"Sciatica is a symptom; not a diagnosis." Understanding the different types of sciatic pain may give you a better understanding of the causes and treatments available. The single commonality of all sciatic pain is that it is nerve pain and can present pain as radiating, shooting, sharp, tingling, or numb.
"Sciatic pain involves an irritating mechanical force on a nerve, usually somewhere along the neurons (nerve cells) that make up the sciatic nerve (usually because irritation of the other nerves can sometimes radiate to the sciatic nerve distribution area as well)."
- Til Luchau, Advanced Myofascial Techniques: Shoulder, Pelvis, Leg and Foot
The sciatic nerve primarily supplies sensation and strength to the muscles and reflexes of the lower leg, including the calf, ankle, and the back portion of the knee. It connects the spinal cord with the outside of the thigh, the hamstring muscles in the back of the thighs, and muscles in the lower leg, ankle, and feet. When the sciatic nerve is impaired, it can lead to muscle weakness and/or numbness or tingling in the leg, ankle, foot, and/or toes.
Excerpt from Til Luchau's Advanced Myofascial Techniques: Shoulder, Pelvis, Leg and Foot
Axial- arises from compression on the nerve roots at the intervertebral foramina of nerves L1-S3; involves narrowing of the foramina (the openings between the vertebra where the peripheral nerves exit the spinal canal)
Narrowing of the foramina can be caused by:
- Postural or positional issues
- Bone-to-bone or disc-to-bone compression
- Articular disc degeneration, herniation, or bulging into the foramina space
- Stenosis (bony deposits in the foramen or spinal canal)
- Infections, tumors, cancer or trauma at the nerve roots (or elsewhere along the nerve)
- Pain in the low back along with buttock and thigh pain, usually without pain below the knee
- "Sciatic Scoliosis": a reluctance to put weight on the affected side in order to minimize pain
- May be accompanied by appendicular sciatica
Appendicular- pain from nerve entrapment distal to the nerve roots
- Typically related to the soft tissues, which often respond well to direct manual therapy
- Characterized by increased pain from sitting, walking up stairs or inclines, or with resisted active external rotation of the femur
With more than 3 million US cases per year, disc herniation occurs when the soft center of a spinal disc pushes through a crack in the tougher exterior casing. Spinal discs serve as shock absorbers in the spine, and when the disk material 'leaks out' or herniates, it irritates or pinches the adjacent nerve root and causes sciatic symptoms. "Lumbar herniated discs are a widespread medical problem, most often affecting people age 35 to 50."
"About 90% of people who experience a lumbar herniated disc will have no symptoms six weeks later, even if they have had no medical treatment." It is also common for people to have a disc herniation and not have any associated pain or symptoms at all. This can go on for years. "A lumbar herniated disc may also be described in reference to its main symptoms, such as sciatica, which is caused by the leaked disc material affecting the large sciatic nerve." Pain, tingling and numbness are sciatic symptoms that may radiate down the posterior leg along the path of the sciatic nerve, down the back of the leg and into the foot and toes.
Piriformis syndrome is also a common cause of sciatic pain, where the sciatic nerve is compressed by the piriformis muscle. There are a number of reasons why this can happen. If it's resulting from a new trauma or injury, then the client should see their medical practitioner to see if it needs immediate treatment.
When the piriformis muscle becomes too tight, it puts pressure on the sciatic nerve giving the symptoms of sciatica. This is often a result of trigger points in the piriformis which cause the muscle to become tighter, shorter, and less efficient. Neuromuscular therapy and specific injury techniques would be an excellent treatment option during massage.
Symptoms are commonly exacerbated by prolonged sitting, walking, or running but may feel better after lying down on the back. Sleep difficulties may arise from the inability to find a comfortable position and relieve the sciatic pain.
Lumbar Spinal Stenosis
"There are more than 200,000 cases of spinal stenosis per year in the United States, making it a highly treatable condition with a wide variety of options for relief." Generally occurring in adults over 50, spinal stenosis is a condition in which the narrowing of the spinal canal occurs causing spinal nerve roots in the lower back to become compressed and place pressure onto the spinal cord, producing sciatic symptoms. This condition can also occur in the neck region, being termed Cervical Spinal Stenosis.
In other cases, some people may be born with a congenital form of spinal stenosis or it may develop over time as a result of normal wear and tear on the spine, arthritis, scoliosis, acute injury or accident, and herniating or bulging discs. Treatment options include anti-inflammatory medications, physical therapy, steroid injections, and specialized back braces which take pressure off of the spine. Surgical intervention could also be an option for extreme cases which would, in turn, create space inside the spinal canal.
Degenerative Disc Disease
Degenerative disc disease is one of the most common causes of low back pain. It refers to symptoms of back pain caused by wear-and-tear on a spinal disc. Although degenerative disc disease can cause radicular symptoms such as weakness, numbness, and shooting pain down the legs, "degenerative disc disease typically consists of a low-level chronic pain with intermittent episodes of more severe pain." The name degenerative disc disease may imply that symptoms worsen with age (degeneration) or that it is a disease, however it would be better represented as the process of the disc degenerating over time. "It is a condition in which natural, age-related wear-and-tear on a disc causes pain, instability, and other symptoms. This condition usually does not result in long-term disability, and most cases can be managed using non-surgical treatment methods."
