So you’ve got this funky leg pain that starts in your glutes and maybe travels down the back/side of the leg into the calf. Google has diagonsed you with “sciatica”. But what actually IS sciatica and are you sure that’s what you’ve got??
Sciatica is an “umbrella term” for pain that may start in the lower back/pelvic region and travel down the leg, meaning that there can be many different causes for this pain. The sciatic nerve is the biggest and longest nerve in the body and starts in the lower lumbar spine, coursing through the back of the hip and down the back of each leg where it divides into two branches at the back of the knee.
Sciatic pain typically is felt along the path of the sciatic nerve (who would have thought…!!) and may be felt as a deep ache in the glutes and down into the back of the leg, as far as the calf and foot. Tingling (pins and needles) and/or numbness may be experienced in addition to the pain and sometimes there can be weakness in the leg also. Sometimes, people can get extreme shooting pains along the course of the nerve, like an electric shock which can be exacerbated by a cough, sneeze or sudden movement. The pain can vary from a dull toothache type pain to excrutiating sharp pain. In most cases, sciatica is only experienced in one leg at a time, but rarely, can be felt in both legs simultaneously. Sitting positions tend to worsen sciatica.
So what are the different reasons you could be experiencing sciatica?
Lumbar Disc Herniation
One of the more common causes of sciatica, this occurs when one (or more) of your lumbar discs sustains an injury resulting in the disc pressing against the nerves that exit the spinal cord in the lumbar region of your spine (predominantly L4, L5, S1). Sciatic-type pain can not only result from the disc pressing against the nerves, but also the inflammation around the nerves in the acute phases of the injury. Additionally, muscle spasm of the lumbar erector spinae, quadratus lumborum and iliopsoas can increase tension through the lumbar spine causing additional pressure on the already irritated nerves.
Bony spurs that form as we get older due to wear and tear (arthritic type changes) can form around the space where the spinal nerves exit, causing irritation and/or compression. The spurs themselves are not painful, but they can take up space normally reserved for nerves to exit freely.
Spinal canal stenosis
This is a narrowing of the spinal column (canal) which can lead to increased pressure on the nerves exiting the spine. Sometimes this is due to osteophytes (as mentioned earlier).
Sacroiliac joint dysfunction
Hypomobility or hypermobility around the sacroiliac joint can cause sciatic pain, mostly due to muscular imbalance and tightness. The piriformis, in particular (an external rotator of the hip), can become overactive and tight which can cause pressure on the sciatic nerve that passes behind it.
This is a relatively rare condition in which the sciatic nerve courses through the piriformis muscle, as opposed to around it.
A condition of the spine in which one vertebrae slips forward in relation to the one above it. This causes a disruption of the spinal column and a narrowing of the space where the nerves exit from.
In any case, it’s best to leave the diagnosis up to a health professional as each condition will require different type of treatment and intervention! If you are suffering with sciatic-type pain and are experiencing muscle weakness, or any having problems with your bladder or bowels, please seek medical advice immediately!
Keep checking back for the next blog post (Sciatica Part 2) as I will focus on some mobility advice for relieving sciatica!