Sciatica meaning?

Sciatica is generally a term used to describe pain in the back of a the leg that’s usually thought to be caused by the sciatic nerve. Compression is the most common reason for this nerve to become painful.

Picture of sciatica definition
Image defining sciatica

Generally sciatica means that one of the lumbar nerve roots (L4-L5 most commonly) is irritated and referring down the back of the leg. Formally this is termed as a lumbar radiculopathy or basically “pain originated in the low back”. This can occur with or without low back pain.

Additionally the sciatic nerve it’s self can be painful without involving the low back nerve roots and this is know as a peripheral Neuropathy.”Pain originating in the leg”

Both Lumbar radiculopathy (Low back Referral) and the peripheral Neuropathy (The sciatic nerve hurts, but low back doesn’t) fall in the Sciatica diagnosis umbrella.

“Pain down the back of the leg below the knee is the signature sign of Sciatica”

Anatomy of Sciatic Nerve

The course of the sciatic nerve from the spine to the bottom of the foot.

The sciatic nerve is the largest in diameter peripheral nerve (outside the spine) in the body. It originates from the nerves of the lower back. (L4-5), travels under the buttocks (gluteus maximus) and down the leg to the to the back of the knee.

Usually at this point (behind the knee) it divides into 2 branches (like a tree) into the tibial and peroneal nerve that travel to the foot.

Therefore, technically sciatica can be anywhere between the buttocks and the foot! So explains  sciatica that makes you walk with a limp.

Symptoms of Sciatica

  • sciatica cuased by sciatic nerve pain
    A patient experiencing sciatic nerve symptoms.
  • Radiating pain anywhere from buttocks to the bottom of your foot.
  • Most commonly pain occurs primarily in the buttocks and back of the leg (hamstrings area).
  • Commonly mimicking hamstring injuries during running, Plantar fasciitis, calf strains and achilles tendon pain. (Missed by many Chiropractors and PT’s)
  • Pain varies from dull achy, severe sharp pain,  and burning pain in the back of the leg or calf.
  • Numbness in leg
  • Coughing can make it worse and aggravated by sitting
  • Bending over to touch the toes creates one sided leg or calf pain.
  • Severe cases weakness can occur causing foot drop ( can’t hold ankle flexion)

When to see a doctor for Sciatica?

Generally it’s recommended that you seek medical treatment for sciatica when the pain is severe in the low back or leg. If your experiencing any numbness, tingling or weakness then regardless of pain it’s advised that you seek the opinion of a medical professional.

Sports Chiropractor performing a slump test on a runner with scaitica
Dr. Dean performing the slump test that’s creating sciatic nerve pain.

6 Major causes of Sciatica

1) Intervertebral Foreamen Compression (IVF)- “The pinched nerve.”

The Garden Hose Analogy!

A little girl discovering the increase pressure of pinching a garden hose.
Comparing a pinched nerves pressure to that of a garden hose.

You ever pinched a garden hose so you could super soak your brother or sister from a greater distance? This creates a  space advantage to run away before getting clabbered?

Well:

That occurs because you effectively increased the pressure, but the overall volume of water is actually dramatically decreased. This is the same thing that occurs with blood flood (that supply the nerve) at this IVF opening for the nerves.

Don’t believe me?

Try filling up a bucket with a pinched hose vs  unrestricted hose and see which on fills up faster.

pictures of a bucket filling up with water unrestricted. Analagy to a nerve that becomes unpinched

That’s a simple way to explain what’s occurring at this IVF.

There is a essentially a hole in the bone that the nerves of the low back exit to start their decent down the back of the leg.

 

Any decrease in the size of this hole can create low back pain and sciatica.

pictures of the bones, disc and nerve roots of L4-S1 vertebrae.
A pinched L5 nerve in low back from a disc herniation.his whole can create a compression “pinched nerve” and give you sciatica and walking problems.This hole is the most common location of compression (pinched nerves) and irritation of nerves of the lower back.Common reasons of pinched nerves at the IVF:

 

  • Herniated Disc, Slipped disc, bulging disc
  • Arthritis- Bone deformation decrease the overall size of the IVF.
  • Inflammation
  • Fluid dynamics- “Blood flow congestion aka Pinched hose analogy”
  • Poorly controlled movement that stress the nerve

Scientific studies have showed us that this hole in the spine increases and decreases it’s dimensions with various movement patters. So we know that certain movements increase the size and others decrease it. So repetitious movement in a closing direction (smaller hole) is a logical mechanism of pain generation for sciatica.

2) Excessive Sitting

One of most common complaints of patients with sciatica is that  leg pain is worse with long periods of sitting. This pain could be as soon as a person is seated with severe cases. Minor cases can take a few hours to creep up.

Person experiencing sciatica while sitting.
Sitting is known to cause many painful areas of the body including low back pain and sciatica.

Scientific studies have showed us that this hole in the spine increases and decreases it’s dimensions with various movement patters. Sitting is theorized put strain on the sciatic nerve.

