Updated: Jan 27, 2022
First off, what is sciatica? Sciatica is defined as pain that radiates along the path of the sciatic nerve. The "path" of the sciatic nerve is the key term here because this path includes regions of the glute and hamstring. Therefore almost any pain that radiates down the glute or back of the thigh is commonly diagnosed as sciatica. Lower back pain is very commonly experienced with sciatica but isn't always present. This causes an ill-description of what the exact cause is because it does not define what is actually causing the sciatica which leads us to the first thing you should know about sciatica.....
1. Sciatica is NOT a diagnosis!
Many people are told that they have sciatica. In fact, sciatica is one of the most common diagnoses associated with low back pain and leg pain. However, it is important to understand that sciatica is not a diagnosis, but rather a symptom. Sciatica causes may include many different factors, and do not always mean the sciatic nerve. Any radiation going down the glute or hamstring can be considered sciatica since it matches the same path as the sciatic nerve. This means that many different things can potentially be the cause of sciatica.
Sciatica pain is a very non-specific term and can be misleading to individuals and providers alike. You would not tell someone who had fallen and scratched or bruised their glute/hamstring that they had sciatica because that would be silly. Same goes for anyone else being told they have sciatica purely because their symptoms are located in the same region. There is further evaluation that needs to be performed to determine the reason sciatica symptoms are present. This leads us to the second thing you should know about sciatica.....
2. What else can cause sciatica?!
Now that we understand sciatica is not a diagnosis, we can better understand that many different things cause sciatica. 3 common things that can cause sciatica are disc herniations, SI joint dysfunction, and trigger points.
Disc herniations are a common cause of sciatica. A disc is made up of a soft gel-like center called the nucleus, and a tough outer portion called the annulus. A disc herniation occurs when the nucleus pushes through cracks in the annulus and creates a bulge or herniation into the central canal where the spinal cord goes through, or through the IVF (intervertebral foramen) where the nerve root exits the spinal cord. This results in either pressure from the disc bulge directly on the nerve root, or the nucleus material leaking out onto the nerve root, both of which can cause nerve root irritation and radiating symptoms. There are certain tests we perform during our online assessment to determine if an individual's sciatica is from a disc herniation, or from the additional possibilities listed below. Classically most individuals will feel sciatica pain when bending forward as if they are picking something up or putting on socks and shoes. But this is not the case all the time, and it is important to understand what movements both trigger and alleviate symptoms.
SI Joint Dysfunction
The SI joint has been known to refer radiating symptoms down the leg causing sciatica as well. Keep in mind, just like individuals experiencing a heart attack can experience referred pain in their arm or jaw, other areas of your body can cause referred pain too. SI joint dysfunction is defined as improper movement of the SI joints leading to sacroiliitis. SI joint dysfunction or sacriliitis can be caused by too little movement due to degenerative changes or poor mobility, and by too much movement due to overstretched ligaments from pregnancy or injury. It is important to be able to distinguish between SI joint referred pain and a disc herniation since the symptoms can present quite similar. Specific tests and assessments should be utilized towards the two potential conditions to tease out a proper diagnosis. A proper diagnosis will then lead us to the correct treatment for that individual.
Trigger points (knots) can also be a cause of sciatica. A trigger point is know as a hyperirritable spot, and is typically a palpable nodule in the taut bands of the skeletal muscles' fascia. When these spots are pressed on, they will often send pain to distant areas. 2 common trigger points can cause sciatica which are located in the glute minimus and piriformis. These muscles are located in the glute/hip region and palpation of these muscles could help identify their contribution to an individual's sciatica. When a trigger point is found in one of these muscles, pressing down on the trigger point may reproduce sciatica which would provide confirmation that the individual's symptoms may be related to these trigger points and their treatment should reflect that. Common treatments for trigger points are dry needling/acupuncture, soft tissue work, and muscle activation exercises.
3. How do I know if my sciatica is from a disc/nerve injury affecting the sciatic nerve?
Although there are many things that can cause sciatica, a disc herniation or pinched nerve can be a common reason associated. But how do you know if your sciatica is from a disc herniation or pinched nerve? Individuals with disc herniation or sciatic nerve derived sciatica may notice that their pain or stiffness is worse when....
first waking up in the morning
after sitting for long periods
when attempting to bend over or reach for the toes
may experience a burning sensation around an inch wide down the leg
may experience an electric shock that goes down the leg when bending over
These are often the most common symptoms associated with disc herniation or sciatica. The reason for this is something called nerve tension.
Imagine a rubber band is attached from the back of your head, down your back, down your legs, and under the bottom of your feet. When you stand straight up there is no tension on that rubber band. However, if you bend over to touch your toes then that band will tighten. If the nerve root is irritated by a disc herniation, then it will become sensitive to stretch and will indicate nerve tension. That is why sitting for long periods, bending over to touch your toes, or tying your shoes is often a very irritating movement for individuals with this kind of low back pain. Sciatica stretches may sometimes make your sciatica symptoms worse for this reason. There are other sciatica exercises that may provide better relief. Here is a video that shows how nerve tension works and a common exercise that may help mobilize your sciatic nerve.
What to do now?!
Don't fear, sciatica relief is possible and there are many ways to safely and effectively resolve sciatica pain. Sciatica treatment should always start with conservative care utilizing exercise and rehabilitation movements. We have plenty of videos on our instagram @rehabfix that address the low back and the glutes/hips that may provide a place to start with exercises for sciatica. In addition, feel free to click the link below to get our FREE LOW BACK GUIDE sent right to you!
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