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Sciatica: What You Should Know
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Sciatica is a condition that can cause pain in your lower back and legs. It is caused by compression of the sciatic nerve, which runs from your lower back down to your feet. Sciatica can be caused by a variety of things, including herniated disks, bone spurs, spinal stenosis, pregnancy, and Piriformis Syndrome.
What is Sciatica?
As mentioned earlier sciatica is a condition that can cause pain in the lower back and legs.
Sciatica can be accompanied by weakness, numbness, or tingling in the affected leg. The severity of symptoms changes accordingly to how much the nerve is irritated, pinched, or compressed.
A lifetime incident of sciatica is around 10 to 40% and 2 to 5% of the global population suffers from sciatica each year.
Sciatica is a term used to describe pain that radiates along the length of the sciatic nerve; this is the reason it is often misdiagnosed because even general cases of low back pain, without sciatic nerve irritation, may cause pain that travels down to your leg. Sciatica is always caused by compression or irritation of the sciatic nerve, which can occur at any point along its length.
Sciatic Nerve: Anatomy
The sciatic nerve is the longest and widest single nerve in the human body. It extends from the lower back, through the buttocks, and down the back of the leg. The sciatic nerve is made up of two smaller nerves, the tibial nerve, and the peroneal nerve, which branch off from the spinal cord in the lower back. The sciatic nerve provides sensation to the skin of the leg and foot, as well as motor control to the muscles of the leg. The nerve roots that comprise the sciatic nerve runs from the L3 to S3. These numbers and letters refer to the vertebrae where the nerve run through (from the third lumbar vertebrae to the third sacral one). If you are interested to learn something more about Anatomy check the MiTo Blog Guide to Human Anatomy.
Main Causes Of Sciatica
A variety of things may irritate your sciatic nerve here’s a list of the principal causes:
1. Herniated Disc: this is the most common cause of sciatica. It is a condition in which one of the discs that cushion the vertebrae in the spine becomes ruptured or displaced. If you want to learn more about herniated disks have a look at MiTo Blog Disc Herniation: What You Should Know.
2. Spinal Stenosis: a condition in which the spinal canal narrows and puts pressure on the spinal cord.
3. Piriformis Syndrome: a condition in which the piriformis muscle, a small muscle in the buttocks, irritates the sciatic nerve.
4. Pregnancy: during pregnancy, there are different body changes: uterus growing and relaxing of ligaments (caused by the hormone relaxin), these changes caused a shift in the center of gravity and less spinal room. Although these are necessary and compromises you may suffer from sciatica due to nerves being pinched because of lack of space.
5. Spondylolisthesis: a condition in which one vertebra slips forward reducing the space in the vertebral canal pinching the sciatic nerve.
6. Bone Spurs: this is a degenerative condition that happens the cartilage around your vertebrae is consumed and therefore your joints are rubbing together. Your bone to compensate for this rubbing process and the lack of cartilage develops smooth rounded-shaped bony growth which unfortunately decreases the room for your sciatic nerve to slide leading to impingement.
What is Sciatica Pain like?
Sciatica pain can vary greatly from person to person. Some people experience a sharp, shooting pain that runs down their leg, while others have a more generalized pain that is more difficult to pinpoint. Sciatica can also cause numbness, tingling, or weakness in the affected leg.
For many people, sciatica pain is worse when sitting or standing for long periods. It may also be worse when bending over or twisting the spine. Some people find that sciatica pain improves with walking or other forms of gentle movement.
If you are experiencing sciatica pain, it is important to see your doctor for an accurate diagnosis. Many different conditions can cause sciatica-like symptoms, so it is important to rule out other potential causes. Once a diagnosis is made, your doctor can develop a treatment plan that is right for you.
How Can You Relieve The Symptoms Of Sciatica?
If you’re one of the millions of people suffering from sciatica, you know how debilitating the condition can be. The good news is that there are some things you can do to relieve the symptoms of sciatica. Here are a few tips:
1. Apply ice or heat: ice can help reduce inflammation, while heat can help relax the muscles.
2. Take over-the-counter pain relievers: Ibuprofen and acetaminophen can help ease the pain.
3. Exercise: While it may seem counterintuitive, exercise is one of the best things you can do for sciatica. Stretching and strengthening the muscles can help relieve pressure on the sciatic nerve.
4. Check with your GP: If the pain is severe or doesn’t improve with self-care, it’s time to see a doctor. He or she may prescribe stronger pain medication or recommend other treatments, such as physical therapy or manual therapy.
5. Physiotherapy: together with medications it is usually one of the first treatment options and it is based on giving your spine and muscle much more flexibility to create more room for the sciatic nerve, reducing spams, control the pain, reducing joint stiffness and strengthening your muscle for more stability.
