What A Pain In The A$$: The Truth About Sciatica

In my experience, sciatica may just be the most misunderstood condition I have encountered. To understand sciatica, we need a quick dive into anatomy first. The term “sciatica” refers to pain along the path of the sciatic nerve. The sciatic nerve is a critical nerve that starts in your glute and goes down the backside of your thigh until it gets to your knee, where it splits and changes names. So “sciatica” is pain that starts in your glute and travels down the back of your leg. Sciatica often gets confused with low back pain with radicular symptoms. This pain is located in the low back and radiates down into the calf or foot. At this point, you may be thinking, why is this a big deal? It sounds close enough; does it even matter?

This distinction matters; because it can significantly alter what a provider will do for treatment. Most people mistake their radiating low back pain for sciatica. Sciatica is a hip problem; radiating low back pain is a spinal problem. Treatment for sciatica will first focus on decreasing pain and sensitivity of the sciatic nerve and piriformis muscle. Re-establishing mobility (especially rotation and extension) of the hip, increasing the lateral stability of the hip, and lastly, increasing the strength of the hip flexors and extensors come afterward. Treatment for radiating low back pain will differ. The first step will be to decrease the pain and sensitivity of the affected nerve root. Once that is accomplished, the patient must then be able to stabilize the low first, and then we can work on increasing the mobility of the spine. The last step will be to address movement patterns, most importantly hinging and squatting. Now, this is an article about sciatica, so if what was described sounds like something you are dealing with, let us talk about what to do about it.

The first treatment step with sciatica is to decrease pain and sensitivity. You will need a chiropractor or another manual therapist to do some of these. The hip joint can be adjusted, which relieves tension and increases motion in the hip capsule and the supporting musculature. Myofascial decompression, or cupping, is placed on the affected glute while lengthening the tissues to decrease the sensitivity of the sciatic nerve. Myofascial release methods further reduce tension and sensitivity and improve mobility. One of my favorite self-care myofascial release methods uses a lacrosse ball. Sit with the affected glute on the lacrosse ball, then cross that leg over the other. Roll around on the ball for about 30 seconds. The relief will be noticeable.

Once pain and sensitivity are more tolerable, re-establishing mobility and stability of the hip need to come next. Rotation of the hip is typically the most restricted motion. My favorite hip rotation drills are the hip shift and the seated figure 4 stretch. The lateral stability of the hip needs to get addressed as well. Lateral stability prevents your body from falling over when you stand on one leg, like walking and running. Single leg exercises such and Romanian deadlifts on one leg and single leg glute bridges are excellent.

By going through the steps outlined above, you will see significant improvement in your sciatica symptoms. Sciatica treatment often falters right from the get-go. You need to know what you are treating to have effective treatment. Radiating low back pain is not the same as sciatica. If you or someone you know has been dealing with sciatica that isn’t going away, reassessing your symptoms is a great place to start. If you do have sciatica and not something else, follow the steps outlined above or seek help so you can start moving and feeling better.

Dr. Michael Powell

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