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What is Sciatica?

Sciatica is one of the most common things we see in practice and probably one of the most misunderstood condition. This blog will help clear the air.

January 22, 2020
Dr. Donald Mull, DC

What is Sciatica?

Sciatica

Sciatica is a symptom that causes radiating pain and is a result of injury to the sciatic nerve. This injury causes a painful response of the sciatic nerve that often times originates from the lumbar spine (lower back area) and radiates into the buttock, thigh, calf and sometimes down into the foot. 

You probably hear the phrase “Sciatica” being thrown around all of the time and immediately picture a middle aged to older individual hunched over writhing in pain. However, it is important to know this may not always be the case.

Sciatica causes different levels of disability depending on how irritated this sciatic nerve is. It can range from sciatica less intense symptoms in the hip or buttock region to excruciating pain that radiates all the way down into the foot.

What Triggers Sciatica?

Many of our patients ask us “What can make sciatica worse” or “What causes sciatic buttock pain?”. 

Sciatica is triggered whenever the sciatic nerve is chemically inflamed or loses blood flow. The loss of blood flow to the sciatic nerve occurs most often from one of two things; stretching or compression of the sciatic nerve. 

  • Stretching the hamstring (especially by bending forward at the low back) 
  • Bending forward for many reps (i.e. gardening or moving boxes)
  • Bending forward for long periods (i.e. tile work, putting together Ikea furniture)
  • Sitting for a long time
  • Inability to coordinate core musculature
  • Stress
  • Lack of Sleep
  • Introduction to new activities or exercises
  • Increase in exercise beyond the normal capacity

Sciatica Causes

Sciatica is caused by the disruption of blood flow to the sciatic nerve or presence of inflammation surrounding the nerve. This is often caused by the interaction of the surrounding tissues of the sciatic nerve. This is what a lot of people refer to as a “pinched nerve”.

Pinched Nerve

This is a broader term to describe a cause of sciatica being surrounding tissues physically crowding the sciatic nerve. This could be in reference to a number of different tissues as you will see below. 

Disc herniation, Slipped Disc, Bulged Disc 

When a disc herniates it is a result small fissures or cracks in the outer portion of the disc (the cushion between each back bone). These small cracks allow the softer inner portion of the disc to migrate backwards causing a herniation that pushes out toward where nerves exit the lumbar spine.

These nerves that exit the lumbar spine come together to make the sciatic nerve that is about the size of your index and middle finger put together! The pressure of the bulging disc onto these nerves causes compression at the low back nerves and can increase sciatica symptoms with certain spinal movements.


Lumbar Stenosis 

Stenosis is a narrowing of the hole where the nerves of the lumbar spine exit out of the spine to come together and make the sciatic nerve. This is often due to bone spurs and bone growths which cause the hole to become smaller. Similar to a herniated or bulging disc, this can cause compression and increase sciatica symptoms with certain spinal movements. 


Piriformis syndrome

The piriformis is a muscle of the hip so when it contracts it helps stabilize and move your thigh. The sciatic nerve travels directly next to this muscle, and in a small percent of people the sciatic nerve actually travels through the middle of the muscle!

The piriformis muscle can cause an increase in sciatica due to muscle spasms, especially if the sciatic nerve travels through the muscle belly. This syndrome has been less researched but because treatment involves relatively no harmful risks, it is often treated in conjunction with stenosis or disc injuries.

Inflammation

Inflammation that causes sciatic pain and can be driven by two categories: mechanical or Chemical. Mechanical driven inflammation is caused by something physical, like compression or stretching. Chemical driven inflammation is caused more so by systemic issues like stress, sleep or co-morbidities like obesity, diabetes, de-conditioned tissues under too much load at once, etc. 

In regards to mechanical vs. chemical causes, there is not one without the other. The mechanical and chemical almost always exists together. The importance lies in knowing which of the two is driving MOST of the sciatic symptoms. This better directs the course of care.

Chemical drivers need the help of chemical solutions (like a Medical Doctor's prescription for a strong enough anti-inflammatory like an oral steroid for example). Mechanical drivers respond really well to rehab, manual therapy and chiropractic care.

Sciatica Treatment

Here at Kinetic Impact we provide you with an individualized treatment for what is causing your sciatica symptoms. This includes an assortment of body work (massage), joint mobilization, biomechanics advice, and/or exercises that are based on the specific cause of your sciatica. 

Some common treatments for sciatica include:

  • Mckenzie Method/Mechanical Diagnosis and Therapy to treat herniated discs/slipped discs and or lumbar stenosis.
  • Nerve Flossing to mobilize and increase blood flow of the irritated sciatic nerve.
  • “Opener Exercises/Stretches” to increase the space around the sciatic nerve origin to increase blood flow.
  • Cupping techniques to decrease pain that may help with the mobilization of skin layers and small nerves within the skin. 
  • Fascial Manipulation/body work to decrease pain, decrease muscle tone and increase range of motion.
  • Joint mobilization (including adjustments) to decrease pain, decrease muscle tone and increase range of motion.
  • Core exercises to stabilize the torso and move stress from the low back into the hips and upper back (just until it calms down). 

When you see us at Kinetic Impact we will always be open and honest on how and if we can help you with your sciatic pain. If your sciatica symptoms are being caused mostly by a chemical driver, then we will make sure to tag team with a Medical Doctor we absolutely trust to first get some pain knocked down to get you to a place where we can help.

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