Sciatica

Sciatica is often used as a blanket diagnosis. There are several causes for Sciatica, some serious, some not.

In Latin, ‘Sciatic’ means ‘back of the leg’. The ‘ca’ at the end of Sciatica means ‘pain associated’. Therefore Sciatica means ‘pain down the back of the leg’.  Rather than a diagnosis per-say, the word sciatica is simply a description of pain radiating down the leg.

Pain Referral Patterns Sciatica

Pain referral can occur for many different reasons, but too often we get focused on it coming from the nerves. In clinical experience, we know that there are many kinds of referred pain and the cause is not always a neural impingement.

Often, Sciatica is blamed on the Sciatic nerve (again named because it runs down the back of the leg). This nerve can sometimes get irritated by a tight Piriformis muscle.

Sciatic Nerve

The Sciatic Neve (yellow) runs through the Piriformis muscle (red). This can be the site of impingement.

 

Pain referral for this is normally straight down the middle of the hamstring muscle. For treatment, the average physio or massage therapist will try to massage and release the muscle. This will work to an extent, but only if the reasons that the Piriformis muscle got so tight are addressed at the same time. This is where many treatment plans fall short. They identify the area that is irritated (the nerve), they even look at the ‘irritating factor’ (a tight muscle), but never actually get to the reason the muscle got tight in the first place….

Q: What if the pain moves around? What if it’s more on the side of my leg, or front of my thigh or edge of my knee. Is the Sciatic Nerve still causing it?

A: It is unlikely the sciatic nerve itself is involved if your pain is not down the middle of the hamstring.

 

While your sciatic nerve might also be irritated, the chance of it actually being responsible are low. So too are the chances it is coming from a disk or a spine issue.  Even when it is spinal in nature, soft tissue therapy is still the key in correcting any of the postural issues associated with disc issues (read more about this here).

ProlapsedDiscIllustration

Bulging or herniated discs were once considered to be a primary cause of lower back pain and sciatic issues. Medicine has very much moved away from this idea and now views disc issues as more of a postural symptom rather than a primary cause. Consequently we see less and less back surgeries, more and more soft tissue solutions for sciatica.

What is the primary cause of Sciatica we see in a clinical setting?

Most experiences of Sciatica come from strong muscular imbalance, The most common kind of Sciatic pain that presents in a clinical setting is caused by a seriously overactive kinetic chain (groups of muscles), that have become so tight and dysfunctional they aren’t able to switch off and relax.

Every time you need these muscles to shorten (as an example, when we are seated, we shorten our hip flexors), or when you need them to carry weight (when you walk around your hip flexors need to carry your body), these same muscles have gotten so irritated that even without much activity you are in serious pain.

How our view of the body has evolved over the last 15 years….

Looking at the body and thinking that the nerves and the bones are the most important things is an old fashioned and outdated perspective. We now know that soft tissue balance (fascia and muscles) are just as important. They are also just as capable of creating severe pain. When you look at structural issues like worn out joints or irritated nerves, you are only looking at half of the puzzle. Why is the joint worn out? What is impinging on the nerve.

When you start to look at the soft tissue, you not only find the cause of the issue, you also often realise its not what you thought it was to begin with.

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