Sciatica: It's a Pain in the Butt!
Lately I've had quite a few people coming in complaining about sciatic pain. So what exactly is sciatica anyways?
Sciatica refers to pain that radiates along the path of the sciatic nerve. The sciatic nerve is the largest in the body and is formed by the union of five nerve roots exiting from the spinal column in the lower back from L4, L5, S1, S2 and S3. These nerve fibers are generally responsible for motor and sensory functions of the lower body. The five nerves group together near the piriformis muscle deep in the buttock to form the sciatic nerve. The nerve leaves the pelvis below the piriformis muscle, progressing downward between the muscles of the thigh to the knee, where it divides into 2 branches: the tibial nerve and the common peroneal nerve, which continue on to the foot.
Sciatic pain can be localized in one area, extending down the length of the nerve or also go right down to the foot. It's not always just pain though; you can also feel burning, tingling or numbness as well as muscle weakness. The pain can vary widely, from a mild ache to sharp pain or excruciating pain; sometimes it can feel like an electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.
Mild sciatica usually goes away over time. Call your doctor if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if you have sudden, severe pain in your low back or leg along with numbness or muscle weakness in your leg, if the pain follows a violent injury (such as a motor vehicle accident) or you have trouble controlling your bowels or bladder.
Common causes of sciatica can include a herniated or bulging disk in the lower spine, degeneration of tissues in the lumbar spine, a narrowing of the spinal canal, pregnancy, obesity, muscle spasm and piriformis syndrome.
Piriformis syndrome is when the piriformis muscle compresses the sciatic nerve; for many people this is the cause of their sciatica. The piriformis muscle is a small muscle located in the buttock region and runs from the front portion of the pelvis around S2 to S4 and attaches to the greater trochanter. The sciatic nerve can run in front, behind or through the piriformis muscle depending on your own unique anatomy.
In general, the way to tell the difference between whether your sciatic pain is coming from your spine or from muscles is in the way the pain presents itself. If the pain is never ending, always constant and the same, with no relief at any time, it's probably something to do with the spine. However, if the pain comes and goes, is not constant and you can get relief at times, it's likely that muscles are the culprit, with the piriformis muscle being the most likely.
So what's the best way to treat your sciatica? If you don't require surgery there are a few ways to help yourself feel better and get on the road to recovery.
Exercise: it's good to keep moving and avoid prolonged inactivity. While it may seem counter intuitive, exercise is usually better for relieving sciatic pain than bed rest. Resting for a few days after the pain flares up is fine, but after that, inactivity will usually make the pain worse. Without exercise and movement, back muscles and structures of the spine become weak and less able to support the back. This weakening can lead to back injury and strain, which can cause more pain. The trick is to find that fine line between doing enough exercise to keep limber and healthy, and doing too much which can aggravate your condition. When you're feeling better, exercises to strengthen your core, glutes and leg muscles are ideal.
Avoid prolonged rest: prolonged sitting or bed rest can actually make the pain worse. Sitting especially can further cause the muscles around the sciatic nerve to become even more short and tight than they already are. Lying down is a bit better, especially on a firm surface, but after a few days light exercise and stretching should be started.
Using heat and cold: applying either heat or cold to the area can help relieve some of the pain and spasms of sciatica. Heat is helpful to relax the muscles, cold for reducing inflammation. Use what you feel gives you the most relief; heat can be applied for 20 - 30 minutes at a time, cold for 5 - 10 minutes at a time. If you're not sure which to use, alternate between the two, starting with heat and ending with cold.
Medication: both over the counter and prescription medication can help alleviate some of the pain of sciatica. NSAIDS (non-steroidal anti inflammatories) such as aspirin, ibuprofen, acetaminophen and naproxen can help, but don't use them long term without consulting your doctor. Muscle relaxers such as methocarbamol found in Robaxacet may also help, just don't use them if you have to drive or operate heavy machinery as it can slow your reactions. If the over the counter options don’t help, your doctor might prescribe stronger medications such as stronger muscle relaxants or anti inflammatories. Tricyclic antidepressants such as amitriptyline (Elavil) and anti-seizure medications (like Gabapentin) sometimes work as well.
Alternative therapies: therapies such as Massage Therapy, Chiropractic, Acupunture and yoga can help alleviate some of the pain, muscle tightness and spasm that accompany sciatica. By improving blood circulation, relaxing tight muscles and releasing endorphins, these therapies can greatly affect a speedy recovery.
Stretching: most people don't stretch enough, let alone when they are in pain. There are certain stretches, when regularly performed, that can really help to ease the pain of sciatica. I'm a visual person, so I routinely show my clients how to do specific stretches that can help them feel better. It's important to remember that when stretching, you need to do both sides (if one side feels tighter, just hold it longer), hold your stretches at least 30 seconds each, to not feel pain during stretching (you just want to feel the stretch, not an increase in pain), to do it several times a day, and to do a bit of a warmup first. Check out this Youtube video for stretches that can help loosen up the piriformis and other muscles that are involved in sciatica:
If your sciatica is really severe and caused by spinal issues, more invasive treatments may be required, such as surgery, nerve blocks, or epidural steroid injections. All of the aforementioned self help suggestions still can help relieve some of your pain if this is the case.
In some cases, sciatica can be prevented; there are several lifestyle changes that can reduce the chances of developing it, including regular exercise and making sure proper posture is used when standing, sitting upright, and lifting objects. However when you do experience sciatica, treatments such as stretching and Massage Therapy, as well as others, can help to limit the length of time you suffer from this literal pain in the butt.