Dealing with Sciatica

Sciatica is a term you’ve probably heard at some point. It may have been from your grandmother or lifting partner. If you haven’t experienced it yourself, it can sound scary but it doesn’t have to be. Basically, sciatica refers to pain along the sciatic nerve. The sciatic nerve is made up of the spinal nerves of L4 – S3. These nerves join together near the piriformis to form the sciatic nerve. It is the thickest and longest nerve in the body. It runs down the back of the leg giving off branches and dividing into smaller nerves. 

Everyone experiences sciatica different. Some may just feel irritation around the glutes and top of the thigh. Others may feel a tingling or burning sensation down to the knee or even all the way to the feet. Some of you may have experienced a combination of all three. 

There are a variety of causes for why you experienced this tingling, burning, numb or sharp shooting pain down your leg. All of them involve some type of irritation of the sciatic nerve. There could be general inflammation around the nerve root or where the nerve exits the low back. There could be a backup of venous blood flow around this area as well. You could be experience irritation of the disc, called discogenic pain or you could have a bulging or herniated disc. 

The piriformis muscle is often implicated as the culprit for sciatica. Given the close location of the piriformis and sciatic nerve, it seems like a good choice. It is thought that the piriformis gets tight or hypertrophies and compresses the sciatic nerve. There are anatomical anomalies where the nerve pierces through the muscle instead of traveling under it. Recent research has suggested that there is no relationship between these anomalies and sciatica. Additionally, the causes of piriformis syndrome are also up for debate according to the literature. 

When I see a patient with sciatica, my first thought is always the disc. It is irritated and is expressing as pain into the leg. If this is you, your first step should be having an exam by a qualified healthcare practitioner (Clinical Athlete or Rehab2Performance are good sources) to rule out red flags . If you are not given any homework to do, you need to find someone else. Additionally, your personal trainer or coach who is also not a clinician is not a good source of information for this condition. 

While the following and our videos do not replace an evaluation by a healthcare provider, there are some easy movements to try to relieve the pain. The first is the press-up. It’s basically a lazy pushup where the legs stay down and you keep your core relaxed. Any pain that travels down your leg should start to move back up towards the butt. If it doesn’t and travels further down the leg, stop. These aren’t for you. If these help, do sets of 10 regularly (like every hour). The next videos we posted were the static opener and nerve flossing. Check those out as well. 

Stretching is a common suggestion for sciatica. I do not recommend it. If the nerve is truly irritated, stretching will add to that even if it feels good in the moment. Stretching a nerve reduces its oxygen supply which they don’t like and can increase the sensation of pain. 

So you might want to know how to prevent this pain in the future. I get it. I had sciatic pain for 6 months straight then on and off for years. If you are a lifter, you want to dial in your form on squats and deadlifts to reduce any movement of the mid section during the lifts. Some great exercises are suitcase walks, side planks, dead bugs etc. Another factor to consider is your training load management. You want to make sure you aren’t making significant jumps in weight or frequency. A slower progression tends to work better in terms of reducing risk of injury. Along with this, you want to make sure you are managing fatigue and recovering well. This means sleep well and enough, eating well and enough, keep stress levels manageable etc. All of these factors helps to decrease the risk of injury and allow your body to perform its best. 

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