Sciatica is a painful experience caused by the compression or irritation of the sciatic nerve. There are a range of possible situations and conditions that can cause sciatica.
The symptoms of sciatica can vary based on the specific cause of the condition.
Some people may experience mild discomfort, others may have severe pain and stiffness, making movement difficult.
Sciatica is characterised by a distinct, sometimes intense, shooting, aching or burning pain along the path of the sciatic nerve. There can also be stiffness in the leg, weakness, numbness and tingling in the lower back, buttock, leg or foot.
The sciatic nerve is a long thick nerve, and is the longest nerve in the body.
Five sciatic nerve roots emerge each side of the spine, at the lower two lumbar vertebrae, and the sacrum. These pass downwards and group together in the buttock area, forming one thick nerve each side. This nerve is like a flattened band about 5mm thick and 10-15 mm wide.
These two sciatic nerves run under each buttock, behind the hip joint, and down the back of each leg.
Each sciatic nerve divides into two at the back of the knee. These branches run down into the foot.
A healthy sciatic nerve is well protected by the buttock muscles. Sciatica is caused when the nerve is inflamed or impinged somehow.
The sciatic nerve can be impinged anywhere along its length. This could be in the lower back or anywhere along the nerve in the thigh or leg.
Sciatica symptoms are often felt in the areas around and below the location where the sciatic nerve is affected, though pain can also be referred along the nerve into the leg.
In many cases the nerve has become pinched.
In other cases the fascial (connective tissue) casing of the nerve may have formed an adhesion to the tissues around it. This means that when you move, the nerve is unable to slide freely as it is designed to do. Nerves like to slide and don’t respond well to being stretched.
Here are some common causes of sciatica:
Herniated disc: A herniated or ‘slipped’ disc occurs when a vertebral disk bulges and presses on one of the nearby sciatic nerve roots.
This is common, and a mild bulging of a disc may come and go. It can be addressed in Rolfing by improving everyday posture and movement patterns, optimising spinal alignment.
At an advanced stage, if the disc splits and the soft tissue inside leaks out, this is a serious situation and surgery is required.
Bone spur: Bone spurs that grow in the lower part of the spine can press on the sciatic nerve roots as they exit the spine. Your doctor may advise a treatment of pain medication, physical therapy, or in some cases, surgery depending on the size, shape and position of the bone spur.
Piriformis syndrome: The sciatic nerve usually passes under the piriformis muscle but in about 16% of the population the nerve passes through it. This can increase the chance of the nerve becoming compressed or irritated, particularly if the piriformis is under a lot of tension. Optimising your posture and movement patterns to release any tightness in the piriformis muscle and to reduce the chances of adhesions forming, can ease the situation, reducing the risk of pain occurring.
Pregnancy: Pressure on the sciatic nerve can occur during pregnancy due to the growing uterus or changes in posture.
Muscle strain: Pulled muscles around the lower back and pelvis can potentially lead to inflammation or compression of the sciatic nerve.
Seeking medical attention is crucial for a clear diagnosis, in case it is a severe situation where surgery is needed. Most of the time though surgery is not needed, but finding out about the likely main cause or trigger of your sciatic symptoms can help to find better ways to ease the condition.
Managing sciatica day to day is challenging. Sometimes the pain makes you want to be still and not move your body at all. Unfortunately this can make the situation worse, sending you into a downward spiral and a worsening of the situation.
Rolfing is a process of learning more about your body and its habitual patterns. It helps to turn a worsening situation into an 'upward spiral' towards healing. Gentle yoga can be useful in gradually introducing appropriate movement during your healing process.
Releasing tension patterns in the muscles and fascia improves overall posture, body awareness, and habitual movement patterns, addressing in different ways the contributing factors that may lead to sciatic pain, tingling or numbness, now or in the future.