not about aesthetics, it’s about functionality, and in essence it is a reflection of our overall health. Next time you are in pain, slouching over, remember what I said! If your posture is compromised, it becomes very easy to damage and irritate your soft tissue, which includes muscles, tendons, blood vessels, connective tissue, and nerves.
The best way to address the postural decline and maintain functionality in all your joints and soft tissue is with Dynamic Neuromuscular Stabilization (DNS) or Developmental Kinesiology. Watch this to learn how this simple concept is missed so often.
So in order to maintain a properly functioning body where nerves, in this case the sciatic nerve, are not compromised, movement has to be done based on the way we were designed to move. From birth to ages 3-4 we start playing sports, attending school, and choosing lifestyles that are in conflict with this design. This deviation from the designed movement compromises the ‘map’ of movement called Homunculus and once the map is modified, we will move differently from how we are supposed to.
This is referred to as negative neuroplasticity. The good news is that just like we can mess things up within our bodies the reverse is possible too! That is, once we find what parts of the brain, with regards to movement and sensation, are modified and weakened, we can go back and exercise those parts to regain the function. This is referred to as Postural Neurology.
So to get rid of the problem for good, we need to treat the immediate area, remove the cause (lifestyle and habits that are contributing), take a look at the map of movement through postural neurology, make sure our movement is now corrected by applying the concepts of DNS or Developmental Kinesiology and then going forward, be aware of what we learned along the path.
Thankfully at our clinic, we apply the same principles to all musculoskeletal conditions and recommend you do the same.