Updated September 18th, 2022
Introduction
I can’t even begin to tell you how many patients and community members I have talked to that told me they have pain down one or both of their legs. This is often referred to as “my sciatic flared up” or “I have the sciatic”. Sciatica, or pain down the leg, is actually very common. 60% of people who report low back pain also have pain down one or both of their legs. Although the pain is in your leg, the most likely culprit is your back. I will explain this in more detail later. (1)
Most people who develop this debilitating issue just deal with it until it fades away for a while. The problem is that it keeps coming back year after year until it becomes a constant problem. Bending, reaching, twisting, and sitting in the car all become your worst enemy. Well I am here to tell you that this is a curable issue!! Before we move on though, I have to mention that if you have general back pain that DOES NOT radiate down your leg, read my Baby Got Back…Pain article.
Anatomy
I want to go through some quick anatomy with you because I think it is important to understand why you have pain going down your leg. Shown above is a picture of the spine, with discs and nerves included. The yellow nerves move away from the spinal cord and head down the arms, legs, head, and torso to communicate with specific muscles and other tissues.
As you can see, the space for them to divert away from the spinal cord is already very small. So imagine what would happen if one of the discs moved slightly back into that area or if a bone spur developed. Bone spurs and arthritis are very common in these areas as we age, especially if you don’t take care of our bodies. The discs in between each vertebra help to lubricate the back as it moves, while protecting the surrounding structures. So try to picture the back bending forward. The discs would move backward in response to the bones coming together in the front of the spine. And the opposite would occur if the back bent backwards. This is an automatic reaction. The only problem is that the average person bends forward over 5,000 times per day (cleaning, picking up a kid or object from the floor, looking at a phone, sitting slouched, etc.). This causes excessive time spent with the disc pushed back into that little area that the nerve comes out of.
A disc or bone spur can push onto that nerve, causing pain, numbness, tingling, or burning symptoms throughout the whole or part of the nerve distribution. Shown above is the bundle of nerves that come together to form the sciatic nerve and then its path down the leg. As you can see, sciatic nerve pain can be caused at multiple locations in the back.
Stop Pinching My Nerve
Although the back is the most common culprit for sciatic pain, one can also develop a pinched nerve in addition to, or instead of, back pain. Like I said, the sciatic nerve travels down the leg, weaving in and out of muscles and other tissues. So any muscle on the way down could also alter the sciatic nerves path. The muscle usually blamed for this is called the Piriformis. This tiny muscle runs from your femur to your sacrum (or in easier terms: it runs across your butt horizontally). The piriformis helps to rotate your hip outward and becomes very tight when someone has back or hip pain. The tighter this muscle becomes, the more it presses on the sciatic nerve that travels underneath it.
If you feel tightness in your hips or feel like this describes your condition, try the exercises below. These stretches are also great for someone with general back pain as well.
McKenzie Approach
As mentioned in my Baby Got Back…Pain article, I used the McKenzie Method to treat my back and sciatic nerve pain years ago. I also use this method with the majority of my patients with acute low back pain, as long as it works for them. This method involves a series of movements aimed at reducing AND preventing low back and sciatic nerve pain. The basics of this method are:
Finding the proper balance between back flexion (or bending forward) and extension (bending backward)
Tummy Time!! Yes, just like for infants, you also need time on your tummy. This position allows the back to completely relax for once. I usually have my patients start just with tummy time for about 5-10 minutes per day to get them used to lying on their stomach again. Usually someone who has more severe back pain will have difficulty staying on their stomach for more than that amount of time.
Progressing extension: if you can tolerate being on your stomach for a while and it is reducing your symptoms, then you can progress the amount you bend backward with the video below. If you still have pain just laying on your stomach, then this progression is not appropriate for you. (2)(3)
Let’s go back to our talk about the discs. Remember, as we bend our spine forward, the discs are compressed backward into that space where the nerves come out from the spinal cord. So if we can do the opposite of this more often throughout the day what would happen? We will bend backward, causing the discs to move forward instead of back into that little space.
Give the following video a try and see if this method works for you! Remember to start out slow and check your symptoms. One way to know this process is working is if your symptoms centralize. If you have pain going down your leg, then you try this method for a few days and it comes out of your leg and up to your back, this is a GOOD thing. We want the pain out of the leg because that means the nerve is becoming less aggravated. This will likely cause more back soreness right off the bat, but it won’t last long.
Exercises
It’s never really too early to start some core stability exercises to help support your back, as long as the movements aren’t painful. Check out the videos below for some of my starter core exercises, progressing from easiest to hardest in order. If you would like to learn more about the importance of core stability check out Shawn’s How To Strengthen And Stabilize Your Core article.
Conclusion
Thanks for joining me in this deep dive of the complex sciatic nerve. As you can see, there are a few different directions the treatment of back and sciatic pain can go. If you are still stuck and need more help, seeing a Physical Therapist in this situation can be very helpful!! Just make sure you find the right PT for you, someone who will watch the way you move and determine what exercises are the best for you.
References
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