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The term sciatica is often confused and used to describe various types of low back, buttock, and leg pain. However, true sciatica occurs only when there is irritation of the sciatic nerve. There are many nerve roots along the lower spine that can become compressed, causing “sciatic” symptoms including low back pain that travels into the buttocks and legs. Sciatica is not necessarily a condition, but rather a symptom of an underlying cause of irritation to the sciatic nerve itself – that may or may not result in low back pain. There are many different reasons the sciatic nerve may become irritated, which we will discuss in this article.
Let’s Talk About The Sciatic Nerve.
The sciatic nerve originates from nerve roots in the lower spine, specifically L4-S3, which can be seen in the image below. These nerve roots come together to form the actual sciatic nerve, which is the longest and thickest nerve in the body. You have two sciatic nerves, one on the right side of your body and the other on the left.
The sciatic nerve runs from nerve roots in the low back to the knee, where it branches into other nerves and continues on all the way to the toes. The sciatic nerve and its branches are responsible for controlling movement at the hamstrings, hip adductors, calf, lower leg, and some foot muscles. Branches of the sciatic nerve also provide sensation to the back and outside of the lower leg as well as the bottom of the foot. You can see how important it is for this nerve to function properly!
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What Can Cause Sciatic Pain?
Arthritic Changes, Degenerative Disc Disease, and Spinal Stenosis
Arthritic changes in the spine can result in pressure on the nerve roots that make up the sciatic nerve outlined in the above image. Additionally, between the bones that make up your spinal column called vertebrae, sits a disc of cartilage that acts as a shock absorber and provides space between each vertebra. Degeneration of these discs, along with arthritic changes such as bone spurs and other structural changes can result in a narrowing of areas of the spine where the nerves run through, causing pinching of the nerve and irritation.
Disc Herniation
Sometimes for various reasons, the disc between the vertebrae protrudes or herniates out of its typical space, placing pressure on nearby nerve roots. This pressure on the nerve roots can result in sciatic pain, particularly if the herniation occurs at the spinal levels where the sciatic nerve originates (L4-S3). The following populations are more at risk for disc herniations:
• Those with sedentary lifestyles who engage in prolonged sitting
• Those with physically demanding jobs that require heavy lifting or repetitive flexion and twisting movements
• Males
• Individuals between the ages of 35-50
Piriformis Syndrome
The piriformis is a buttocks muscle that rotates the hip externally and can become tight or spasmed. Due to where the sciatic nerve travels, if there is tension in this muscle it can cause pressure on the nerve, resulting in sciatica symptoms. This particular condition does not originate in the spine but does irritate the sciatic nerve.
Pregnancy
During pregnancy, various hormones result in increased ligament laxity – essentially the ligaments become looser. Since ligaments serve to stabilize joints, an increase in movement in the lower spine and pelvic regions can result in pressure or irritation of the sciatic nerve. This is typically addressed with postural correction and exercise. For increased stability of the pelvis and low back, some women opt for a sacroiliac stability belt.
Symptoms of Sciatica
Sciatic pain can result in symptoms anywhere along the path of the sciatic nerve, that as we learned above runs from the low back down to the lower leg and foot. It’s important to note that symptoms can be present in the hip, buttocks, or leg with or without low back pain due to the many spots along the nerve that are prone to pinching or irritation. Some hallmark symptoms of true sciatica include:
• Burning, stabbing, aching, or a sensation of sharp, shock-like pain
• Pain that is worse in the leg than the lower back
• Constant or intermittent pain
• Pain exacerbated by coughing or sneezing
• Symptoms that are aggravated by prolonged sitting
• Numbness or tingling into the leg
• A feeling of leg weakness
• Typically only one side or leg is affected
How You Can Treat Sciatica
Engage in Physical Therapy
Physical therapists are trained in performing a comprehensive physical evaluation to determine the cause of your sciatica symptoms. It is important to have a true understanding of where the pain is originating from to implement effective treatment that targets the underlying issue for lasting results.
Treatment of sciatica typically includes patient education, postural correction, proper lifting mechanics, strengthening of the core, hip, and gluteal muscles, and stretching of tight muscles in the lower back, buttocks, and legs. Check out our article, 5 Exercises for Low Back Pain and Sciatica, for a peek at what exercises your physical therapist might prescribe for you!
Be Proactive
Practice proper posture and an active lifestyle. Avoid prolonged sitting, take daily walks, and keep up with your exercise regimen. It’s important to partake in these activities even if you do not have pain at the moment. Having healthy, strong, and flexible muscles is the best way to prevent injuries, including sciatic pain.
Lower back, buttock, or hip pain got you feeling down? Connect with one of our licensed physical therapists by downloading the OneStep Digital Physical Therapy app to get started with a personalized exercise program designed just for you.
References:
Sciatica. Mayo Clinic. Updated August 2020. Accessed March 14, 2022.
Sciatica. Cleveland Clinic. Updated March 2020. Accessed March 14, 2022.
