Have you ever woken up and noticed a tingling pain down the back of one (or both) of your legs? You are not alone! 1-10% of the population have reported they have experienced this pain, commonly known as sciatica. You may have noticed that some things make it worse and other things alleviate the pain. But what’s causing it? How can you stop it?
What is Sciatica (Lumbar Radiculopathy)?
Well, it starts with understanding the sciatic nerve. The sciatic nerve is the largest nerve in the body; running from the lower back (L4 through S3), through the buttock and into the thigh and down the back of the leg to the toes. The sciatic nerve starts as a collection of nerve fibers (roots) that exit the spinal canal through openings, called foramina, in between the vertebrae. These fibers combine to create a single nerve (the sciatic nerve) that at its largest point combine to be as big as a man’s thumb. The sciatic nerve runs directly behind the piriformis muscle (which is why many people end up having problems there). When the sciatica reaches the knee, it splits into two; the tibial nerve and the common peroneal nerve. The peroneal nerve travels sideways down the outer part of the knee and through the upper foot. The tibial nerves travel downward to the foot.
The sciatic nerve is responsible for sensation, strength, and the reflexes of the leg. The spinal cord is connected with the outside of the thigh, hamstring, and muscles of the lower leg are connected by the sciatic nerve. When someone is told they have sciatica, they are being told they are experiencing a symptom or an underlying medical condition.
Symptoms of Sciatica
Sciatica pain varies from person to person. Typically sciatica only affects one side of the body. For some, sciatica pain can be debilitating while for others it may just be irritating. For one patient, it may be long term and for another person it may be short term. Some people may notice lower back pain, but more commonly people experience pain down the leg.
Sciatica is most commonly described by patients as a burning, pins & needles sensation that radiates down the leg into the foot. Others describe it as electrical shocks down the back of the leg. Other symptoms may include:
Pain that improves when the patient lies down or continues to walk (as opposed to sitting or standing)
Weakness of the leg or foot (or both)
Shooting pains that make it difficult to stand up
Numbness or tingling of the toes
When should you see a doctor?
As with most symptoms and conditions, if the sciatica is getting worse (not better) with time or if your symptoms become bilateral (meaning the symptoms are happening in both legs), you should seek professional medical attention.
Things NOT To Do
In order to avoid making the sciatica symptoms worse, there are a few things to avoid:
Hinging motions: Avoid hinging forward towards your toes. Exercises like crunches or dead lifts will cause added pressure to the sciatic nerve and therefore more pain!
Running: For those of us who are avid runners, this may be difficult, however… necessary. Running can cause jarring of the body which could in turn cause additional pressure to the sciatic nerve.
Leg circles (Pilates): When you open your legs in a full circle motion, you stretch your hamstring. When the hamstring is stretched too suddenly, you are likely to experience severe pain down your leg.
Sitting or standing for long periods: Sitting or standing without moving for extended periods of time can bother your sciatica. Be sure to get up, stretch, and move around throughout the day. Unfortunately, we can’t tell you “you can’t go to work.”
High heels: For certain people, this may be difficult due to the nature of your job. When you wear a high heel, say above an inch, your body weight is shifted forward which is an unnatural alignment for your back. The shift puts a greater strain on your legs & back.
Things TO Do
It’s easy to avoid things, but there are other things you should be doing to help alleviate your sciatica pain.
Piriformis stretch (figure 4): One of the most common stretches for sciatica is the piriformis stretch. While laying on your back, bend both knees with both feet still touching the ground. Take the affected leg and cross it over the other, your ankle should be resting just above your knee of the opposing leg. Pull the opposing leg in towards your chest. Hold for 30 seconds and repeat a total of 3 times.
Child’s pose: For our yogis out there, you may already be familiar with this one! Start on your hands and knees. Sit back your buttock onto you heels and stretch your arms out in front of you and hold for 30 seconds. Repeat a total of 3 times. This will help reduce the compression on the lumbar spine.
Hip flexor stretch: Especially if you are sitting for prolonged periods, this stretch will be great to help reduce the anterior pelvic tilt. If you are able to get to the floor, kneel with one leg out directly in front of the hip. Allow your weight to shift forward to get a stretch down the front of your leg and in front of your hip bone. Hold for 30 seconds and repeat a total of 3 times.
Marching: Because sit ups or crunches are not the best for you when your sciatica is acting up, these are a great exercise to create core stability. Lie flat on the ground with your knees bent, feet flat on the groud. Keep the tailbone down and neck relaxed. Raise one leg up to table top position to begin, exhale down, and inhale before lifting. Pull the belly button in and continue through the lift. Exhale down and repeat. Complete 3 sets of 10 on each side.
Myofascial release: Since you can’t have a massage therapist at the ready at all times throughout the day, use a tennis ball to perform myofascial release on your piriformis. Depending on the amount of pain you are in, you can either:
Sit on the tennis ball just beneath the buttock (at the crease of the leg & buttock)
Sit on the tennis ball and use your arms to lift your body weight to then roll the tennis ball up and down your leg.
If the pain lasts longer than 3-5 days, you may want to seek a medical professional's help. You can schedule a FREE injury assessment here at Envision Sport and our physical therapists can help guide you on what to do to see improvement.
Have questions? Feel free to contact us! We'd love to help see you return to the things you love!
SPINE-health, "Sciatic Nerve Anatomy" by Steven G. Yeomans, DC, March 25, 2019, https://www.spine-health.com/conditions/spine-anatomy/sciatic-nerve-anatomy