Sciatica.

One thing I have noticed over the many years of treating patients is the self-diagnosis of Sciatica anytime pain in the lower extremity is felt. This is probably due to Sciatica being a common issue and a lot of people have heard of it so it’s the go to diagnosis. But what actually is Sciatica and how do you know if you actually have it?

Sciatica is the name given to pain caused by irritation of the sciatic nerve stemming from the nerve roots of L4 to S3 (Lumbar 4 – Sacral 3). Anything that irritates this nerve can cause pain, ranging from mild to severe. Sciatica is usually caused by a compressed nerve in the lower part of your spine called the Lumbar spine.

The sciatic nerve is the largest nerve in the human body and is formed by 5 nerve roots of the lumbar and sacral spine. Nerve roots are them thick noodle looking structures that come out from the spinal cord. It then passes deep in the Gluteal muscles (Buttock muscles) and down the back of the thigh where the Hamstrings are located, all the way to the heel, sole of the foot and to the toes. The sciatic nerve has an important role in communicating the central nervous system (spinal cord & brain) with the skin and muscles of the thigh, leg, and foot. This communication sends what is called sensory and motor information back and forth from the leg, calf and foot to the brain and spinal cord.

So when something is irritating the Sciatic nerve it can cause problems with the information (sensory and motor) that is distributed alongside a shooting pain anywhere along the sciatic nerve pathway.

Other common symptoms of sciatica include:

numbness in the leg along the nerve
tingling sensation (pins and needles) in the feet and toes

I always try to explain the Sciatic nerve irritation to my patients by making them visualise a garden hose, when you turn the tap to allow water to run through it that represents a perfectly working nerve, with Sciatica it’s like you pinching the hose just as it leaves the tap. This in turn causes obstruction to the information (water in this example) along that nerve.

So what can cause that irritation then?

So the most common cause of Sciatica is a herniated disc. Try to visualise a jam doughnut, now visualise your hand slowly pushing down on the doughnut, the jam is going to start bulging out the side. Well that’s as close of an example to a disc herniating I can describe to you. The jam that has then bulged out of the doughnut (intervertebral disc) would then be compressing on the nerve roots that run close to them. This in turn causes irritation to the nerve roots.
Lumbar spinal stenosis Is another cause of Sciatica, the spinal cord runs down a canal within the spine once it leaves the brain, the canal that it runs down is called the spinal canal, it is like a gutter for the spinal cord to go down while its protected by the bones which form the vertebral column (spine). Sometimes the spinal canal can become narrower which then compresses the spinal cord that runs through it or even the nerve roots that then run out but that’s called foraminal stenosis.

A Spondylolisthesis can be a common cause of Sciatica, I know the word is a bit long and a mouthful but its pretty simple to explain. The vertebrae are stacked on top of each other like an Oreo cookie comprised of a vertebral disc (bone) either side of an intravertebral disc (jam doughnut mentioned earlier). However the spine is a very strong and rigid structure, a lot harder to move than a stack of Oreo cookies. Well sometimes due to certain conditions the discs can shift forward which can then put pressure on the nerves that leave the spine alongside the spinal cord itself.

Hormones produced during pregnancy, such as relaxing, cause ligaments to become more elastic and stretch, this can potentially cause structures such as bones and joints to move a lot easier. This in turn can cause a lot of back and pelvic pain in some women, when this happens it can then cause irritation to the Sciatic nerve if it gets compressed or torsioned as a result of the increased joint movement.

There are other factors that can cause Sciatica but I am not going to be able to explain them all as this article would then turn into a book.

Dr. Mark Kovacs, a certified strength and conditioning specialist, adds that the best way to alleviate most Sciatica pain is to do “any stretch that can externally rotate the hip to provide some relief.”

Here are six exercises that help to externally rotate the hip:

reclining pigeon pose
sitting pigeon pose
forward pigeon pose
knee to opposite shoulder
sitting spinal stretch
standing hamstring stretch

Aim to do these exercises every day, along with other activities like walking, swimming or yoga. Your pain should start to ease within 2 weeks and will usually pass in about 4 to 6 weeks.

Here are some exercises recommended by the NHS to help relieve Sciatica symptoms.

Knee to chest stretch

Start position: Lie on your back on a mat or the carpet. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: Bend one knee up towards your chest and hold it with both hands. Hold for 20 to 30 seconds with controlled deep breaths.

Repeat 3 times, alternating legs.

Tips:

Don’t tense your neck, chest or shoulders.
Only stretch as far as is comfortable.

Variation: Grasp both knees and press into your chest.

Sciatic mobilising stretch

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: Bend one knee up towards your chest. Hold the back of your upper leg with both hands, then slowly straighten the knee. Hold for 20 to 30 seconds, taking deep breaths. Bend the knee and return to the starting position.

Repeat 2 or 3 times, alternating legs.

Tips:

Don’t press your lower back down into the floor as you stretch.
Only stretch as far as is comfortable.

Back extensions

Start position: Lie on your front and rest on your forearms with your elbows bent at your sides. Look towards the floor and keep your neck straight.

Action: Keeping your neck straight, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles. Breathe and hold for 5 to 10 seconds. Return to the starting position.

Repeat 8 to 10 times.

Tips:

Don’t bend your neck backwards.
Keep your hips on the floor.

Standing hamstring stretch

Start position: Stand upright and raise one leg on to a stable object, such as a step. Keep that leg straight and your toes pointing up.

Action: Lean forward while keeping your back straight. Hold for 20 to 30 seconds while taking deep breaths.

Repeat 2 or 3 times with each leg.

Tips:

Only stretch as far as is comfortable.
Your lower back shouldn’t arch at any time.

Lying deep gluteal stretch

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your left leg and rest your right foot on your left thigh.

Action: Grasp your left thigh and pull it towards you. Keep the base of your spine on the floor throughout and your hips straight. You should feel the stretch in your right buttock. Hold for 20 to 30 seconds while taking deep breaths.

Repeat 2 or 3 times with each leg.

Tip:

Use a towel around your thigh if you can’t hold it.

Speak to one of our Osteopaths if:

your pain doesn’t improve within a few weeks
you experience severe pain while trying any of these exercises

So hopefully after a lot of examples and descriptions being used you have more of an understanding on Sciatica. The good news is the vast majority of cases, surgery is not needed. Around half of people will recover within a matter of weeks. However, there could be an underlying cause that was explained earlier that hasn’t been diagnosed and could gradually get worse.

If you think you could have Sciatica why not speak to one of our Osteopaths for a free consultation and see how they can help you. Our Osteopaths are highly trained medical professionals and can help treat many medical conditions such as Sciatica.

Get in touch here: https://www.correctosteoclinic.co.uk/contact-us/