Generally developing in adulthood, this condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra. Stress to the bone causes the fracture, and with "a combination of disc space collapse, the fracture and the vertebral body slipping forward, the nerve can get pinched and cause sciatica." Isthmic spondylolisthesis most commonly occurs at the L5-S1 level of the spine, the lowest level of the lumbar spine. There may be no symptoms, and "it has been estimated that 80% of people with a spondylolisthesis will never have symptoms, and if it does become symptomatic, only 15 to 20% will ever need surgical correction."
Sacroiliac Joint Dysfunction
Irritation of the sacroiliac joint at the bottom of the spine can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing pain and sciatic symptoms. The sacroiliac joint (SI joint) is formed by the connection of the sacrum and the right and left iliac bones. The primary function of the sacroiliac joints is to absorb shock between the upper body and the pelvis and legs. With little movement, SI joint dysfunction can be caused by too much movement, or hypermobility (which leads to instability and pain), or too little movement, or hypomobility (causes muscles tension, pain, and may inhibit mobility). Sacroliliac joint dysfunction most commonly occurs in middle-aged women or women who are pregnant or have recently given birth.
Irritation of the nerve from adjacent bone tumors, muscle tightness, pelvic fractures, internal bleeding, infections, and, for some women, pregnancy.
- Chiropractic Adjustments
- Massage Therapy- Neuromuscular & Trigger Point Therapy
- Physical Therapy
- Heat & Ice Packs
- Mild yoga stretches
- Herbs and Oils such as tumeric or St. John's Wort oil
- Pain medications, pain relievers and muscle relaxants
- Epidural steroid injections
Learn more about The Earthly Embrace Model & Benefits
- Tight lower back muscles can place stress on your nerve roots; massage therapy loosens these muscles and helps prevent pinching or irritation
- Releasing the piriformis muscle (involved with external rotation, abduction and partial extension of the hip) takes pressure off of the sciatic nerve and may improve sciatic symptoms while relaxing the other gluteal muscles and reducing muscle spasms
- A massage encourages the release of pain-fighting endorphins—this can provide temporary relief from symptoms like the throbbing pain in your foot or the burning sensation in your leg
Myofascial Release- Long, firm stretching strokes are employed without the use of oils to release fascial restrictions in the soft tissue caused by trauma and injury, poor posture, or inflammation; fascia is defined as a band or sheet of connective tissue that attaches, stabilizes, encloses, and separates muscles and other internal organs.
Far Infrared (FIR) Therapy- Far infrared waves are easily absorbed into our skin as deep as 3½ inches to treat muscle and joint pain; promotes metabolism and improved circulation and gives strength to the immune system by our bodies' absorption of 33 key minerals coated into the iron mineral plate of the TDP (“special electromagnetic spectrum”) Lamp.
Jin Shin Do® Bodymind Acupressure®- Gentle, yet deep finger pressure on specific acu-points and verbal Body Focusing techniques, to help release “armoring” or chronic tension, balance the “Qi” or energy, and improve vitality; a unique synthesis of traditional Japanese acupressure technique, classic Chinese acupuncture and acupressure theory, Taoist philosophy, Qigong (breathing and exercise techniques), Reichian segmental theory and principles of Ericksonian psychotherapy.
- Tennis balls or lacrosse balls
- Kong® dog toy- works great!
- Foam roller for the lateral hip
Luchau, Til. Advanced Myofascial Techniques: Shoulder, Pelvis, Leg and Foot (Volume 1). Scotland: Handspring Publishing Limited, 2015. Print.
Hochschuler, Stephen H., MD. "Sciatica Causes." Spine-health.
Retrieved from www.spine-health.com/conditions/sciatica/sciatica-causes
Härtl, Roger, MD. (2016, July 6). Lumbar Herniated Disc: What You Should Know. Retrieved from www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc
“What is Spinal Stenosis?” Minimally Invasive Spine Care.
Retrieved from spinecare.luminhealth.com/conditions/spinal-stenosis/
McHugh, Brian J., MD. (2017, December 13). What Is Degenerative Disc Disease? Retrieved from www.spine-health.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease
Ullrich,Peter F. Jr., MD, Orthopedic Surgeon. (2011, February 22). Isthmic Spondylolisthesis. Retrieved from www.spine-health.com/conditions/spondylolisthesis/isthmic-spondylolisthesis
Yeomans, Steven G., DC. (2017, February 7). Sacroiliac Joint Dysfunction (SI Joint Pain). Retrieved from www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain
"Sciatic Nerve Pain Stretches & Exercises - Ask Doctor Jo." YouTube, uploaded by AskDoctorJo, 21 June 2012, youtu.be/8oPHrX_oALk
Photo credit: Internet Archive Book Images on Visual hunt
Photo credit: Internet Archive Book Images on Visualhunt.com
Photo by Toa Heftiba on Unsplash
Photo credit: Internet Archive Book Images on Visualhunt