Understanding Sciatica and How to Calm an Angry Sciatic Nerve
Just recently, I had a patient complain to me of terrible unrelenting sciatica. The sharp, acute pain was shooting down her leg. She couldn’t find a position that gave her any relief and it was really starting to interfere with her daily life.
As a new mom and avid gardener she just couldn’t bear this sciatic pain any longer. She came to the clinic seeking any sort of relief she could get for her back and leg pain.
During our initial assessment, I noticed that this patient had some hypermobility in her low back, tight glutes and hamstring muscles that were limiting her range of motion. She also had weakness through her glutes, hamstring muscles, and inner core.
I explained to her that all of these findings may explain why she was having this sciatic nerve pain… and the good news was that all of these findings can be helped by physiotherapy and chiropractic treatment.
What is Sciatica?
The term sciatica is typically used to refer to this, sometimes, excruciating pain that radiates into the buttocks and down the back of the leg. However, it is mostly a descriptive symptom rather than an actual diagnosis.
Sciatica is typically the term used to describe pain, discomfort, weakness, etc. from irritated nerves, nerve compression, or inflammation in structures (i.e. muscles) anywhere along the sciatic nerve pathway. This can cause your pain to radiate down your leg along sciatic nerve pathway..
Sciatica can come from a number of contributing factors including, but not limited to:
- Herniated discs
- Degeneration in the spine
- Spondylolysthesis
- Spinal stenosis
- Hip joint dysfunction
- Tight muscles anywhere along the back of the thigh, buttocks, and/or low back
- Pregnancy
The list goes on and on…
Most often, sciatica is a result of inflammation in an area around the sciatic nerve that compresses or irritates the nerve and causes symptoms.
So…due to all of these possible causes, it is important for your physiotherapist or chiropractor to complete an accurate assessment which will include a physical exam. Once your physiotherapist or chiropractor has finds the root of the problem, then they can help you calm whatever is irritating the sciatic nerve so you can get pain relief.
Experiencing chronic back pain? Click here to read more about how physio can help!
The Sciatic Nerve
The sciatic nerve is the longest and largest nerve in the body. It is made up of 5 spinal nerve roots (L4-S3) that come together to form the sciatic nerve.
You have two sciatic nerves, one running down your right leg and the other running down the left. The nerve runs from your low back, through your buttocks, down the back of your thigh, and divides typically just below the knee.
Therefore, you may feel sciatic nerve symptoms down your leg to just below your knee. You may also have symptoms lower down as the sciatic nerve divides to innervate musculature in the lower leg, foot, and toes.
Symptoms of Sciatica
The symptoms of sciatica or sciatic nerve pain are caused by nerve compression or nerve irritation. This can be at the spinal nerve root before the nerve is formed, or at another spot along the sciatic nerve’s path.
People with sciatica often feel symptoms in the buttocks, back of the thigh, the lower leg, foot, or even toes. It is not very common to feel sciatica symptoms in the low back. If you’ve had any of these symptoms you know how seriously it impacts your quality of life.
What does sciatica feel like?
Sciatica often causes severe pain that is commonly described as:
- Sharp pain
- Burning
- Searing
- Electric shock
- Shooting
- Throbbing
- General discomfort
- Pins and needles
These symptoms can be constant or intermittent. More often than not, the symptoms are also only down one leg. Some people also describe a tingling or a dull ache.
Sciatic nerve pain is also typically worse with forward bending and twisting activities. For example, your symptoms may be reproduced when you bend forward to tie your shoe, or sitting for long periods of time, gardening, coughing, etc.
Weakness with Sciatica
Along with those sensations, if you have sciatica, you may notice that you have weakness in your leg. You may have weakness in your thigh muscles, specifically when you try to squeeze your legs together. Or possibly in your lower leg when bending your knee. You may even notice weakness in your foot when pointing and/or flexing your toes.
There may also be tingling, pins and needles, a sensation of ants crawling on your skin, and/or numbness.
These are all neurological symptoms that go along with angry nerves.
What is the medical treatment for sciatica?
When you come to the clinic, the physiotherapist or chiropractor will gather as much information as possible to find what could be causing your sciatica. These medical professionals will conduct an interview and then conduct a physical assessment to identify contributing factors.
The physical assessment will look at your posture, how you move, your range of motion, muscle strength, how your joints move, etc. They will also see if any of these tests reproduce your symptoms.
Once the physiotherapist or chiropractor identifies the cause of the problem, they will provide you with a specific treatment plan that is personalized to you.
Treatment methods often include working on your posture, inner core strength, and getting the nerve moving. This technique of getting the nerve moving is called nerve flossing, which we will get into soon…
What is the inner core?
You have two layers to your abdominals – your outer core and your inner core. Your outer core refers to those 6-pack muscles… not the ones we are concerned about right now. On the other hand, your inner core refers to the muscles that stabilize your spine as you move. This inner core needs to turn on before and as you move to allow you to move efficiently.
The inner core works like a girdle to keep your innards in and keep your spine stable. You can also think of your core as a canister and all the outer walls need to work together to hold what’s inside. The top of the canister would be your diaphragm, the front wall is your transverse abdominus, the back wall is your multifidi muscles, and the bottom is your pelvic floor.
That’s enough human body anatomy for now though…
In physiotherapy, we will teach you how to engage your inner core muscles. Then afterward we will challenge you to move various limbs as you hold your inner core. Afterward… once you’re a pro… we will start to engage that inner core in more functional movements as well.
