Sciatica… just hearing the name evokes a sympathetic shudder. That deep pain in the buttocks that radiates like burning lightning down the leg to the knee (and sometimes into the calf). It’s a fairly common pain with people, and there are several causes, and and fortunately a number of treatments that can really help relieve, manage, or even eliminate sciatic pain. Let’s talk about it!
Sciatic Nerve from Gray's Anatomy
The sciatic nerve starts in the Lumbar and Sacral parts of the spine in the lowest part of the back. It travels laterally from the sacrum out into the posterior hip deep to the piriformis muscle. The sciatic supplies nearly the whole of the skin of the leg, the muscles of the back of the thigh, and those of the leg and foot. As you can see in the drawing to the left, the sciatic nerve travels out into the buttock and down the thigh to the knee, where it splits into the tibial and common peroneal nerves. I’ll write about them in another entry.
Anyway, the sciatic nerve is huge – about as thick as your thumb, and when it becomes impinged or pinched, the results can be quite arresting. Pain like a deep burning, throbbing ache deep in the buttocks, sometimes with paralyzing burning, electrical pain down the thigh. I’ve seen firsthand what a sciatic attack looks like when the leg become paralyzed, and it looks like one of the most intense pains to have to endure. It’s no wonder that so many people with sciatic pain often resort to powerful pain killers.
What causes Sciatica?
There are a number of possible causes of sciatic pain
Spinal disc herniation/compression
Let’s talk behavior first. Sitting on a wallet can eventually lead to entrapment of the sciatic nerve beneath the buttocks, pinching the nerve by the piriformis muscle. This is easily prevented by not carrying your wallet in your back pocket, and especially not sitting on it. Also, standing for long periods at a time or carrying a heavy tool or utility belt can also cause sciatic pain. Sometimes standing or wearing a belt will make the pain seem to come behind the knee, as the biceps femoris muscle become hypercontracted and traps the sciatic nerve in the thigh. These are the most preventable forms of sciatic pain, as they can be mitigated by behavioral changes.
So I’ll just say this to my male readers: STOP WEARING YOUR WALLET IN YOUR BACK POCKET! There, I feel better already.
Next up, Piriformis Syndrome. About 15 percent of the population has a sciatic nerve that runs through the piriformis muscle instead of beneath it. These people are more likely to get sciatic pain because the muscle surrounds the nerve instead of sits atop it. In these cases, release the tension in the piriformis muscle can be very helpful it managing the likelihood of sciatic pain. And for them, it’s even more important to not wear a wallet in the back pocket.
If we look at the drawing to the right, we can see the piriformis in relation to the other deep muscles in the buttock. Which the piriformis, which means pear-shaped in Latin, is the most important muscle relating to sciatic pain, the other lateral hip rotators – the deep six, as they are sometimes called, can also be implicated in sciatic pain. These small but mighty muscles can become very tight and make it difficult for the sciatic nerve to glide along its pathway during movement.
When a spinal disc is compressed or herniated, the material that makes up the disc can bulge out and compress on the root of the nerve, which can send pain shooting down the nerve. Twisting while bending and lifting is a common way to injure vertebral discs, so it’s critically important to be mindful of how we lift or otherwise use our backs. Also, losing weight if one is overweight will put less compressive force on the spinal discs and will help to relieve the potential for sciatic pain.
Trigger points, which you might think of as knots in the muscles, in the low back and deep hip muscles like the quadratus lumborum in the back, the piriformis or gluteus minimus muscles in the hips can cause sciatic nerve pain because of how they distort the surrounding tissues – the QL muscle attaches to the top of the hip, the lumbar vertebrae, and the floating rib, and when it’s tight, it can cause the vertebrae to be compressed to the side of that muscle, which in turn can cause impingement of the sciatic nerve. The piriformis or gluteus minimus muscles can also cause the nerve to compress, referring pain in the buttocks and down the leg.
In each of these situations, receiving deep, focused massage can help manage and even eliminate signs and symptoms of sciatic pain. When muscles are relaxed and at their full resting length, greater space is opened up for the sciatic nerve to reside and the nerve can be untrapped and unimpinged, which in turn will allow for any inflammation of the nerve or its sheath to be relieved.
You don’t have to be in pain!
I am very experienced in relieving sciatic pain, and have developed through my years of practicing massage a highly effective treatment protocol for clients. While each clients is unique, and all treatment sessions are tailored for your specific needs, knowing where to apply bodywork brings the best result for you, the client.
Wouldn’t you rather get on with your life instead of sitting on the sidelines, trapped by sciatica?