The quick answer to what sciatica is a general term that describes pain referred down the buttocks and the back of the leg. The pain typically follows the path of the sciatic nerve, a large nerve that originates in the lower back, and runs down the back of the thigh, finally branching into smaller nerves to supply the leg.
The quick answer is Sciatica may result from several issues, but it is usually it comes from issues in the lumbar spine or lower back. Spinal nerves exit the spine through spaces called lateral foramen. These spinal nerves have small branches that provide innervation to the structures of the spine, such as the disk and facet joints. In the lumbar spine or lower back, some of these spinal nerves merge to form the sciatic nerve. Irritation or bulging of the disk or irritation of the facet joint may trigger a pain response in one of the small nerve branches of the spinal nerve. If this happens, the brain may interpret that irritation as coming from structures from which that nerve receives information. This may lead to the perception of pain in the buttock or leg, AKA sciatica. A more severe case may be when a disk becomes herniated to the point where it actually compresses the larger spinal nerve. A herniated disc may lead to more severe symptoms such as loss of strength or sensation in the area in which the pinched nerve travels.
The quick answer is that piriformis syndrome is a less common cause of Sciatica. The piriformis muscle lies under the gluteal muscles in the buttocks and functions to rotate the hip outward. The sciatic nerve runs very close anatomically to the piriformis muscle. If the piriformis is really tight or inflamed, it may cause sciatic nerve pain in the leg. Tightness or inflammation of the piriformis muscle can contribute to sciatic nerve issues.
Stretching is important for the body, but nerves typically do not respond well to stretching. Many people with sciatica have the urge to stretch the hamstrings due to feeling pain in the back of the thigh. This may actually be a Sciatic Nerve Stretch and increase pain due to pulling on an irritated nerve or lower back structures. Typically, gentle movements of irritated structures are best for decreasing pain.
Many people find relief with gentle basic exercises. The exercises should not increase symptoms and should be performed slowly. Some clinicians believe in Williams Flexion Exercises and others like McKenzie Extension Exercises. Many clinicians perform a combination of both exercises.
In physical therapy we call these the 3 sciatic nerve stretcher exercises:
How to stretch sciatic nerve: lying flat on your back, take both your hands and place on top of your lower leg below the knee. Next, gently pull your knee to your chest in a controlled manner. Hold 10 seconds, repeat 3 times. This helps stretch the lower back gently.
Laying on your stomach keep your hips flat to the table. Next, press your upper trunk up until you can place both elbows under each shoulder. Hold 5 seconds, repeat 10 times. This helps stretch the lower back.
Lay on your back with the knees bent. Rotate the back to allow both legs to move together side to side. Keep the shoulders flat on the surface. Hold 5 seconds, repeat 10 times each side. This may be a remedy for low back pain for some people.
It is difficult to self diagnose the source of Sciatic Nerve Pain. But if the problem is a tight piriformis, lay flat, cross the leg that you want to stretch over the other leg which is bent at a 90-degree angle. Reach down to the bent leg around the hamstring area and pull back. You should feel a stretch in the buttock of the crossed leg. Again, hold 30 seconds and repeat two to three times. If pain increases, stop immediately. This is also an exercise for the hip for some with lower back and hip pain.
If the exercises do not help or your pain increases, STOP immediately and consult a medical professional. JOI has a dedicated spine center to help. The Spine Center has specially trained spinal clinicians with a vast array of treatment options for sciatica, low back, and hip pain.
Initial treatments may include laser and manual therapy or massage to help calm the acute pain. When the pain is controlled, advancement with functional mobilization and core strengthening will be implemented. The final phase will be education on an effective home program to maintain the progress gained with treatment.
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