What is the Sciatic Nerve?
Nerves have a tremendous responsibility within our bodies. They detect nearly all things that happen TO the body, while also transmitting messages responsible for things to be performed BY the body. That’s why if a bee stings you, you know about it, AND you can immediately take action and run from the hive! Without nerves, these things don’t happen. So be thankful you have your nerves:-)
The SCIATIC nerve specifically is the largest major nerve in our body and innervates the majority of our lower extremities. It starts with a group of converging small nerve roots from the lumbar spine, and then travels down our entire lower body all the way to our toes.
Click here if you’d like to see a little more about the anatomy.
What is Sciatica?
Sciatica is what happens when this nerve becomes agitated. It is generally used to describe pain that travels down the buttock, thigh, leg and/or foot, originating from irritation in the low back region. The pain that you may experience can really occur anywhere along the pathway of the nerve or its branches and can present as dull, sharp, shooting, electric shock, tingling, burning and more. It can progress to numbness as well and actually result in loss of muscle firing when it becomes severe.
How Common is Sciatica?
It is extremely common. See the following data:
- Prevalence: Estimates suggest that up to 40% of people experience it at some point in their lives.
- Age Distribution: Sciatica most commonly affects adults between the ages of 30 and 50 years old. However, it can occur at any age.
- Gender Differences: There is no significant gender predilection for sciatica; both men and women are equally affected.
- Chronicity: About 20-30% of individuals with sciatica may experience chronic pain that lasts for more than a year. Recurrence rates for sciatica are relatively high, with 20-40% of patients experiencing another episode within a few years
If I had to make a guess, I would say between 25-50% of our patients at any given time are dealing with some form of this condition. Good news is, we typically get them better with a combination joint mobilizations, dry needling, and corrective exercise! Often they reach 100% pain relief.
To hear from those who have done it, check out our testimonials page here.
Cause of Sciatica- The Science
To understand how we treat sciatica it helps to understand where the cause lies. USUALLY sciatica comes from a herniated disc in the low back. I won’t dive into any of the other causes in this article. Discs are basically cushions that sit between each vertebrae in our spine (including in your mid back and neck).
In certain circumstances, they become pushed out or “herniated” from their normal position and move out into less favorable spaces where nerve roots lie. These nerve roots (which we talked about earlier) ultimately lead into the sciatic nerve. Furthermore, it is the irritation on these nerve roots that then causes the pain running down that darn sciatic nerve.
What Activities Cause Sciatica?
Typically, disc herniations occur as a result of repetitively placing your spine in a “flexed” or forward bent position. For example, if you pick up a pencil off the floor, you are flexing the spine forward. Now, picking up a pencil in isolation is NOT going to cause a disc herniation. However, if you pick up pencils repeatedly for 8 hours a day for a year straight, we may be looking at a herniated disc. We also may not, which can be part of what makes this tricky.
There are a lot of factors at play and things can be somewhat unpredictable. However, we can usually count on repetitive forward bending being a large source of the pain. At our clinic, we see it very frequently in pickleballers who bend forward for hours at a time while playing.
Another situation in which people herniate discs is desk jobs. If you sit in a slump or lean forward at your desk (as most of us do), a disc or two may slowly start to herniate. In fact, you may have great posture and you still may have this happen. Prolonged sitting just tends to be a little tough on lumbar discs. That’s why getting up and moving around is so important.
What Can I Do to Get Rid of Sciatica?
Now, here is the good part: Treating it! Is it doable? YES! Is it tricky? Unfortunately, also yes. Treating this condition is multifactorial. You must figure out the things you are doing during your day that are contributing to it most. Often the things we identify surprises people. For example, someone may sit back on their couch with their feet up thinking that it stretches them and that the elevation is a good thing. Sorry, but it’s not. Most likely, you are putting tension into your nerve, flexing the lumbar spine, and then staying there without getting any fresh blood flow.
Next in the treatment, you must add exercises that immediately reduce irritation on the nerve root. Meanwhile we mobilize regions that have become stiff so that stresses are dispersed evenly. Then, you must strengthen areas that are weak to improve stability. Most importantly, we integrate you back into the things that irritated you to begin with, but now with your new and improved tolerance:-)
Self-Treatment for Sciatica
I truly cannot give anyone a perfect exercise to fix sciatica without evaluating them in person. Every person truly is different. Even with one particular patient, their treatments change from week to week. But I’m going to provide some key items that should help, as these tend to be threads that run common through people with sciatica. The key with any of these is stopping if they make things worse. If they help you, AWESOME!
- Stop slumped posture: So cliche, right? If you are having symptoms of sciatic nerve pain though, this does actually make a difference. Do not slump into your couch at night with your feet up. The best sitting position is with your buttocks pressed to the back of a firm chair, a 3 inch thick cushion just above your sacrum (tailbone area), and a relaxed posture leaning back over this cushion. This puts your lumbar spine into a back bend instead of a forward one. If sitting like this sounds awful to you, then trying simply lying flat on your couch, on your back or side. You can actually use a recliner, but you should still be using the lumbar support described above. Feet down is best if your recliner allows it.
- Get up frequently: If you sit a lot, try to get up every 20-30 minutes and move about. Even if you sit in the picture perfect posture, staying there too long isn’t great. The more you get up and move, the more you keep blood flushing through the area. Long story short- blood flow is healthy.
- Walk: Walking is an awesome thing for low back pain and sciatica. Try to walk throughout your day as much as possible. It doesn’t have to be a super long walk; a few minutes is great. But do it frequently if you can.
- Back extensions: These can make things better, or they can make things worse. So proceed with caution. Typically the start to recovery however starts with some form of back bending. You can try doing this standing up, but just bending backwards over your hands on your hips. Don’t push it hard; just bend lightly and repeat. You can try the same thing lying down, like a cobra stretch. For both, you want to use repetition rather than long holds. Feel free to do a set of 20 a few times per day if they make you feel better.
- Cat-cows: The key is doing this lightly. Don’t feel the need to crunch up into a deep sustained stretch. Just move back and forth lightly allowing some multidirectional movement to your spine.
Simplified Summary
The sciatic nerve is the major nerve of the lower body. It usually becomes painful when the nerve roots in your low back become agitated by a herniated disc. This occurs often when your low back has sustained repetitive forward bending over long periods of time. To improve it, try to balance your movements with both flexion and extension. If you have to sit a lot, use lumbar support to create an extension curve in the low back. Walk frequently, and try a couple of the exercises above!
I hope you found at least one thing helpful in this article!! Thank you for stopping in.
If you or anyone you know is struggling with anything like this, reach out and we would love to help you!! You’ve got this!
Best,
Dr. Trem