
Sciatica is a pain that affects the sciatic nerve. The sciatic nerve is a nerve which runs from the lower back down the back of both legs, and is comprised of five different nerve roots originating from the lower back. The nerves which make up the sciatic nerve branch off the spinal cord between the L4 and L5 levels of the lumbar spine, and the nerves that emerge from the sacral foramen (S1, S2, and S3). When any of these nerve roots, or the main nerve becomes irritated or compressed sciatica is caused.

## Symptoms of Sciatica

Typically, sciatica causes pain on only one side of the lower body, and sends pain from the lower back, through the thigh, and down into the leg. Sciatica can be characterized by any combination of these symptoms:

- Electric or searing pain in the leg
- Pain in the lower back that is lesser than the pain in the leg
- Constant pain on one side of the buttock or leg
- A pain that worsens when the patient is standing or sitting
- Pain that follows the path of the sciatic nerve
- Pain that is typically sharp rather than dull
- A “pins-and-needles” or prickling in the leg
- Numbness or weakness in the leg
- Numbness or weakness when moving the leg or foot
- Severe, shooting pain in one leg that makes moving difficult
- Pain in the feet and toes

The specific pain of sciatica depends on the patient, the cause, and which nerve root is affected.

Symptoms of specifically affected nerve roots:

- L4 nerve root sciatica usually effects the thigh. It might cause a weakness when straightening the leg, or cause a diminished knee-jerk reaction
- L5 nerve root sciatica may extend the pain to the big tow and ankle. There may be a numbness on the top of the foot, particularly in the web between the big toe and the second toe
- S1 nerve root sciatica causes pain in the outer part of the foot, possibly radiating the little toe or toes. It may also cause a weakness when raising the heel off of the group to stand on tiptoes, and the ankle-jerk reflex may be reduced

Several of these nerve roots may be affected at once and cause a combination of these symptoms can be present.

Although it is rare, in severe cases the sufferer of sciatica can experience a loss of feeling in a limb, extreme weakness, or a loss of bowel or bladder function. In these cases, medical attention should be sought immediately.

## What Causes Sciatica

Sciatica can have a number of specific causes, but the in each case the sciatic nerve is being irritated or compressed at its origin in the lumbar spine (lower back) causing pain.

Specifically, sciatica is commonly caused by these 7 things:

### Lumbar Herniated Disc

A herniated disc occurs when the fibrous outer core (annulus) of the disc is damaged and soft inner core (nucleus pulposis) becomes displaced and encroaches into the area where the nerve root exist the spine. This can put pressure on a nerve and cause sciatica.

### Lumbar Degenerative Disc Disease (DDD)

Trauma or normal wear and tear can cause a disc to become worn and compromised. If the degenerated disc causes specific nerves to be pinched, it can cause sciatica

### Isthmic Spondylolisthesis

Spondylolisthesis is when a minor fracture causes a disc to slip over the one beneath it, causing a misalignment and occasionally pinching nerves. This usually occurs at the base of the spine, making it a common cause of sciatica. Spondylolisthesis can be traumatically induced or can be the result of a congenital anomaly.

### Lumbar Spinal Stenosis

Aging causes the bones, discs, muscles, and ligaments in the spine to degenerate and change. These changes can cause misalignments which put pressure on the nerves when active, and when in the lumbar spine can cause sciatica.

### Piriformis Syndrome

The sciatic nerve runs either above, below or directly through the piriformis muscle which is a deep muscle in the buttocks, and it can irritate or pinch the nerve causing the symptoms of sciatica. This is a common condition in runners.

### Sacroiliac Joint Dysfunction (SI Joint Pain)

The sacroiliac joint is located at the bottom of the spine, and when irritated it can also irritate the nerve above it (at the L5 level) causing sciatica-type pain.

### Pregnancy

Because of the weight and stress cause by pregnancy, the spine can become misaligned, or a nerve can be pinched and cause sciatica.

Factors that can increase risk of sciatica occurring include age, obesity, occupation (such as a job that requires a lot of lifting, twisting, or sitting), prolonged sitting, and diabetes.

## Treatments for Sciatica

For most cases of sciatica, non-surgical remedies and regular exercise can make most if not all of the pain subside. Before starting any treatment, it is recommended that a patient should see a health care professional in order to get a correct diagnoses and rule out any possible, serious problems.

Non-surgical treatments for sciatica include:

### Ice and Heat

Ice and/or heat packs can be applied to the leg to alleviate pain. Some people choose either heat or ice, whichever works best for the particular person, and will apply it for approximately 20 minutes and repeat every two hours. Others will alternate between heat and ice during a session, or whenever one seems like it would help more to alleviate pain. If using ice, it is best to place a towel between the ice pack and the skin to avoid ice burn.

### Exercises

It is recommended that before beginning any exercises to treat sciatica, a patient sees a health care professional in order to be evaluated and ensure that the exercises will be tailored towards the underlying causes of the patient’s sciatica. Doing the wrong exercise can worsen sciatic pain.

