Sciatica Pain: What you need to know
Sciatica pain can be caused by a number of things. This article will highlight a few main causes and simple, effective exercises you can do to treat it.
Disclaimer: Although I am a physical therapist by profession, I am not YOUR physical therapist. This article is for informational and educational purposes only, does not constitute medical advice and does not establish any kind of therapist-patient relationship with me. I am not liable or responsible for any damages resulting from or related to your use of this information.
What is sciatica?
Sciatica is inflammation of the sciatic nerve. This can be felt as back, buttock and/or leg pain. The leg pain can be located in a number of locations:
- the buttock
- the lateral (or side of) the hip
- the hamstring or into the calf
- the front of the thigh
- the foot or the toes
Typically, the further down the leg symptoms are felt, this indicates the more irritated the nerve is.
Sciatica and associated anatomy
The sciatic nerve originates in the spinal cord, travels through the buttock (piriformis), down the back of the leg and finally, to the foot. It is made of up 5 nerve roots in the spine from L4 to S3.
There are some individual anatomic variations as far as where the sciatic nerve travels relative to the piriformis muscle. As a result, some people may be more prone to sciatic pain.
How do I know I have sciatica?
- You have symptoms in any one of the variations of leg distributions (or similar) as listed above
- Your nerve pain can be described as any one of the following: burning, numbness, tingling, hot, or sharp shooting pain
- Your pain may have come on gradually over time, with symptoms coming and going
- Your pain may have started off slight, but is now worsening in intensity or location(s); i.e. it’s now traveling further down the leg
- You may experience the feeling of weakness or of the leg
“giving way” - There may have been a specific event that brought on your sciatica, like lifting something heavy, or twisting or bending the wrong way
Sciatica and the Spine
The sciatic nerve can be pinched at its origins in the spine. This may be due to spinal stenosis (a narrowing of where the nerves exit the spinal canal), spondylolisthesis (slippage of one vertebra over another) or a herniated or “slipped” disc.
In the case of impingement at or near the spine, certain spinal motions will worsen symptoms, and other motions will improve it.
With proper rehab and recovery, symptoms should centralize back to the spine. This means that syptoms retract or move back to where they are originating from. In this case, we want to eliminate any pain or symptoms in the foot, leg or hip, and have them come back up into the low back, and then, eventually resolve from there.
Spinal motions
You would know if pain is originating at the spine if certain motions of the spine make your symptoms worse or better.
We can test this with repeated motions. Obviously, you should only continue to perform motions that make your pain centralize, or get better.
To test:
In standing, with the knees straight, perform 10 forward bends as though you were trying to touch your toes. This motion creates flexion in the spine.
Then: In standing, place your hands on your hips, and lean backwards 10 times. This motion creates extension in the spine.
Thinking about each motion: Does one direction make your pain centralize to the back or does it make the nerve pain worse and radiate further toward the foot?
To Treat:
If one of these motions helps, do it every time you start getting sciatic symptoms or every couple hours, whichever is less.
In most cases, a herniated disc will prefer exension while a stenosis or a spondylolisthesis will prefer flexion. There are, of course, some exceptions so this is not a hard and fast rule.
Sciatica and the piriformis
If your nerve impingement is caused by a tight piriformis or buttock muscle, it can be squeezing on the sciatic nerve and causing pain.
In this case, mose people have more buttock than back pain. Another sign is that there is an increase in symptoms when sitting due to the pressure on the sciatic nerve itself in this position.
To test:
In sitting, take the ankle of the symptomatic side and cross it over the opposit knee. Are you able to drop the knee on the symptomatic side (the bent knee) so that it is parallel to the ground? or is it sticking up toward the ceiling? Or are you even able to get your ankle over the opposite knee?
What’s normal? You should be able to cross your ankle over the opposite knee comfortably. The bent knee should be able to drop comfortably toward parallel with the floor. If you have an abnormal test, this indicates that your piriformis might be tight.
Keep in mind, that this test can also be positive if there are anomalies at the hip joint as well. So again, not a hard and fast rule.
To Treat:
Perform stretches for the piriformis in whatever way is comfortable and tolerable for you. Stretching should never be painful, but should be a gentle pulling sensation.
There are many ways to stretch the piriformis. Choose one that is comfortable for you but also allows you to feel a pulling sensation in the buttock. Examples of some stretches are:
Secondly, to treat your sciatica due to a tight piriformis, perform some self trigger point releases with either a tennis ball or a foam roller. Use a foam roller on the floor as shown. A tennis ball can be substituted for the foam roller in this example, or you could use a tennis ball while seated in a chair.
If you are unable to tolerate the leg in this position, you can modify by hugging the knee to the chest, as shown in the first piriformis stretch above. This works while on the floor, or while in a chair.
Finally, if neither of these is working, use of positional release should help. The goal here is to put the piriformis on slack long enough to coax it into relaxing, and thereby, decreasing tightness.
To do it: Lie on your stomach on the floor or bed. Pull your knee up toward your ribs on the affected side so that you are in a “frog leg” position.
Hold this position for 90 seconds minumum. Feel free to hold it for longer if you are finding relief or a decrease in your symptoms.
Sciatica and the hamstrings
Because of where the sciatic nerve runs, sciatica can originate in the hamstrings. Just like with a tight piriformis, a tight hamstring can pinch the nerve and cause symptoms.
To Test:
To test hamstring length, perform the 90/90 Hamstring Length Test. To do it, lie on your back on either the floor or your bed. Bend your hip up to 90 degrees of flexion. Hold behind the thigh of the symptomatic leg with the hands. Then, straighten the knee so the leg extends up toward the ceiling.
If you are unable to straighen the knee within 20 degrees from being perfectly straight, you have tight hamstrings. 20 degrees or less is considered a normal hamstring length. More than that, then you need to address it.
Additionally, in this same position, if you flex your foot (bring your toes toward your head) and your sciatic symptoms worsen, it’s likely that your hamstrings are playing a role in your pain.
To Treat:
Come into the same 90/90 position as mentioned above. As you straighten your knee toward the ceiling, flex your foot at the same time. Hold for a count of 3 to 5 seconds and then release, letting the foot relax and the knee bend. Repeat 10-15 times.
What you’re doing here is performing nerve glide by stretching the nerve for a brief period and then releasing it. Unlike stretching for a muscle, nerves do not like prolonged holds.
Sciatica and Pregnancy
A lot of times sciatica in pregancy is caused by baby’s position in the uterus and direct pressure on the nerve. Sciatica typically hits in the 2nd to 3rd trimester as baby’s size increases.
Sometimes, you just have to wait for baby to move to relieve the pressure. Sometimes regualar movement, yoga or exercise can encourage baby to move.
Otherwise, you may be able to remedy your pain with any of the above tests and treatments. Keep in mind that if you’re beyond your first trimester, time spent on your back should be brief or you can modify with a wedge or a few pillows.
As always, don’t do anything that doesn’t feel right or is worsening symptoms. Seek guidance from a medical professional as needed.
Many causes, many treatments
This list included here is by no means exhaustive. It is also not individualized to YOU. These are some things that you can try at home to help alleviate your sciatica based on your presentation or symptoms.
If your symptoms are staying the same or worsening, use common sense! Go see a medical provider (like a physical therapist) for a complete and individualized evaluation and treatment prescription.
Questions/Comments?
I’d love to hear from you. Please feel free to comment or ask a question below.
Additional Articles of Interest:
FREE Guide: Strengthening for Pregnant Runners
