Do you really have Sciatica?
I’ve had many people walk into my clinic telling me “I have sciatica”, when actually, they probably don’t. There are numerous things that can cause buttock / leg pain, which may resemble something like sciatica, and they can be agonizing – nerve impingement or not. But the reality is that it’s pretty hard to compress a big old thing like the sciatic nerve.
What is sciatica?
Sciatica describes the symptoms of irritation or impingement of the sciatic nerve, causing shooting pain into the buttock and leg. There may or may not be back pain. The nerve itself travels out of the lower spine through the pelvis deep in the buttocks, through the leg and into the foot, and enables movement and the feeling of sensation in the leg. Nerves are part of the neuro-musculo-skeletal system, which comprises all that enables us to be upright and move around: nerves, muscles, tendons, joints, ligaments, fascia… all part of the same complete system working together, you cannot move without them all being involved.
Whatever structures are involved, if symptoms are on-going can you resolve the problem as opposed to just seeking short-term pain relief? In my experience with recurring or chronic problems, successful treatment often involves analysing and working with the whole body.
Sciatica, or not sciatica?
A clear symptom of sciatica is sharp shooting pain that travels below the knee, technically called ‘lancinating’ pain; it’s described as hot/sharp/electrical rather than diffuse/aching. Actual sciatic nerve impingement will cause altered sensation below the knee, either numbness (meaning you can’t feel a light scratch on the skin) or pins and needles (paraesthesia) – although, muscle trigger-points occasionally cause tingling too!
Numbness is the only symptom that can’t be confused with other issues such as muscular trigger points, which is why symptoms can be confusing!
Muscle issues are much more common than nerve problems, and can be as painful or more so. Burning, tingling, stabbing, shooting and heaviness can all be caused by trigger points or knots in muscles, and can easily be confused with nerve symptoms. They can also cause, or be a complication of, sciatica.
Hamstrings and piriformis syndrome
Specifically the hamstrings and piriformis muscles can cause symptoms easily confused with sciatica. The piriformis muscle is deep in in the buttock and can affect the sciatic nerve when it’s excessively tight but trigger points of this muscle can also radiate down the leg so it can be hard to tell the difference between a pinched nerve and a piriformis trigger point.
Intervertebral disc herniation
Lumbar/low back disc prolapse, also misleadingly called a slipped disc, can press on to the sciatic nerve roots as they exit the spine. However, the pain associated with this condition is potentially more likely to be caused by muscular dysfunction. Very often a disc bulge is asymptomatic and only causes symptoms when other factors are present. Even if it looks bad on an MRI scan, it’s often not the cause of symptoms (MRI scans can show disc bulges on people with no symptoms whatsoever!). It’s also good to know that resorption of an intervertebral disc is common; it un-slips in 60% of herniations – they just go away.
Sacro-iliac joint dysfunction
This is a really stable joint, which has very subtle movement. It’s where the sacrum (the lowest part of the spine) slots into the pelvis and it is also one of the structures that can cause radiating pain down the buttock and leg, and is therefore, another scenario that can be confused with sciatica.
Pain relief – a short-term solution
Pain management is important. Common forms include ice for inflammation and heat for muscle pain. Medication has become a go-to for pain control but this is problematic long term if there’s no alternative. Anti-inflammatory medication, muscle relaxants, steroid injections for inflammation, and even anti-depressants for chronic pain… these are all medications with side effects. And there is growing evidence that painkillers aren’t as effective as previously thought.
Taking medication is a passive way of dealing with symptoms, so what is the alternative?
Importantly, none of these options address underlying causes or maintaining factors, they don’t address the reason symptoms have occurred in the first place, or why they are not resolving, whether true sciatica or similar indicators caused by other structures.
Another form of pain relief can come from movement. Or, specifically, movement strategies. This approach can be used as you would a painkiller, to provide immediate pain relief, but with the additional goal of changing movement patterns to help symptoms resolve in the long term.
Address potential cause(s) and contributing factors for longer-term results
Sciatica (or symptoms like sciatica) doesn’t just happen, there’s a reason for it, especially if it’s chronic.
Whether nerve or muscle problem, any painful joint-soft-tissue-muscle-nerve issue may also depend on other variable factors. Looking at what the whole body is doing and also looking at behaviour, to put the problem in context can be powerful.
Pain is a message. It’s the body’s way of letting you know that something needs to change. And what’s causing the problem may be further away from the symptomatic area. Keep in mind that body movement is a team effort, feet feed the knees, which feed the hips, which feed the low back and so on… and vice versa. And the brain is a big part of this picture too. It’s an integrated and reciprocal system, which is often incredibly effective in sorting out and adjusting to issues. But it can only deal with so much.
For example, bio-mechanically, if you are sedentary or sit for long periods, you are potentially adjusting how your body can deal with stress and strain.
Our bodies are dynamic, and made to move. If this movement chain has a link that is unable to do its job well, due to injury or chronically altered posture, or lack of good functional movement, the whole chain has to adjust to its new limited movement opportunities.
The good news is that very often it’s possible change how the body has adjusted to historic or new issues. If you understand the cause of your sciatica and why your body’s movement patterns have adjusted you are more likely to be able to do something about it, and achieve long-term relief.
Don’t necessarily buy into the assumption that this is just the way your body is, that you have a “weakness”, or that you will be injured or prone to symptoms forever. In most cases there is great scope for improvement, even if it’s a long-term problem or keeps recurring. And treatment should put you back in the driving seat in terms of understanding how to effectively deal with your body health.
Even if you have pain, there will be other ways of moving that are pain free, so investigate and utilise this. Movement creates more movement. If joints are under-used, the surrounding muscle function will be stifled, and very often by utilising pain-FREE movement, the pain-FUL movement improves and pain becomes less. Investigate pain-free stretches that address hip flexion-extension to lengthen/shorten hamstring and quadriceps muscles, gluteal stretching, body extension and side bending. Visit my youtube channel for some ideas.
Weight bearing, whole-body exercise, done consistently on a regular basis, is essential to getting the whole neuro-musculo-skeletal system back on track. Walking, running, swimming, cycling… find something you enjoy that involves your whole body. It doesn’t have to look like ‘excercise’, it could be dancing or gardening. If you have pain during activity, try stretching before, during and/or after. If you are still struggling seek help and advice, get in touch with any questions using the form at the bottom of this page.
Avoid habitual sitting for long periods on a daily basis
Whether you have sciatica or not, this causes chronic lack of functional movement; large parts of the body are effectively switched off, importantly the movement-power-house muscles around the pelvis (gluteals, hamstrings and quadriceps) essential for everything we do, from standing to walking and running. They are key in back and pelvic function. If these powerhouses aren’t given the opportunity to load and function because of prolonged sedentary positions, they are unable to stay strong and supple. Tailored movement strategies can be quick and simple and be very effective in counteracting the effects of sitting.
Eat well, Sleep well, Address stress, Move regularly
CTH Healthcare is all about helping you get better, quicker, so that you can overcome pain and be independent of ongoing treatment. If you have any questions on this article or would like to find out how treatment might be able to help you get in touch using the form below.