Typically, the exercises done will include strengthening and stretching the abdominal and back muscles that make up the core in order to provide more support to the back and to alleviate pain caused by tight, inflexible muscles. Hamstring stretches are another common exercise to reduce sciatic pain because overly tight hamstrings can increase stress in the low back and in some cases may be the cause of sciatica. Aerobic exercise, such as walking, encourages fitness for the general body and can contribute to alleviating sciatic pain. Also, learning to exercise correctly can ensure that they are benefiting the patient, and can teach them how to lift or move correctly in the workplace.

(For specific exercises that can be done depending on what they underlying cause of sciatica is, see below)

### Chiropractic

Spinal adjustments are focused on bringing and/or maintaining proper spinal alignment, which should help address the underlying causes of sciatica. This can create a better healing environment for the body.

### Non-surgical Decompression Therapy

This is accomplished through the use of a specific table similar to traction that is able to create decompression of the disc and spine at a specific level. One table that has a proven track record is the DRX-9000. The treatment involves a series of treatments, usually about 20 visits over a 6 week period of time.

### Massage Therapy

Massage therapy has been shown to have benefits for the back including increased blood circulation, muscle relaxation, and release of endorphins. A massage therapist that is knowledgeable can target the shorter tighter muscles and assist them is relaxing and lengthening to a more normal position.

### Trigger Point Therapy/Active Release Technique

A trigger point is a focalized contraction of a muscle that becomes irritated and inflamed. When present a trigger point will give a specific referral pattern. In the case of a trigger point in the piriformis muscle the referral pattern is throughout the same area as the sciatic nerve. Often a person will have both a trigger point and irritation of the sciatic nerve. There are self-treatment options for treating trigger points. I have included pictures in this article. If self-treatment doesn’t get rid of the problem, than consult a professional who is knowledgeable in either trigger point therapy or is certified in active release technique (ART).

### Acupuncture

The practice of acupuncture is based on the philosophy that by placing small needles in the skin, energy paths can be opened and the body to achieve or maintain wellbeing. It has been approved by the U.S. FDA as treatment for low back pain.

Only in the most extreme cases do I recommend that a patient resort to steroids, pain medication, epidural injections or surgery in order to alleviate pain. However, in cases where the pain is severe, not going away, or increasing, I recognize that it may be a necessary path of treatment.

There are certain disc conditions where surgery is the only option. When I consult a patient with sciatica often an MRI is ordered. If I see for example that a patient has a complete tear in a disc resulting is what is called a disc extrusion or (free floating segment) I refer them to an orthopedic or neurosurgeon.

## Exercises for Specific Causes of Sciatica

Again, before starting any treatment, it is recommended that a patient should see a health care professional in order to get a correct diagnoses and rule out any possible, serious problems. Also, it ensures that the exercises being preformed are correctly targeting the underlying causes of sciatica, and that they are being preformed correctly. This section is intended for the patient who has already been to a health care professional and has a knowledge of the specific cause of their sciatica.

### Piriformis Stretch

The piriformis muscle is a deep gluteal muscle that is responsible for external rotation of the femur. To effectively stretch this muscle, simply lay on your back, bend your knee and hook your heel over the other knee. Next bend the leg that is straight and bring that knee up towards your chest. Be sure to keep the opposite knee down towards the floor as you perform the stretch. Hold the stretch for 10 seconds and remember to breathe. Perform the stretch 3-5 times per side paying special attention to the symptomatic side.

### Supine Hip Extension

Often times the gluteal maximus muscle is weak when the deeper external rotators are tight. For this reason it is important to not only stretch the external rotators but strengthen the gluteus maximus. One exercise the efficiently targets this muscle is the supine hip extension exercise (illustrated below). To perform this exercise, lay on your back with your knees bent at a comfortable angle. Next, push your pelvis up towards the ceiling by contracting your gluteus maximus. Perform this exercise for 10 to 15 repetitions and repeat for 3 to 5 sets.

### Wall Squat

This is another effective exercise for strengthening of the gluteus maximus. It can be performed either with your back against the wall or with a swiss ball behind your back and against the wall. Pay special attention to the placement of your feet and the alignment of your knees while performing the squat. Often times the feet will want to excessively rotate externally when the piriformis and other external rotators are short and tight. If your feet want to externally rotate past 10 degrees simply be sure to move your foot into more internal rotation before performing the squat. With respect to your knees, make sure that your knee cap (patella) is aligned over your first and second toes as you move into the squat. It is common for the knees to move outward when the external rotators are short and tight.

These are just a few exercises that should help a person suffering from sciatica. By no means are they the only exercises that can help correct the problem. If you are unclear about how to perform these exercises properly or you aren’t getting any relief, please find a healthcare professional capable of helping you.

We offer Corrective Exercise here at Bradley Chiropractic Nutrition. If you like to learn more or would like to call to schedule, please Contact Us.


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Sciatica, What It Is and How to Reduce Pain

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