Sciatica is one of those topics that everyone thinks they understand but few actually do. It’s a very generic term, and extremely non-descript. I liken it to someone saying they have a headache. There are several different types, presentations and causes, and the only commonality amongst them all is that it is “an ache in or around your head.” Sciatica is essentially the same. The common point among all forms of sciatica is that it’s pain that travels down your leg from a higher area. I get a bit concerned that this definition sort of carries on into the medical community, outside of specialists. I don’t think it’s that the non-specialists don’t know the difference between the types, they just they either don’t treat it at all or end up treating most of it the same anyway and feel further explanation doesn’t really do any good. So here’s sciatica and its most common causes, and more importantly, how to avoid it.

The sciatic nerve is the body’s longest and thickest nerve, coming together right at the middle of your butt cheek and splits back into differently named nerves at the knee pit. The origins of the sciatic nerve are from five lumbar spinal nerves, L4, L5, S1, S2 and S3. They group up and form the lumbosacral plexus which then has it’s major branch being the sciatic nerve. Now, straight Latin origin, sciatica would be pain along the distribution of this nerve due to it’s specific injury or compression. Here’s where it gets tricky. Most “sciatica” is not because of specific injury or compression of the sciatic nerve. Rather, a majority of sciatica symptoms are caused by some level of biomechanical dysfunction or anatomical problem that disrupts the normal nerve signals along one or more of the involved nerve root’s distributions.. This biomechanical dysfunction is often a pelvic or lumbar spine situation, where the body knows that the range of motion is being somehow compromised, which then leads to spasm, inflammation and (you guessed it) sciatica symptoms. Why? Because one of the most common muscles to tighten up when the function is disrupted is the piriformis. It lays RIGHT OVER THE SCIATIC NERVE! This is sometimes called piriformis syndrome. Any time it is the actual nerve being affected, it is better termed radiulopathy, as it may not even involve the sciatic nerve past its formation, but for the sake of my typing hands (which are very important to me in my profession), we’re rolling with “sciatica.” It can also be related to a disc injury, whether a bulge or a herniation at the L4/L5 junction, L5/S1 junction. The discs below that don’t herniate, as they’re stuck in the tailbone (or have disappeared like in most adults. A disc can essentially pop like a jelly donut, leaving the jelly to smack against the nerve, again, leaving nerve root compression and thus creating symptoms down the leg. Symptoms may be weakness, spasm, pain, numbness or tingling. There could also be a nerve tumor or growth that can cause these symptoms, which usually requires surgery, but is far less common.

There can be joint pain that refers to the butt only or down the leg as well, usually from the sacroiliac or SI joint and sometimes from the hip joint, where your leg bone meets the pelvis. (Side note: Any time I say “sacroiliac,” I hear my Kentucky relatives with their accents complaining about their backs. “Bertha, call the choirpractor. My daggummed sacroiliac went out on me again!” Where did it actually go? I’ll go get it. And folks, it’s CHIROPRACTOR! Sorry, big digression.)

So that’s a quick lesson on the background. Now, how can you avoid sciatica? As I said, it’s usually some sort of joint dysfunction, so the key is maintaining function. Even most disc herniations that aren’t from MAJOR accidents are typically the result of a longer term dysfunction. I can’t say how many times I’ve heard, “I was just doing _____ and my back started hurting, and pain was running down my leg.” The reality is that there had most likely been a problem for some time, but it was being ignored, and the little micro-injury became the big injury. We, as a society, typically wait until the pain is so bad to get any care. Prevention isn’t the typical MO. I want to change that. Again, we can’t always control abnormal anatomy and strange growths like nerve tumors, but we can control function!

I want you to take a minute and stand on one leg. Now the other. Can you balance easier on one leg? Does your hip have to come up or do you have to lean hard to one side? My guess is yes. You have dysfunction. Whether it is asymmetrical muscle development or weakness, inappropriate joint range of motion, or just simple poor neurologic coordination, this will affect your function, and potentially accelerate degenerative changes. Every time you walk, you are asking your body to have one leg in control while the other is along for the ride, albeit in short bursts. Find out which side is weak or painful, and strengthen it appropriately and under guidance of a doctor or therapist. Get adjusted to improve range of motion and reset the abnormal neurologic firing mechanism that creates habits. Eat right, sleep and sit ergonomically, and stretch as needed. Ultimately, get it checked out by a specialist if this has been going on for greater than a few days at a time.

If you are interested in getting more information about some of the stretches or exercises you can do to further prevent sciatica, please sign up for my newsletter by sending an email to info@drcraigbanks.com or visit me at my office, Pinnacle Chiropractic. I promise I won’t blast you with frequent junk, just great info and I will give you access to more information than you can handle. Be patient with me, though, as it’s just getting underway!