Seattle Health and Fitness Professionals: What is Sciatica?

Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve or by compression or irritation of the sciatic nerve itself.

Generally speaking it is pain in the lower back, glutes, leg and foot. The pain may be in one of those places or all of them and can be mild or very severe. Someone with Sciatica may also feel numbness, and may experience muscular weakness causing difficulty moving or controlling the leg. Typically the symptoms are on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

What are the causes of Sciatica?
The number one cause of Sciatica is a disc herniation – A condition where two vertebrae’s are compressed together forcing the jelly like cushioning to bulge out from in between the vertebrae’s. There are others causes though, such as:

Spinal Stenosis - A condition due to narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity.

Spondylolisthesis refers to the forward slip of a vertebra over the one beneath. There is different grades of this, which explains why some people don’t have pain with this condition.

Pregnancy - Weight gain, uterus growth, ligaments and joints relaxing due to hormonal changes, cause shift in the pelvis, which can in turn cause compression on the sciatic nerve.

Sacroiliac (SI) Joint Dysfunction – SI Joint becomes inflamed; the portion of the sciatic nerve running in front of the joint will become irritated.

Piriformis Syndrome - is a condition due to an over active Piriformis causing compression on the Sciatic nerve.

Daily Habits and Activity – Daily activities can cause overuse of the Piriformis muscle or place more stress on the joints, which can cause added compression or irritation to the sciatic nerve.

Can sciatica be cured?
There is no cure for sciatica. You can relieve the symptoms to the point you don’t have any more pain or discomfort though a series of stretching and exercises. However, these symptoms may come back depending on the cause of sciatica. The best thing to do is, once the symptoms are relieved continue with the stretching exercises prescribed by your doctor or physical therapist. This will help in future prevention of the symptoms of sciatica to come back.

What can I do to relieve the symptoms?
Depending on what is causing sciatica depends on the treatment. There are many different forms of treatment that your doctor will prescribe to you depending on the cause of sciatica. Below are different approaches that may help to relieve symptoms. In most cases many of these will help. Always ask your doctor before beginning any form of treatment though.

Below is a list of treatments and description of each, try the least evasive forms of treatment first.

Stretching Exercises – Though a series of stretches for the hips and back you may relieve the symptoms of sciatica. This will help to relax the over active muscles compressing on the sciatic nerve.

Physical Therapy – Will rehabilitate the herniated disc or the over active muscles as well as give you a program to follow to prevent recurrent flare-ups and compression on the sciatic nerve. This program will help you to strengthen the muscles supporting your back, stretch the over active muscles, and improve the posture, which can cause the compression on the nerve roots.

Massage Therapy – Massage therapy along with trigger point therapy is a great way to help alleviate the symptoms of sciatica by getting the muscles around the area to relax releasing the compression on the nerves.

If these forms of treatment do not relieve the sciatica symptoms, then trying these more aggressive forms of treatment.

Non-Surgical spinal decompression - this technique is great for those with herniated or bulging disc that are causing the sciatic symptoms. It gently separates the vertebrae from each other, creating a vacuum inside the discs that we are targeting. This moves the herniated or bulging disc into the inside of the disc, off the nerve root. Eliminating the symptoms of sciatica.

Medications – you may be prescribed anti-inflammatory medicine to reduce the inflammation of the muscles that are creating sciatica along with a muscle relaxer to allow the muscle to relax. If you have a lot of pain a pain killer (narcotic) may be used for short term relief. In some instances your doctor may inject a corticosteroid medication into the affected area to help relieve pain.

Surgery - in some severe cases, this is an option when the compression is causing excessive weakness, loss of bowel or bladder control, and when the pain is progressively getting worse, even following all other treatment options.

What are some Exercises and Stretches I can do at home?

Low Back Stretch – Start by lying on your back pulling one or both knees to your chest holding for 30 seconds

Lumbar Rotation – Lie on your back with both knees bent, hands and arms making a “T” shape, drop your knees to the side, keeping your feet flat on the ground the whole time. Hold for 30 seconds and repeat on the other side.

Kneeling Hip Flexor Stretch – Start by kneeling on the floor, place left foot in front creating a 90degree angle. Press hips forward while engaging the left glute to help the left hip flexor relax. Hold 30 seconds and repeat on the right side.

Piriformis Stretch – Lie on your back cross the left knee over the right, raising the knees and pulling across the midline of the body. Hold for 30 seconds and repeat on the other side.

