Sciatica and the sciatic nerve are one of the most common and often misunderstood things I see in clinic. The following post should help clear up a few questions!

What is Sciatica?

Sciatica is when the sciatic nerve (the biggest nerve in the human body) becomes irritated. This can happen in one of two ways; through direct compression of the nerve itself or more commonly through chemical irritation from surrounding structures. It’s actually a misconception that with sciatica and other trapped nerve type conditions that the nerves are actually getting squashed when actually it’s inflammation of nearby structures that causes chemical irritation in the surrounding areas that happen to irritate nerves as they’re passing through.

Anatomy of the Sciatic Nerve

The sciatic nerve is made of different branches (L4-S2) that exit the spine in the lower back and then converge together, traveling down past the hip and into the leg all the way to the toes.

Symptoms of Sciatica

When the sciatic nerve is irritated the typical presentation is pain down the length of the leg. However because it is a nerve this can also present as paresthesia which is often called ‘Pins and Needles’,  or anaesthesia which is numbness. You can also get weakness into the leg too or something else that’s called dysesthesia which is like an altered sensation and hard to describe

Sciatica Causes

The most common structures that can cause sciatica are from a disc prolapse. The intervertebral discs a little squidgy bits that sit in between the vertebra. The fluid inside the disc can push up against the outside and cause a bulging effect i.e. disc bulge. Alternatively if it was to bulge too far, that ruptures and the fluid escapes into the surrounding tissues i.e. disc prolapse. This kick-starts a massive inflammatory process and really aggravates the surrounding nerves that exit the spine, such as the ones that go on to form the sciatic nerve.

The other most common cause is from a muscle called your piriformis that’s in your hip. The sciatic nerve runs very close to this muscle and in some circumstances travels straight through it. If the piriformis gets irritated then almost certainly the sciatic nerve is going to be involved to some extent.

Do I Have Sciatica?

Sciatica is typically made worse by lying on your back and then lifting you’re symptomatic leg straight. This movement puts mechanical tension through the sciatic nerve so if it’s irritated this movement will aggravate it. In a similar fashion if you’re sitting down and you drop your chin down to your chest and slouch forward and then straighten your leg on the symptomatic side at the knee, this will also put pressure through that sciatic nerve. So if you’re feeling discomfort in your back or down into the leg that’s an indication the sciatic nerve is getting involved.

Treatment

So if you haven’t gathered by now sciatica is just the symptom of a bigger problem. It’s exactly the same as how having a runny nose is a symptom of having a cold. This is an important distinction to make because when you’re treating a cold you don’t treat the runny nose you treat the cold itself. This is the same as with sciatica; you don’t treat the sciatica but treat the problem causing it.

So what do you do if you think you have sciatica? Well the good news is mostly sciatica will get better on its own after about six weeks. However if you are six weeks in and it’s showing no signs of progress or getting worse, then you absolutely need to talk some professional.  However pain is pain so even if it hasn’t been six weeks, if you or someone you know is struggling with sciatic type symptoms, please don’t hesitate to contact me by clicking here.

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