Experiencing sciatica while sitting is generally due to strain on the low back.   Thus creating referral down the back of the leg into the sciatic nerve.

Remember that hole?

 

3)Improper lifting Mechanics

The majority of cases of sciatica and leg pain are referral from the low back. Therefore lifting mechanics becomes a vital aspect of both creating and eliminating sciatic nerve pain.

“The common myth is that you “should lift with your knees”. In reality you should be lifting with your hips.” Quotable

Lifting with your back, rather than with your hips place forces on the spine that overtime can create sciatica. World leading expert in spinal biomechanics (Stuart McGill) shows that lifting with a forward flexed position can injure the lumbar disc after many repetitions. This is common know as a herniated disc.

This herniated disc created then can decrease space in the IVF mentioned in #1 and create sciatica regardless if the low back hurts at the time.

This generally occurs when there isn’t enough core stability or the weight that’s being managed isn’t directly under the plum line of the person.

4) Poor Control of the Pelvis

Walking and running requires that a person is able to control the pelvis. Therefore managing  impact forces of the foot interacting with the ground is crucial!

The Egg Drop Analogy.

If you throw an egg up in the air and catch it with a stiff hand?

What Happens?

It Breaks…

If you throw an egg up into the air  and disperse the energy over a larger range of motion (as you catch it), then it doesn’t break.

Crazy I know…

This is the way I explain the importance of being able to control yourself, before you wreck yourself.

The picture below is showing pelvic drop that can occurs during walking and running.

Runner on a treadmill having scaitica during a gait analysis.
Patient that has leg pain after running and first thing in the morning.

This occurs due to a poorly controlled pelvis.

Remember that hole in the spine where nerves can become pinched.?

Well:

When the pelvis drop occurs there is an increase in strain on the joints and nerves of the low back. Similar to stepping off a curb when you didn’t expect it. It Hurts!

This is one of the most common reasons that I see for sciatica in runners.

This runner was complaining about sciatica after running.

5) Deep Fascia and Muscle Tightness

Have you ever wore a tight pair of pants that limited your ability to move?

What happens?

You lift your leg, the pants bunch up and then you have to move from the spine to accomplish the task.

This is similar to what occurs when your muscles and fascia are tight.

Group of muscles are covered by connective tissue that encases the muscle group much like putting sock on a your foot.

A picture of the deep fascia connection to low back pain and sciatica.
Example of how the deep fascia is important for normal glide and slide of the muscles.

That sock decreases friction and allows you to slide on your shoe with more ease. Especially if you have those fancy dress socks on.

Well:

Fascia surrounds muscles  decrease friction of muscle groups allowing proper gliding and sliding next to each other. This is pivotal to ensure normal biomechanics. When gliding and sliding are altered in the low back or hips it can put increased pressure on the sciatic nerve.  Therefore creating that nagging sciatica that can occur with walking and standing.

6) Decreased Flexibility of the Sciatic Nerve.

Myth Buster #1:

It’s common belief with both patients and some doctors that nerves don’t stretch.

Wrong:

Nerves are made of highly elastic (stretchy) connective tissue and need to be able to stretch during normal human movement with walking, running and even doing the splits. (ouch for me)

Research has found that nerves can stretch up to 22% before failure. That’s increasing their length by 1/5!

If the sciatic nerve becomes tight, then it can become sensitive, creating sciatic nerve symptoms.

So all you need to do is stretch your hamstrings….. right?

WRONG!

The sciatic nerve and the hamstrings need to be stretched in 2 completely different ways.

“Stretching your hamstrings will make sciatica worse, not better”

Part 2: How Do I Treat my Sciatica at Home?

I know it must be killing you by now.

So…

How do I Stretch the Sciatic Nerve?

We need to understand some fundamentals about nerves personalities (neurodynamics) in order to understand how stretch them. I’ll keep this Joe Dirt Simple.

Nerves hate sustained tension (stretch), compression and being deprived of oxygen.

They love being in a position of rest, being slacked and receiving lots of oxygen.

Here it comes:

My “go to favorite” home remedies for sciatica is the Standing Leg Swing Nerve Stretch

Step by Step Instructions
  1. Hold on to something!
  2. Kick the painful leg forward until you feel a very light STRETCH in hamstring, back or even  calf. There should be NO PAIN. If this is a very short distance than that’s completely OK!
  3. Do 15 repetitions.
  4. Take a full 60 seconds break.
  5. Do this 3-5 times a day if the pain isn’t made worse. If so, consult a medical professional. (recommended regardless)

This is a safe way to stretch the sciatic nerve by giving it what it loves, rather than what it hates.

Ok,

So what’s Next?

Sitting is the New Smoking: Take micro breaks to Relief Sciatica and Low Back Pain.

Back in the 90’s it was popular in the corporate wellness world to have professionals come and give long ergonomic advice workshops.

Unfortunately the only ergonomic position that can relieve your low back pain and sciatica is the position that you frequently take a break from.

The 45:1 rule

Stand up and move for one minute  every 45 minutes you’ve seated.