The goal here is to teach you how to engage your inner core and get rid of muscle weakness that is contributing to your problem. You do not want to be doing these exercises forever… so you need to learn how to hold your inner core tight as you do activity.
To learn how to engage your core try lying on your back with your knees up.
Take a deep breath in… you should feel your diaphragm rise (just above your stomach)
Breathe out slowly
At the end of your exhale, pull your belly button to your spine.
Try not to engage your outer abdominal muscles.
Try this exercise for 5 minutes a day.
What is nerve flossing and can this treatment method help treat sciatica pain?
Nerve flossing is a technique that gently mobilizes nerves so that they can glide more nicely between the structures that surround them. This technique lets the nerves learn that they can and should move as you move. Ultimately, nerve flossing should alleviate your nerve-y symptoms.
You can compare your nerves running between structures in your body to a straw with a spaghetti noodle inside.
Your nerve should glide between your muscles, joints, etc. without any resistance. it should be a smooth and easy movement just like a raw spaghetti noodle gliding in a straw.
On the other hand, if there is inflammation in tissues surrounding your nerve, then the nerve won’t glide as nicely. This resembles more of a cooked spaghetti noodle in a straw… it keeps getting stuck to the straw (or surrounding structures).
Ok… but how do we get it gliding and sliding nicely? I want that raw spaghetti noodle in the straw to be my sciatic nerve!
Think of flossing your teeth…When you floss, do you pull on either end of the floss? Or do you close the floss back and forth between your teeth?
Well… nerve flossing works the same way. With nerve flossing you are trying to glide your nerve back and forth between the structures that it runs through and adjacent to.
This is why you shouldn’t feel any tension or pulling with these exercises. Nerve flossing exercises should not provoke your symptoms.
Lie on your back with your knees bent.
From there, point and flex your foot slowly.
This should not cause any pain or adverse effects like muscle spasms. If you feel any pain or discomfort stop immediately and get in touch with a physiotherapist or chiropractor.
So… What can I do now to manage my sciatica?
this doesn’t feel like a typical muscular injury it may be a feeling that you have never felt before.
Nevertheless, getting at the root cause of the nerve pain is so important. As this nerve pain can be caused by nerve compression at any point along the nerve’s path, it is imperative to identify where along the chain the irritation is.
Once you figure out where the irritation is… your physiotherapist or chiropractor can treat causing factors to get rid of your nerve pain. Tackling the root cause can help prevent your sciatica from returning once it is dealt with.
Our team of physiotherapists and chiropractors at our clinic located between Bloor West Village and the Kingsway have advanced clinical skills that will provide you with the right treatment, as well as help you to find security and comfort in all of your treatment options. For more information, request an appointment at PhysioPlus Health Group today.
However…in the mean time…you can try the two exercises provided above.
- Engaging your inner core while diaphragmatic breathing.
- Nerve flossing
Give these gentle exercises a try and see how they go.
Your sciatica can be conquered with the right treatment and it can help reduce your pain and prevent it from coming back.
References
- Freutel, Natasha. “Sciatica During Pregnancy: Symptoms, Causes, Treatments.” Healthline, November 16, 2016. https://www.healthline.com/health/pregnancy/sciatica-pain-stretches.
- Mosenthal, W. P., MD. “Sciatica Cause Not Always Spine-Related.” SpineUniverse. Remedy Health Media. Accessed November 13, 2020. https://www.spineuniverse.com/conditions/sciatica/sciatica-cause-not-always-spine-related-0.
- “Sciatica.” Physiopedia. Physiopedia. Accessed November 13, 2020. https://www.physio-pedia.com/Sciatica.
- “Sciatica: Causes, Symptoms, Treatment, Prevention & Pain Relief.” Cleveland Clinic. Cleveland Clinic, March 25, 2020. https://my.clevelandclinic.org/health/diseases/12792-sciatica.
- Steven Yeomans, DC. “Types of Sciatic Nerve Pain.” Spine. Veritas Health, July 6, 2019. https://www.spine-health.com/conditions/sciatica/types-sciatic-nerve-pain.
FAQ’s
How do I know if my lower back pain is sciatica?
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it’s especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.
What does sciatic back pain feel like?
Sciatica pain is typically felt like a constant burning sensation or a shooting pain starting in the lower back or buttock and radiating down the front or back of the thigh and leg and/or feet. Numbness. Sciatica pain may be accompanied by numbness in the back of the leg.
What is the best sleeping position for sciatica?
If you suffer from sciatic nerve symptoms, you may notice that your symptoms doesn’t just go away when you sleep. They may actually be worse when you’re trying to sleep. Getting enough GOOD QUALITY sleep is crucial for healing though…
The best sleeping position for sciatic nerve symptoms is sleeping on your back. If you are experiencing the same level of symptoms, try putting a pillow under your knees to bend them slightly. This position should take tension off the nerve and allow it to relax…allowing you to get some sleep!
Why is sciatica so common during pregnancy?
Sciatic nerve symptoms are common with low back pain during pregnancy. Also, sciatic nerve symptoms can be caused by tight muscles or hypermobile joints. Joint mobility can be increased during pregnancy because of increases in hormones such as relaxin, which causes your ligaments to loosen. Additionally, the added carrying weight in the front put stress on your low back, pelvis, and hip joints which could irritate the sciatic nerve and cause symptoms to radiate down into the buttocks and/or posterior leg.
