Just hearing the word can send people into a panic. Sciatica. Once you experience it, you hope it will never visit again. Often self-diagnosed “my hairdresser’s aunt had exactly the same thing”, what you think may be sciatica is not. It is characterized by a one-sided predominant leg and butt pain that can range from mildly annoying, to deep, shooting pain that will not quit.
Let’s examine sciatica: causes, symptoms, treatments and prevention.
Sciatica is named after the nerve causing the problem, the sciatic nerve. It originates from lumbar vertebra 4 -5 and sacral 1 – 3. It is the largest nerve in the body, almost the diameter of your thumb! It runs down the back and on the side (posterior/lateral) of the buttocks all the way to the bottom of the foot. There is one on each side.
The nerve is encased in fat called a neurolemma. The neurolemma has a dual purpose: it allows for the high-speed transmission of a nerve impulse to a muscle and to act as protection for the nerve. Inside the neurolemma is a myelin sheath, which has direct contact with the nerve. Why the double protection, and for that matter, a mini anatomy lesson? Think about this:
The slightest perceptible touch to the neurolemma can create significant pain, think about feeling a strand of hair beneath a piece of paper.
Fortunately, the sciatic nerve is deep into the body underneath layers of muscles and body fat. Even a direct fall on the nerve does not usually injure it. When the nerve is irritated or inflamed (swollen) the condition is “sciatica”. This irritation or inflammation happens at the root of the nerve, at the place where the nerve exits the spinal column.
This is a lumbar vertebra, the area where the nerve exits is called the IVF (intervertebral foramen). The white area is the disc. Discs frequently thin as we age.
As the nerve courses down the leg, many small nerve fibers (nerve plexus) cover a larger area. They are also involved in sciatica.
There are several causes for sciatica. For instance, sciatica often occurs during pregnancy because of the rapid front-end loading, a big belly. Mom must shift her weight back so she is not tipping forward. Usually, sciatica is resolved when the baby is born. Here are some of the other most common reasons for sciatica:
- Lumbar spinal stenosis – a narrowing of the tunnel through which the nerve exits the vertebra
- Degenerative Disc Disease – the lumbar discs are getting thinner, or have herniated
- Spondylolisthesis – one vertebra begins slipping forward because of arthritis or a small fracture in a part of the vertebra
- Skeletal Imbalance in the lumbar spine – being crooked, an unequal load on one side causing excessive wear and tear in the area of the nerve root.
- Being overweight is a contributing factor.
Sleeping on a too soft bed can also bring it on. Although super athletes experience sciatica, it is more common in people who don’t exercise.
Symptoms of sciatica, although predominantly leg, buttocks and low back pain, it can vary. These are the most common symptoms:
- burning or electric shock-like pain (radiculopathy or radicular pain).
- mild numbness and tingling sensation, sometimes the numbing causes complete loss of sensation in the foot making it difficult to walk.
- dull deep pulsing pain similar to a toothache pain.
- It can be felt from low back, through the buttocks all the way to the bottom of the foot.
- Sometimes, the radicular pain will skip areas where you may only feel it behind the knee, or in the foot.
- It may be constant or intermittent (hurts on and off).
Once you have experienced sciatica, you know when it is on the verge of returning. It can be very painful when driving or sitting in general. It can wake you up at night. Sometimes, sciatica can be decreased by a different body position and sometimes absolutely nothing helps. Very frustrating!
The good news is sciatica not fatal nor is it a disease. The bad news is that it can hang on for a long time; weeks or even months. Very few medications are effective, and there are mixed reviews on the outcome of surgical procedures.
Rarely do you experience sciatica on both sides. Most often the onset is gradual and insidious, it can’t be pinpointed to a specific event. People with sciatica complaint of difficulty rising from a seated position, sometimes it is accompanied by a limp as an avoidance of putting too much pressure on the leg. Often, you see crooked or bent forward position (antalgic). Laying down can decrease the symptoms.
WHAT SCIATICA IS NOT
Sciatica has medical criteria. Simply put, sciatica must involve the L 4 – L 5 and/or S 1, 2 and 3 nerve roots (where the nerves exit the spine). Other issues can be equally as painful but are NOT sciatica. These include:
- Piriformis Syndrome – The piriformis is a muscle in the buttocks which helps to keep the sciatic nerve in place. If the muscle is too tight, it can put pressure on the nerve and create sciatica-type pain. Even though the nerve is irritated, the irritation comes from the muscle rather than at the nerve root.
- Arthritis – Or a degenerative joint disease. The joints in the spine are too close together, or there is joint laxity (too loose).
- Sacroiliac Joint Dysfunction – the sacrum is out of balance (some people mislabel the area as the “hip.”
- Joint Problems in the Spine – misalignment and muscle spasm can radiate, but the cause is postural
- IT Band – Can give pain down the outside of the leg from the hip to the knee.
WHAT TO DO ABOUT IT
Treatment options are dependent on what doctor you see. If you make an appointment with your primary care doctor, he/she will probably take x-rays to rule out any other condition. Possibly write a prescription for an anti-inflammatory, pain medication and refer you to physical therapy.
If you are referred to an orthopedist, that would be for a surgical consultation.
If you see a chiropractor, they will adjust your back to re-establish range of motion, possibly ultrasound or cold laser and give you a list of exercises to do at home as well as some advice about activities of daily life.
If the pain is manageable, or you have experienced sciatica before, here are some things I like to remind my patients to incorporate into their normal activities:
- Ice the area. Place the ice pack where the nerve is located. You want it to become numb.
- When sitting, keep the knee of the affected side higher than your hip. Use something under that foot to raise your knee.
- When laying in bed or on the sofa, put something under your knees to elevate them.
- When sleeping on your side, put a pillow between your knees with the bad side up
- When driving, bring your seat a bit closer to the steering wheel with the back of the seat more reclined than usual. This will bring your knee up higher than your hip.
- At work, sit with your legs crossed, bad leg on top. That ankle resting on the other knee as shown.
Put some downward pressure on the knee that is up
- Stretch your piriformis muscle
This is just like the seated version see above. You want to gently pull the leg toward your chest, exhale as you are doing this. If you have a difficult getting your hands around your thigh, use a towel behind the knee and gently pull the knee toward your chest.
WHEN TO SEE A PROFESSIONAL
If you are not sure it’s sciatica and the pain is getting worse or if you have the symptoms below, it’s time to see a professional:
- Electric shocks down the leg
- Any change in bowel or bladder routines
- If you have sciatica in both legs
- Persistent numbness in your foot, especially if it affects walking
- Your pain is such that focusing on anything else is difficult
Prevention is always the best medicine. The number ONE thing to prevent sciatica is to keep your weight in check, increase your physical activity level, put on core strength, improve your spinal flexibility, keep your spine aligned. Women are more flexible than men, and yet there are more women in yoga classes than men. Come on guys, do yoga!
Dr Beverley Marr, posture expert, chiropractor, and co-founder of PurePosture. Dr Marr believes poor posture should be looked at as a root cause of many health issues we have today. To read more about Dr Marr, click here. To learn more about PurePosture, click here.