6. Manual therapy: it is used as complementary to physiotherapy and medications, to list a few: osteopathy, massage therapy, and chiropractic care.
7. Surgical Operation: if the pain is persistent and the above options did not work, you may be asked by your GP or healthcare practitioner to seek a consultant and consider the surgery. Surgery is usually used as a last resort. The main objective of a surgical operation is to give more room to the sciatic nerve.
Common surgery options:
a) Microdiscectomy: a surgeon will make an incision over the affected disc in your spine and the dysfunctional part of your disc will be removed.
b) Laminectomy: similar to microdiscectomy, but in this case, the posterior part of your vertebra called the laminae will be removed. This will allow more room for your nerves.
How MiTo Can Help With Sciatica?
If you’re suffering from sciatica, you’re not alone. This painful condition affects millions of people each year. MiTo Healthcare Clinic can help with sciatica by also offering osteopathic, massage treatments, and exercises consulting:
1. Osteopathy: is a branch of medicine that focuses on the diagnosis and treatment of medical conditions that are caused by problems with the bones, joints, and muscles. Osteopaths use a variety of techniques to treat their patients, including manual manipulation of the musculoskeletal system, therapeutic exercises, and lifestyle counseling.
There are many potential benefits to osteopathic care, as it can help to improve range of motion, flexibility, and circulation while also relieving pain. Specifically, the aim of osteopathy in a patient suffering from sciatica is to give more range of motion to the lower part of your back, your pelvis, and your hips. Being flexible in these areas is paramount to avoiding sciatic nerve impingement.
Osteopathic treatment will focus on reducing the tension in all of the sciatic nerve pathways: glutes, hamstrings, calves, and plantar fascia muscular tension in these muscles may trigger sciatic pain.
Osteopathy focuses on the individual as a whole so your osteopath will check every single part of your body that can negatively have an impact on your posture and put pressure on your sciatic nerve.
2. Massage: Deep Tissue Massage or Sports massage may be indicated for you as massage improves blood flow to muscle and joint tissues promoting body self-healing, and reducing muscle tension making it easy for the sciatic nerve to slide.
3. Exercises Rehab: stretching, and strengthening types of exercises are usually a fundamental part of any manual therapy as they are excellent to reach a good health condition and maintaining manual treatment outcomes.
Here’s a short list of the best exercises for sciatica.
Pelvic Tilt Exercise in a supine position
1. Muscles involved: Lumbar Erector Spinae, Transversus Abdominis, Pelvic Floor, Glutes (Gluteus Maximus, Minimus, Medius).
2. Joints involved: Pelvis, Lumbar Spine (Low Back), Hips.
3. Procedure: To do this, lie on your back with your knees bent and your feet flat on the floor. Make sure to lie on a smooth and not too hard surface. Slowly tilt your pelvis so that your lower back flattens against the floor. Hold this position for a few seconds, then return to the starting position. Make sure to use a correct breathing pattern during the exercise: Breath in as you relax your abdomen and your pelvis, and engage your abdominal muscles and your pelvis as you breathe out.
4. Precautions: Pay attention to engage your core. Do not force the movement or push beyond measure. If you feel pain stop doing the exercise.
5. Effects: improves the mobility and the stability of your pelvis and lumbar spine as well. Allows you to work on your lower back and pelvis without involving too much range of motion to not cause you pain.
Hamstrings Stretch Exercise in a supine position with a towel
1. Muscles involved: Hamstrings (Biceps Femoris, Semitendinosus, Semimembranosus).
2. Joints involved: Lumbar Spine (Low Back), Hips, Knees, Ankles.
3. Procedure: Another helpful exercise is the hamstring stretch. To do this, lie on your back with your knees bent and your feet flat on the floor. Place a towel around your right foot and slowly straighten your leg until you feel a gentle stretch in your hamstring. Hold this position for 30 seconds, then repeat with the left leg. According to your level of fitness, you may start with a little bending of the knee until you reach a powerful stretch with your leg straight.
4. Precautions: Do not force the movement or push beyond measure. If you feel pain stop doing the exercise.
5. Effects: Improves the flexibility of the hamstrings muscles and therefore the mobility of your pelvis, your hips, and your lower back.
Double Leg Lift
1. Muscles involved: Iliopsoas, Quadriceps (Rectus Femoris), Adductor muscles, Sartorius, Tensor Fasciae Latae, Pectineus, Core Muscles (Rectus Abdominis, Transversus Abdominis, Obliques).
2. Joints involved: Lumbar Spine (Low Back), Hips, Pelvis, Knees, Ankles.
3. Procedure: If you’re looking for more of a challenge, try the Pilates move known as the double leg lift. To do this, lie on your back with both legs extended straight up in the air. Slowly lower one leg toward the floor while keeping the other leg raised. Return to the starting position and repeat with the other leg.
