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Sciatic Pain and Treatment



Sciatic Pain and Treatment

In this article you will discover what sciatica is, what are the common causes of sciatic pain and what things you can do to treat your sciatic pain and help to prevent a re-occurrence in the the future.

Sciatic pain typically causes a deep burning pain into the butt (hip/gluteal muscles) and travels down the effected leg.  If you have ever suffered from sciatic pain, then you understand how debilitating this pain can be and how difficult it can be to resolve sciatic symptoms.

The good news is that with proper identification of the problem and the right stretch and exercises, you can recover and prevent sciatic pain.  So let’s get started!

Just what is Sciatica?

Sciatica is a name given to a condition that happens when the sciatic nerve becomes irritated.  When pressure is placed on the sciatic nerve, the nerve begins to send pain signals along the nerve and to the brain.  Sometimes sciatic pain signals can travel the length of the nerve and other times they are concentrated into a single location.  The muscular tissues that are innervated by the sciatic nerve may or may not be directly affected.

Sciatic nerve and piriformis muscular tissue group picture taken from Principles of Anatomy and Physiology 12th Edition by Gerard J Tortora and Bryan Derrickson.

Both the Sciatic nerve and the Piriformis muscle can be seen in the picture above.  The sciatic nerve is the yellow nerve running vertically down the middle of the leg; while the piriformis muscle is the muscle found directly above the sciatic nerve.  The sciatic nerve runs straight under (sometimes over or through) the piriformis muscle, however it does not innervate this muscle.  The relationship of the piriformis muscle to the sciatic nerve becomes important when trying to treat sciatic pain.

The sciatic nerve runs from the low back down through the muscles of the hips and butt, along the rear of the leg and into the foot.  It receives contribution from L4 to S3 spinal nerves.  It innervates (providing sensation and muscle control) to the deep muscles of the hips, the hamstring muscles, the muscle of the lower leg, and some of the muscles of the foot.   When the sciatic nerve becomes effected any one of the muscles or areas that is innervated by the sciatic nerve can become involved.

What are the Causes of Sciatic nerve pain?

Sciatic pain can have a number of different causes.  Simply stated, any issue that puts abnormal stress and strain on the sciatic nerve can result in sciatic pain into the low back, hips and butt and down the back of the leg into the foot.  Pressure onto the nerve can originate from vertebral discs, misaligned bones, and muscular spasms.  The causes of sciatic pain can be broken down into 2 categories: acute injury and chronic repetitive use injuries.  Acute injury refers to a traumatic event the leads to injury of the low back or hip creating pressure on the sciatic nerve via bony misalignment, contraction of a the surrounding muscles or inflammation from the injury.

Chronic sources of sciatica may be a result of muscle imbalances, poor postural control, weak core musculature, or repetitive work activities that lead to sciatic nerve irritation.  There are 4 common health conditions that are most commonly associated with sciatic nerve pain.

  1. Piriformis syndrome is a common cause of sciatic pain and is a result of the piriformis muscle becoming tight and putting consistent pressure on the sciatic nerve.  Piriformis syndrome can be caused by imbalance of the hip musculature, abnormal walking mechanics (limping), and chronic poor postural positions.
  2. Herniated discs in the spinal column could also put excessive pressure on the sciatic nerve as it exits the spine.  A herniation, or bulging of the disc can be caused by an acute injury or from years of stress from muscle imbalances.
  3. Spinal stenosis, or a decreased in the space the sciatic nerve travels in is another common condition that involves the sciatic nerve.  This decreased space compacts the nerve where it leaves the spine. The narrowing is commonly created by compression on the spinal column as a result of injury or because of muscle imbalance.
  4. Spondylolisthesis, which is a condition where one vertebrae slides forward on another vertebrae putting abnormal pressure onto the sciatic nerve.  Spondylolisthesis can be caused by a traumatic injury or from chronic muscle imbalance.

Muscle imbalance is a common thread through each of the common health conditions listed above.  Muscle imbalances can be treated and corrected with the proper physical therapy techniques, stretches, and exercise. Proper treatment helps to deter pain and prevent sciatic pain symptoms from muscle imbalance.

Typical signs and symptoms of sciatic nerve pain:

Pain – The pain can vary from dull/achy to sharp, and include a burning discomfort anywhere along the nerve pathway.

Tingling/Numbness – This can also occur anywhere along the nerve path.  Discomfort could be experienced in one location with a feeling of tingling and numbness in the same or other areas.  The “Pins and Needles” sensation is typically felt in the lower legs and feet.

Weakness – The musculature that is innervated by the sciatic nerve might become weak over a period of time if left untreated.

Tightness or Spasm – The muscles of the hamstrings or calves may spasm or tighten as a result of abnormal signals being sent along the sciatic nerve.

Treatment for Sciatic Nerve Pain

When sciatic nerve pain is caused by a severe injury the first step is to treat the injury.  The R.I.C.E.R. formula (Rest, Ice, Compression and Elevation, followed by Recommendation) should be followed for the first 48 to 72 hrs. Reducing the irritation caused by the injury will help to decrease the sciatic pain and diminish irritation to the sciatic nerve.  After the initial 72 hours moist heat can be used to help loosen up the tight muscles that surround the nerve.  If symptoms aren’t resolving, then following up with your physician for medications and a referral to physical therapy can help you recover.

A physical therapist will evaluate your symptoms, movement, stability and strength to help determine the cause of your symptoms.  Chronic sciatic symptoms can be the result of differnet “hidden causes”, which include: bony misalignment, repetitive stress from work, faulty postural positions, and muscle imbalance creating abnormal tightness and pull.  Following your evaluation, an individualized plan to diminish symptoms and treat cause will be developed by your physical therapist to help you fully recover.  Your treatment will usually include modalities to help eliminate pain (heat, ice, electrical stimulation, massage), passive stretching, flexibility exercises, strength exercises, core exercises, and stability exercises to assist you in returning to your favorite activities.

Stretch For Sciatic Nerve Pain

The piriformis muscle can become tight an put unwanted pressure onto the sciatic nerve, creating pain.  Here is a stretch for the piriformis muscle: 

  • Lie on your back with both knees bent to 90 degrees, feet flat on the floor.
  • Place one bent leg over the opposite leg with ankle placed on the mid thigh.
  • Using both hands, grab the ankle and the back of the knee of the crossed leg.
  • Gently pull the knee towards the opposite shoulder until you feel a stretch in the buttock of the elevated leg.
  • Hold for 20 to 30 seconds.
  • Relax and repeat 2 times on each side.

Foam Rolling for Sciatic Nerve Pain

Because tightness into the piriformis and other deep muscles of the hip can cause sciatic nerve pain, this is a good area to perform some foam rolling.

  • Foam roll over the area to discover areas of tightness or sensitivity.
  • Try to keep pressure onto the tight or sensitive areas for 1-2 minutes to help the tight “spasm” areas release.

While the above stretch and foam roller activities can help to resolve your symptoms.  I highly suggest that you meet one of our physical therapists and let us perform a thorough evaluation of your symptoms and create a specific plan to help you fully recover!

Relieve, Retrain, Restore!!

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