Understanding Sciatica
I’ll never forget the shouts, screams and eventual tears during my Dad’s first experience with Sciatica. After months fighting to manage the pain he ended up in hospital followed by surgery for a herniated disc.
Second time around - during lockdown - Dad healed himself by seeking a quick diagnosis, exercise and self-care. Dad inspired me to understand more about Sciatica and its vast spectrum of severity, so I enrolled on a webinar. Here’s what I learnt…
What is the Sciatic Nerve?
The sciatic nerve originates in the lower lumber spine (L4, L5, S1, S2 and S3). Here the Lumbosacral Plexus (a posh work for a bunch of nerves) combine to create the Sciatic Nerve. The Sciatic Nerve is huge; the thickness of your little finger, it runs from your lower back all the way to your foot.
The Sciatic Nerve passes through the pelvis, under (or through in some cases) the Piriformis muscles which lies deep under the Gluteal muscles in the buttocks. It then runs down the legs to the knee where it branches out to become the Tibial and Perineal nerves. The Sural nerves then branch off into the foot.
This huge nerve pathway provides sensation to the back of the thigh, the entire lower legs, the ankle and sole of the foot. The Sciatic Nerve is responsible for flexion (bending) of the knee, hip adduction (bringing the thighs together) and dorsiflexion of the foot (flexing toes to the sky).
What is Sciatica?
Sciatica is caused by compression or irritation of the Sciatic Nerve roots located in the lower lumber spine.
This can be caused by a bulging or herniated disc; the latter happens when the outer portion of the vertebral disc tears and the inner portion bulges out, putting pressure on the nearby Sciatic Nerve.
Sciatica can also be caused by misalignment of the lumber vertebrae or Spinal Stenosis (narrowing of the spaces within your vertebrae which usually happens in older people).
Inflammation around the vertebrae can also cause Sciatica, as can an abscess or malignancy. In short, Sciatica is an obstruction to the Sciatic Nerve originating in the lower spine.
Piriformis Syndrome
Sciatica and Piriformis Syndrome are caused by an interference with Sciatic Nerve function. However, Sciatica is the result of a spinal problem such as a herniated disc or Spinal Stenosis. While Piriformis Syndrome is due to an interference of the Sciatic Nerve from the Piriformis muscle rather than a dysfunction of the spine.
Located deep in the buttock, the Piriformis muscle runs close to (or through in some cases) the Sciatic Nerve. If the Piriformis muscle becomes tight it can compress the Sciatic Nerve which results in similar symptoms to Sciatica.
Piriformis Syndrome can be effectively treated with massage and stretching. However, while massage can help with pain management for people suffering with Sciatica, other methods of treatment are required. It is important to get a proper diagnosis for Sciatica from your GP in order to seek the appropriate treatment.
Causes of Sciatica
Sciatica can occur for different reasons in people with very different lifestyles. For example, an active person with a manual job is just as susceptible to Sciatica as an inactive person with a desk job.
Sciatica can also be incited by a sudden action or can be brought on through repetitive action. For example, bending quickly in the garden to pick up leaves or sitting for eight hours every day at your desk.
Symptoms of Sciatica
Symptoms of Sciatica are pain in the buttocks, lower lumber pain, sensory disturbances down the leg, muscles weakness, gait dysfunction (a limp), impaired reflexes (knee and ankle) and even Oedema (swelling).
Sciatica can manifests itself in many different ways, depending on the location of the nerve impingements. This is because the nerve roots serve different parts of the legs.
Impingement in L4 shows itself as pain and numbness in the thigh, weakness straightening the leg and lack of reflex in the knee.
Impingement of L5 manifests as pain and numbness down the side of the leg, in the big and second toes, and on the inside of the foot.
Impingement in S1 can be identified by pain and numbness in the little toes and outside of the foot and back of the leg. There can also be weakness when standing on toes and a diminished ankle reflex.
Impingement in S2 and S3 is transferred as pain and numbness to the back of the inner thigh and buttock.
Treatment for Sciatica
It is important to visit your GP for a proper diagnosis of Sciatica. Sciatica can come and go quickly using treatments such as over the counter painkillers and anti-inflammatories such as paracetamol and Ibuprofen, and self-care techniques listed below.
However, Sciatica can also be severe or chronic and requires longer treatment with help from physiotherapists, stronger analgesics, significant lifestyle changes and in some cases corticosteroid injections or even surgery.
Self-Care for Sciatica
Move Often: Don’t stay in the same position for long periods of time. This fatigues the muscles and cases spasm or lack of blood flow. If you have a desk job then it’s important to move about regularly or switch from a sitting to standing desk regularly. Too long either standing or sitting can exacerbate the symptoms of Sciatica.
Improve Posture: Avoid compression of the vertebrae. Try to correct your posture if you find yourself slumped in a chair or hunched over while standing.
Exercise: Light exercise such as walking for short periods can really help.
Hot/Cold Therapy: This is a great option for pain management. Heat or ice packs can help to make life more comfortable while sitting.
Massage: Whether it’s self-massage or you book in for a treatment, a massage can help you relax and manage the pain of Sciatica.
Anti-inflammatory Diet: A great way to ease inflammation naturally is by removing sugar from your diet. The easiest way to do this is by eating a wholefoods diet and avoid processed foods or foods high in added sugars.
Hamstring Stretches: Gentle hamstring stretches can help to ease the pain of Sciatica.
Exercises for Sciatica
Below is a great effective and gentle stretch for Sciatica you can perform. The NHS website also has some great videos here: NHS Exercises for Sciatica
Image: Runners World