Lat Stretch – Start by sitting on your heels. Keeping the hips on the heels, walk the hands out in front stretching though the back only as far as out as you can go while maintaining hips on heels. Hold for 30 seconds.

Marching - Start by lying on your back, placing your heels on the floor at a 90degree angle from your hips. Holding that angle as if in a cast, raise your knee up slightly past perpendicular to your hips maintaining that 90degree angle, lower and repeat 10-15 reps.

Clam Shells – Start by lying on your side in a fetal position, knees bent to almost 90degrees. Roll your hips forward so that the top hip and knee is slightly in front of your bottom hip and knee. With out rocking your hips backward and keeping your heels together, raise your top knee only as far up as you can with out changing the position of your hips.

Quadruped - Start out on your hands and knees by placing your hands directly below your shoulders and your knees directly below your hips. Raise your left leg straight back pushing your heel toward the wall, while raising your right arm straight out keeping it as close to the ear as possible. Hold this for 5 seconds, lower and repeat on the other side, 8-12 reps on each side.

Swimming – Start by lying on your stomach placing hands out in front of you. Raise your left leg and right arm, and lifting chest off the ground, keeping the neck in neutral position, hold for 3 seconds, lower and repeat on the other side, 8-12 reps on each side. REMEMBER do not jerk your body into position only as far as you can controllably raise your chest, arm, and leg.

Bridge – Start by lying on your back, knees bent at a 90degree angle, feet flat on the ground. Squeeze the glute muscles, keeping the abs engaged, lift the hips up off the ground. Hold for 5 seconds, lower and repeat for 10-15 reps.

Pelvic Tilts – Start by lying on your back, knees bent at a 90degree angle, feet flat on the ground. Place your hands on your hips and tilt hips forward, (think about taking your hip bones and moving them to touch your leg bones). It is important to remember to not use your back muscles to create an arch in your bag, but instead using your deep core muscles to move your hips. Then tilt your hips backward (think about taking your hip bones and moving them to touch your rib cage.) It is important again to remember to use your deep core muscles to move your hips rather then squeezing your glutes to move your hips.

For a more detailed view of the Sciatic Nerve see the below pictures.

Pathophysiology

Testimonial:
A couple of years ago I injured my back while training for a marathon. Initially I thought rest and ice would take care of it – it didn’t. I tried going to a chiropractor with no relief. Eventually, my doctor sent me to physical therapy where I received ultrasound treatments and was taught various stretching and strengthening exercises. The PT provided some relief, but I was still frustrated at my lack of progress as I had a nearly constant nagging pain, especially when I sat for long periods.

I spent a lot of time self-diagnosing. An article in a running magazine suggested that one common cause of lower back pain in runners was an injury to the piriformus muscle in the lower back and buttocks. It quite literally is described as a “pain in the butt.” I decided this must be it. At the end of 2009, I started working with Katrina Yniguez at SAC. I explained to her my desire to get back to running, and my belief that my piriformus was causing my back pain.

Katrina conducted an assessment of my biomechanics and immediately prescribed some corrective exercises for my leg and back muscles. She also started me foam-rolling (deep tissue massage) my piriformus muscle and other muscle groups. At first I thought she was crazy as the exercises she had me doing were very easy and seemingly unrelated to my back. Katrina explained, however, that strengthening these muscle groups would improve my biomechanics and ultimately reduce the risk for future injury. I persisted.

Eventually, Katrina stopped being crazy and started being just plain mean. Although always pleasant and upbeat, she had obviously decided at some point that the corrective exercises were not needed anymore, and it was time to start the hard stuff. Now, twice a week, she puts me through my paces with core-focused exercises that primarily work my back, legs and chest. I never look forward to the tough workouts, but I always am glad that I did them after they are through. The good news? My back pain is almost completely gone and, when it occasionally returns, I know exactly what to do to get rid of it. I’m now back to regular running, pain-free.

I appreciate Katrina’s ability to listen to what I thought was happening to my body and to design a program that would target the needed areas. It has been great working with her. She is great to work with an always has a positive attitude, and I’ve discovered she’s not really that mean (well, she kind of is).

Matthew D. Latimer

If you would like to begin developing a training program to assist with your specific situation, please contact Katrina Yniguez.

Written by Katrina Yniguez
Personal Fitness Trainer, Seattle Athletic Club Downtown