Sciatica

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Sciatica is a common lower back and leg problem which affects large sections of all populations. It is typified by pain which can originate in the lower and extend through the buttock, back of the leg and potentially as far as the foot in some cases. This guide to sciatica will look to inform you about anatomy, symptoms, causes and ways to manage symptoms with supplements and exercises.

Anatomy

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To begin to understand what sciatica is and how it affects us, we first need to look at the anatomy involved.

 

Lumbar Spine

 

This is the name for the lower part of the back and it consists of 5 vertebrae and spinal discs, at each level (L1-5) nerve roots exit facet joints between the vertebrae and run off to form nerves. L4-5 and the sacral nerves 1, 2, 3 all have branches that come together to form the sciatic nerve

 

Discs

 

Spinal discs sit between vertebrae and provide shock absorption but also the ability for the spine to move freely in multiple directions.

 

Nerve Roots

 

These are the beginning of nerves and they form at the spine and sit inside a small facet joint which is formed where one vertebra sits on top of another. There is a small hole formed by the facet joints which allows the nerve to poke out.

 

Sciatic Nerve

 

The main nerve that feeds from the lumbar spine, through the buttock and down towards the knee before it splits into its different branches. The sciatic nerve runs underneath the piriformis muscle in the buttock.

 

Piriformis Muscle

 

A small strap-like muscle in the lower glute which runs over the top of the sciatic nerve helps to move the hip and forms part of the glute complex.

 

Lumbar muscles

 

The lower back has a multitude of muscles and importantly they are a combination of large and small muscles which help to move and protect the back.

Symptoms

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Pain

 

The lower back, buttock, back of the leg and even as far down as the calf and foot can experience pain from sciatica. This is due to the sciatic nerve starting at the lower back and the nerves it attaches to finishing at the foot. The lower back can be painful as the cause of the problem can be muscular or disc-related at the lumbar spine. Shooting or pulling pain can extend down the leg and this can be extremely uncomfortable in the early stages.

 

Nerve Pain

 

This affects the leg, calf, and foot when at its worst. Nerve pain when at its best will reduce and track back towards its origin at the spine. Sensations reported include sharpness, shooting, dull ache, trickling and burning. In the foot and calf it can be more tingling and in the worst cases, numbness of the skin. Numbness of the skin can represent that the nerve is compressed by a structure at the spine such as a disc.

 

Cauda Equina

 

In more serious and minimal cases – cauda equina symptoms can develop – this is when the nerves that operate the urinary and bowel movements can be compressed and affected. Symptoms to look out for are incontinence, saddle numbness and loss of sexual function. If you do notice any of these symptoms or any other changes to any of these functions – you must report to A&E immediately – do not wait – changes such as this can be irreversible if not managed quickly.

 

Restricted movement

 

The lower back commonly will be limited depending on the cause but usually forward bending is difficult to do and simple tasks such as washing, dressing and walking are affected. Leg movements such as simply straightening the knee are reported as common problems as the nerve is inflamed, painful and this creates a neural tension in the back of the leg.

Causes

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Disc issues 

 

Bulges, herniation and prolapse of discs in the lower back are the main cause of sciatica. If a disc is placed under too much pressure or injured for example with poor heavy lifting technique – will cause the centre of the disc to bulge outside of its normal wall and press upon a nerve root causing compression – this is then what generates the pain locally and extending down the leg.

 

Spondylolisthesis

 

This is a condition where one vertebra slips backwards and causes pressure to structures in the back such as the spinal nerves and cord – this can produce symptoms of back and leg pain. It commonly requires surgery if symptoms do not resolve and continue to cause a lot of pain.

Tightness of facet joints/muscles – if a section of your back is tight on one side due to poor sitting habits/positions this will cause a build-up o pressure on one side and compression of a nerve root. If you repeatedly sit or lie in the same position, muscles start to pattern, shorten and tighten around bone and nerve structures – when this becomes too tight it will cause sciatica when the nerve is aggravated.

 

Piriformis Syndrome

 

This mimics sciatica but it may be without the back pain and you will typically experience pain from the buttock region and potentially extending into the upper thigh – the piriformis muscle can tighten with excess exercise, poor sitting position and poor exercise technique. This can be easier to manage than true sciatica as it is mainly a muscular cause.

Supplements

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Due to the high levels of inflammation created with sciatica in areas of the back and more so with the sciatic nerve root and body – it is important to control inflammation as this is one of the main causes of pain in the body.

Natural supplements can help to reduce your inflammation levels and it has been shown that turmeric in high doses can have very positive effects. Curcumin is the active ingredient in turmeric that has been found in many studies to have positive anti-inflammatory effects on the body and also to promote circulation to vital structures which are key when you have sciatica.

