Sciatica Pain & Treatment
Sciatic pain is common in athletes, runners, and desk workers, as well as machinists and truck drivers.
Understanding what causes your sciatica is the first step to managing it.
Your sciatic nerve starts in your lower back, then travels down your leg and into your foot.
When there’s pressure on this nerve, it gets irritated and creates pain all along the nerve.
This pain is your sciatic pain!
Risk factors for sciatica include:
Prolonged Sitting
Jobs Requiring Lots of Driving, Heavy Lifting, & Twisting
Smoking
Excess Psychological/Mental Stress
Excess Body Weight
Poor General Health
Symptoms of sciatica include:
Pain radiating from the back into the buttock, back of the leg, and/or foot
Pain ranging from a mild, dull ache to a sharp, burning sensation
Numbness, tingling, and weakness in the leg
Heavy feeling in the leg
Feeling of tension or pulling in the leg and lower back
There are 3 major causes of sciatica.
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Piriformis Syndrome
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Lumbar Disc Disorders
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Pregnancy-Related Pain
Piriformis Syndrome
Your piriformis is a muscle deep in your buttock, underneath your glutes. Its primary action is to externally rotate your leg, or turn it outward. You use this muscle when you’re getting out of a car, when you’re crossing your legs, and while walking and running. The piriformis is also important for stabilizing your legs and pelvis.
Your sciatic nerve runs from your lower back through your buttock near the piriformis, and into your leg and foot. When the piriformis gets tight, it can put pressure on your sciatic nerve. Nerves get irritated when something puts pressure on it, so when the piriformis pinches your sciatic nerve, it creates pain that runs down your leg and into your back.
The overarching cause of piriformis syndrome is tightening or spasm of the muscle. This can be related to:
Prolonged sitting
Having weak gluteal and hip muscles
Overuse, underrecovery, and hypertrophy training in exercise
Long-distance running
General athletic activity and sports
Injury to the hip or glutes, especially sprains and strains
Trauma, such as car accidents or falls
The main risk factors for lumbar disc disorders include:
Work requiring prolonged sitting, like desk jobs or driving jobs
Strenuous work or heavy liting
Being female
Being between ages 30-50
Excess body weight/obesity
Sitting on hard surfaces or wallets
Physical inactivity and sedentary lifestyle
Symptoms of piriformis syndrome can come on gradually over time, they can appear suddenly, particularly after an injury or trauma. Symptoms can include:
Tenderness or a dull ache in the buttock, lower back, and/or SI joints
Numbness, tingling, or pain along the back of the leg
Difficulty sitting, & pain from sitting that grows worse as you continue to sit
Pain that gets worse with activity
Decreased range of motion in the hip, particularly turning your leg outward
Typical Sciatica symptoms, like heaviness or w
Piriformis syndrome and sciatic pain can be managed.
Deal with piriformis syndrome long-term requires identifying the root cause of the tightness and spasm in the muscle. This may be related to your daily routine, exercise regimen, joint mobility, and muscle imbalances.
Treatment for piriformis syndrome may include:
Chiropractic Adjusting - If your sacrum (the bone at the base of your spine) isn’t moving well, your piriformis may tighten up to help encourage or compensate for that lack of motion. Chiropractic adjusting will help the sacrum move freely again, relaxing the piriformis
Soft Tissue Mobilization - Assisted stretching techniques, manual therapy, and trigger point work can also help loosen up a tight and spasming piriformis. These techniques increase blood flow into the muscle to ensure adequate nutrition, while also calming the muscle down neurologically.
Corrective Exercise - Specific stretches and exercises are used to loosen the piriformis muscle, while also strengthening it and other hip and back muscles to prevent the issue from recurring.
Lifestyle Changes - Depending on your occupation and daily routine, certain changes may be necessary. These could include standing or walking more, setting up a better workstation for you, or simply not sitting on your wallet.
Lumbar Disc Disorders
Throughout your spine, you have vertebrae, the bones of your spine, and intervertebral discs, which are shock absorbers sandwiched between all the vertebrae. Muscles and ligaments attach to the vertebrae and the discs, providing additional structure and support for movement while protecting the spinal cord.