4. Precautions: Do not force the movement or push beyond measure. If you feel pain stop doing the exercise. You must keep as much as possible your lower back attached to the floor and make sure to tilt back your pelvis (Pelvic Tilt Exercise) and engage your core muscles.
5. Effects: Improves Hamstrings flexibility, Hips, Pelvis, and Low back mobility. strengthening core muscles, and reducing pressure on the sciatic nerve.
Cat Camel Stretching in a 4 point kneeling position
1. Muscles involved: Upper and Mid Back, Lower Back Muscles (Thoracic Erector Spinae, Latissimus Dorsi, Rectus Abdomini, Trapezius, Supraspinatus, Lumbar Erector Spinae).
2. Joints involved: Lower Back, Hips, Mid Back, Upper Back, Shoulder blades, Neck.
3. Procedure: lay down in a 4 point kneeling position as shown in the video. Round your upper back up, and exhale during this phase of the movement. Go back to the neutral position and slightly arch your back, inhale during this phase of the movement.
4. Precautions: Pay attention to not arch too much your lower back as you may injure your spine, do not force the movement beyond measure. If you feel pain stop doing the exercise.
5. Effects: encourages a good posture, and improves spinal flexibility and mobility.
Sciatic Nerve Gliding in a seated position
1. Muscles involved: Hamstrings (Biceps Femoris, Semitendinosus, Semimembranosus), Glutes (Gluteus Medius, Maximus, and Minimus), Lumbar Erector Spinae, Calves ( Soleus, Gastrocnemius), Tibialis Anterior.
2. Joints involved: Neck, Ankle, Hips, Knees, Pelvis, Low back.
3. Procedure: Sit on a chair, do not slouch with your back. Straight one of your legs. Bend your ankle forward in front of you, and at the same time bend your neck as you want to move your chin to your chest. Keep your leg straight and go back to a neutral position with your neck and ankle. Now extend your ankle towards you and at the same time arch your neck backward. Go back to a neutral position. Relax with your leg. Rest a few seconds and repeat.
4. Precautions: Do not force the movements or push beyond measure. If you feel pain stop doing the exercise. Make sure to find a comfortable chair with enough space to sit and stretch your leg. It is not shown in the video but a chair with back support would be the best solution to practice this exercise otherwise make sure to keep your spine aligned. Do not arch your neck too much.
5. Effects: Release Sciatic nerve from pressure, improves Sciatic nerve sliding.
Based on the area of pain you should perform the above exercise routine at least twice a week.
Stretching exercises: Hold the position for at least 5 seconds, and repeat 5 times on each side.
Strengthening exercises: Repeat 10 times in total. For each single repetitions try to hold the position for 5 seconds, this amount can increase after you become more confident with the movement.
Golden rule: If an exercise is hurting you or triggering your symptoms don’t do it.
If you have any doubts, questions, or need any help to relieve any pain. Call or Book an appointment with us.
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Curious Things And Tips About Sciatica
1. The width of the sciatic nerve is 0.8 to 2 cm.
2. Wearing high heels may irritate your sciatic nerve as it is causing a hip flexion and therefore a stretching in your hamstrings where the sciatic nerve slide through.
3. Put your wallet or other items in your back pocket; If you put any object in your back pocket and you sit on them you will compress your piriformis muscle. The sciatic nerve runs underneath this muscle because of that an irritation of the piriformis may irritate the sciatic nerve.
1. Anon, Sciatica – statpearls – NCBI bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507908/ [Accessed May 15, 2022].
2. Fritz, J.M. et al., 2021. Physical therapy referral from primary care for acute back pain with sciatica. Annals of Internal Medicine, 174(1), pp.8–17.
3. Lewis, D.D. & Summers, G.K., 2017. Osteopathic manipulative treatment for the management of adjacent segment pathology. Journal of Osteopathic Medicine, 117(12), pp.782–785.
4. Natsis, K. et al., 2013. Anatomical variations between the sciatic nerve and the piriformis muscle: A contribution to surgical anatomy in piriformis syndrome. Surgical and Radiologic Anatomy, 36(3), pp.273–280.
5. Ostelo, R.W.J.G., 2020. Physiotherapy management of sciatica. Journal of Physiotherapy, 66(2), pp.83–88.
Sciatica What You Should Know: Medical Disclaimer
Although the MiTo team is composed of healthcare practitioners, we are not your healthcare practitioners (yet XD). All the content on this website is for informational and educational purposes only and does not constitute medical advice. We always strive to provide an accurate and reliable source of information, but the information on this website does not substitute any professional advice and you should not rely solely on this blog content. Always seek medical-professional advice in the area of your particular needs or circumstances before making any decision concerning your health.
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