Supplementation of Magnesium has been stated to be helpful due to its role in muscle and nerve function and can have a role and it may also have some anti-inflammatory properties.

Because sciatica involves the nervous system, B Vitamins are essential for maintaining a healthy nervous system. Vegetarians and older people tend to have a deficiency in some B vitamins which are important for your nerves.

Essential Fish Oils containing omega 3 fatty acids are thought to be essential for helping to reduce inflammation due to them thought to affect the body’s production of prostaglandins in a similar way to what turmeric does.

Exercises

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Exercises for sciatica are essential for the recovery process – to help regulate pain levels and restore function to the body. While you have pain and dysfunction present in the body you will acquire weakness and restriction of muscles and joints. Restoration of these factors is vital for returning to the same level you were at before developing your sciatica. A lot of people will complain that they have sciatica for life or that they haven’t been the same since they acquired it. In these type of scenarios, it is usually a case of getting the correct diagnosis and working diligently on rehabilitation in order to return to normal – however, this can take time so it is important to be patient.

As previously mentioned there are 2 areas/components of the sciatica which cause the problem, the root cause being the lower back and the secondary component the sciatic nerve. At the lower back, it may be a disc bulge or tightness of a joint and muscle causing the compression of the sciatic nerve root – in order to start reducing symptoms and promoting recovery you must address the back mobility to make your movement freer and reduce compression on the nerve.

If you have a long term disc bulge that can take extended periods of time to heal and for your sciatica to resolve it is even more important to allow the disc to heal and your spine regains its optimum mobility. Without lumbar mobility exercises, you may find simple movements such as washing and dressing more difficult. Disc tissue heals at a slow rate but with consistency and gentle exercises you should be able to improve the efficiency of your lower back movement.

Here are 3 simple exercises that you can try and see if they are suitable for your symptoms. Remember to start with small amounts and perform them slowly. There may be a small amount of tightness and discomfort in the back – this will be normal and should reduce over 4-6 weeks of becoming familiar with them.

 

Knee Hugs

 

Lie on your back and gentle hug either one or both of your knees towards your chest – go as far as your symptoms allow – the goal will be to gain full range of movement. This exercise helps you to maintain the lower backs range of movement in flexion, better known as your forward bend.

 

Knee Rolls / Lumbar Twists

 

Lie on your back with your knees bent and feet flat on the bed or floor. Keeping your knees together, gently move your knees to each side and take them as far as they will go. This applies a rotation to the lower back, mobilising the facet joints of the back and also loosening tightness in the lower back muscles.

 

Pelvic Tilting in Supine

 

Lie on your back with your knees bent and feet flat on the floor or bed. Keeping your buttocks and upper body on the floor, try and pick the arch of your lower back up off the floor and then flatten it into the floor – then repeat this through. This movement helps to gain an extension of your lower back. If you get any sharp pain then do not push through this, just go towards the edge of the discomfort until you feel it can be progressed more comfortably.

For the symptoms you experience in the back of the thigh there are some exercises and treatments that can be performed to help improve the level of pain that can often be quite intense and unforgiving.

 

Seated Sciatic Nerve Glider 

 

In a chair, sit up with good posture so the curve in the lower back is present. With the affected leg, pull your toes towards you and gently straighten the leg and then bend it again. This must be performed slowly and should look like you are performing a slow kick with your toes pointed up. Do not kick fast as this can aggravate the nerve and make things worse. Aim to perform this exercise until the leg becomes a bit achy then rest. Perform this exercise whenever you feel the leg pain is at its worst.

 

Piriformis Stretch

 

Stretching the piriformis can help to reduce pressure on the sciatic nerve which can contribute to leg pain. Lie on your back and pull your knee into your chest on the side that is affected and point it diagonally over your opposite shoulder and hold for 20-30 seconds. This will target the small glute muscle which can commonly be compressing the sciatic nerve. Repeat as many times as you need to.

 

Mobility Ball / Foam Roller

 

Again – targeting the affected area of the lower back, glutes and back of the thigh, use any one of the selected tools to help lower your symptoms. The pressure provided to the sore tissues by these tools helps to reduce how you perceive your pain and can often improve your movement in the leg, glutes and lower back. It should feel uncomfortable as you perform this however most people describe this as a nice discomfort and afterwards the relief is worth it!

 

Conclusion

 

Now you know all about sciatica; its anatomy, symptoms, what causes it, the best supplements and how to manage the symptoms with exercise. If you have found this article helpful then share it with your friends, family or anyone who may have sciatica.

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