The discs are made up of a tough outer ring called the annulus fibrosus, and a soft, jelly-like inside called the nucleus pulposus. When you hear someone discuss a disc bulge or a disc herniation, they’re talking about these structures.
With a bulge, the inside of the disc starts to push into the outer ring, without pushing all the way through. A herniation occurs when that inner layer does push all the way through, entering the area around the spinal cord. When a herniation occurs, this can create pressure on the spinal cord or spinal nerves, creating low back or sciatic pain, numbness, weakness, or other symptoms in one or both legs.
As we age, our discs dehydrate and degenerate. This is a completely normal aspect of aging. Research shows that many people without pain or other symptoms show signs of spinal and disc degeneration on MRIs.
But, in some cases, this degeneration can create pain and other issues, like the disc bulges and herniations we described above.
The main risk factors for lumbar disc disorders include:
Age between 30 and 50
Obesity
Smoking
Sedentary Lifestyle
Poor Posture
Repetitive Spinal Motions and Activities
Excess Driving
Symptoms of lumbar disc disorders can show up suddenly or gradually after an injury, or the symptoms can worsen gradually over time without any specific cause or event.
Common causes of lumbar disc injuries include heavy lifting, twisting, straining, or repetitive spinal movements like pulling and bending.
Symptoms of a lumbar disc disorder can include sharp, shooting, stabbing, or electrical pain that is worse when straining, coughing, or sneezing. Weakness, numbness, or tingling in one or both legs is common as well. Standing or sitting for extended periods of time can also cause problems. Rest, especially laying down, will often relieve the pain.
A conservative approach is generally the best place to start when dealing with lumbar disc issues, though your specific treatment plan will be based on your clinical presentation and symptoms.
The major goal when addressing disc disorders is to reduce or centralize any radiating leg pain while decreasing inflammation. After the pain is reduced and we’re out of the woods, creating proper lumbar control and stability to avoid reinjury is essential.
Treatment plans can include directional preference exercises to relieve pain, stabilization exercises to promote proper movement and biomechanics, soft tissue mobilization, and gentle spinal adjusting to increase mobility while reducing pain. Lifestyle factors, including regular walking and proper lifting, are also key to managing your lumbar disc issue.
If you don’t respond well to conservative care, or if the symptoms of your disc issue are severe enough or worsen throughout treatment, a surgical consult may be necessary. A key factor to responding well to conservative care is sticking to the treatment, plan, including the lifestyle and exercise recommendations.
Pregnancy-Related Sciatica
Low back and sciatic pain are quite common during pregnancy, particularly in later trimesters as your body prepares for birth and the baby gets bigger and bigger.
Sciatic pain can occur during pregnancy for a variety of reasons. Sometimes, the baby may sit directly on or near the sciatic nerve, adding undue pressure that irritates the nerve.
Other times, the muscles in your back and hips can tighten up, as a result of carrying a heavy baby in your body and your joints getting looser to help with the birthing process. This can put direct pressure on the nerve, as with piriformis syndrome, or it can make it harder for the nerve to move well along its path.
Symptoms of pregnancy-related sciatic pain include:
Typical sciatic symptoms, causing pain down the leg
Pain may be constant or occasional
Pain may be dull and achy or sharp, stabbing, and burning
Numbness, tingling, or weakness in the leg or foot
Difficulty with walking, standing, and/or sitting
May or may not be associated with low back pain
Pregnancy-related sciatica pain doesn’t have to last until your due date.
There are a variety of options to manage your pain, including chiropractic care and massage.
These treatments may involve very gentle chiropractic adjusting to the hips, lower back, and sacrum to encourage movement, gentle soft tissue mobilization for tight and irritated muscles and ligaments, and light stretches and exercises to help manage the pain. Certain lifestyle changes may help as well, like side sleeping and warm showers.
As with any pregnancy-related issue, if you’re concerned about your pain or the pain is severe, please speak to your OB-GYN first to ensure you and the baby are doing okay.
At Northbound Chiropractic, we work with you to find the cause of your sciatica pain and create an individualized treatment plan targeting your specific problems.
We’ll make a plan with you to get lasting results, so you can continue doing the things you love.