Pictures showing the importance of microbreaks for low back pain and sciatica
Take micro breaks as a method to relief low back pain and sciatica. (Then eat a Kit Kat as a reward;)

Creating a New Habit- Hip Hinging

Since the majority of sciatica is referral from the low back we need to move in such a way that doesn’t put unnecessary stress on the low back.

To put this simple- move from you hips rather than the spine.

The Kiss the Wall with your Butt Exercise

  1. Stand with feet just a few inches from the wall.
  2. Then bend forwards with your body so that only your butt touches the wall.
  3. Move your feet a few inches forward
  4. Continue this until you are far enough away from the wall that you could sit into a chair.

Standing Like a Boss- How to Stand Without Sciatica

Sciatica and low back pain while getting out of a chair is one of the common reasons that patients seek my help.

Usually this patient will press his/her hands on the knees as a point of perceived stability to push themselves into a upright position.

This puts the low back in a position of strain due to most of a persons upper body weight being in front of the persons body.

Exercises to Avoid While Experiencing Sciatica

During acute sciatica there are number exercises that most likely will make the symptoms worst in the long run.

Even if theses exercises makes your leg pain feel better for ten minutes, and then that nagging leg pain returns with a vengeance.

Sound Familiar?

Top Exercises to avoid when you have acute sciatica. (most cases, not all)

  • Sciatica patient bending forward and creating pain in low back and left hamstring.
    Patient bending forward to stretch low back and hamstrings(creating pain in one leg)

    Forward fold from Yoga (See above)

  • Sustained stretching of the hamstring and low back (See above)
  • Burpies

 

 

 

It’s important to note that these are only exercises to avoid while the sciatic nerve is actively generating pain. Once the leg pain has been addressed these exercises can be reintroduced.

 

This guide serves to discuss sciatic nerve anatomy, what causes sciatic nerve pain, symptoms of sciatica, what causes sciatica to flare up and how to relieve pain leg pain from sciatica. This is for educational purposes only and doesn’t replace a proper examination from a chiropractor, physical therapist or medical professional.

How Many Treatments for Sciatica When seeing a Chiropractor?

Visits with Top Rated Chiropractor and Sciatica Relief.

  • Average Pecentage of Sciatica Relief by Appointment

This very much depends on the training of the chiropractor.

Believe it or not,

Not every chiropractor just “pops your back”

To relief you sciatica it’s important to see a top rated chiropractor trained in proper diagnosis and treatment of the sciatic nerve. This includes how to stretch the sciatic nerve, exercises to relieve sciatica, and awareness of leg pain that’s referring from the lumbar spine.

Have a Question? Comment below to have them answered!

Comments (7)

Indeed I find this article educative and helpful. I have tried the Mckienzi exercise and I felt a huge relief. Thank you drjustindean for putting this amazing piece, it has helped me a great deal.

Glad you found the prone press ups(Mckenzie) helpful! Generally I recommend doing at least 20×5 per day.

Awesome article breaking down the various causes of Sciatic pain. It was very informative, thank you. I find that people also want to self diagnose for “IT band syndrome” when they have leg pain. What would be the best way to help people understand the differences between the two?

That’s a really good question! IT band syndrome is generally considered to be pain/inflammation of the connective tissue on the outside of the leg (IT Band). So pain on the outside of the leg is often diagnosed more frequently as IT band syndrome, while back in the back of the leg is usually diagnosed as sciatica. That’s a simple and easy explanation that you will get when consulting Dr. Google. (it’s more complicated unfortunately)

In reality IT band syndrome is extremely over diagnosed and I find that pain on the outside of the leg(IT band syndrome) is usually pain referral from the mid back (T-L junction) or irritation of the lateral femoral cutaneous nerve that travels directly on top of the IT band. Sounds like a good topic for a blog post that I’ll write in the future to dive into greater detail.

I can’t count the number of clients I’ve encountered that point to some random body part and complain that their “Sciatica is acting up again”. I wish I could send this article to all of them! I will definitely pass along the home treatments too. Thank you
Do you have any advice for people who have otherwise impaired hip mobility?

I wrote this blog so it could be an educational resource to medical professionals and patients alike. This information isn’t well known…..yet.

Impaired hip mobility is common issue as well.
The answer very much depends on why the hip is limited. Variety of reasons listed below.
1) poor core control causing the muscles of the hip to become an “artificial core”. This limits the flexibility of the hip muscles need for proper hip mobility.
2) Fascial densification aka the fascia is “tight” and needs to be restored it normal function of gliding and sliding.
3) “Pinched Nerves” By this I mean nerves that are stuck, inflammation or irritated likely from #1 on the list. These nerves include the lateral femoral cutaneous nerve, obturator, hypogastric, femoral, sciatic or cluneal nerves. Address those guys and see the hip open up.

The options listed above are just the low hanging fruit of course.

Hello Drjustin.Well I have this issue that I always keep my legs pushed back while standing and I really can’t help.I can’t stand absolutely straight and it really affects my lower back I get sharp pains and Abit tired.What can I do about the situation?

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