What is Sciatica?

Sciatica is a generalized term for a condition that causes pain to run down from the low back and down to the feet, due to the sciatic nerve being compressed. The reason for the compression can vary greatly. Compression of the nerve can be due to a lesion (a bundle of scar tissue within the nerve root that prevents the nerve from working properly) to swelling pressing against any part of the nerve, after leaving the spinal cord.

The sciatic nerve is a very large, thick nerve, that is part of the Peripheral Nervous System. And unless there is a drastic injury, such as in a car accident or a fall from a great height, is unlikely to have a complete compression of the sciatic nerve. This means generally only one part of the nerve will be compressed, either causing weakness in the muscles in part of the leg, or a loss of sensation. This nerve exits the spinal cord at the L4 to S1 (lumbar and sacrum), then travels down through the gluteal region to the knee. There it splits into 2 parts. One part stays in the back of the leg, the other moves to the front of the lower leg and down to the toes. Because it is such a large nerve, it can be compressed in several places, causing different symptoms. The most common areas that the nerve can be compressed, is where it leaves the spinal cord; when it goes through the glute area and under the muscle that helps turn the leg outwards, known as piriformis (in this case it is called piriformis syndrome and not sciatica), at the knee, and lastly at the ankle.

Types of Sciatica Pain Treatments

This condition, depending on the cause can be fully treated, and healed, through massage, physiotherapy, and/or chiropractic care. Sometimes the treatment may not take long before relief can be felt or symptoms subside completely. However, there are times that such treatments won’t be enough, especially when it becomes a secondary condition to a preexisting one. In these cases, other interventions, or just time will be needed for the condition to be resolved.

What Causes Sciatica?

Pregnancy:

This occurs more often in the later stages of pregnancy. This is because, the weight of the baby slows down venous return (circulation back to the heart) and the lymphatic system (a system that brings fluid that has escaped from the circulatory system, or swelling, back into the circulatory system to be flushed out), which causes there to be more swelling in the body. It is this swelling that pushes on the nerve and will continue until the baby is born. The baby being born doesn’t cause immediate relief, as the body has to flush out that excess fluid, and will take time. The exact amount of time that it will take, varies between each person. This isn’t the only reason why the sciatic nerve can be compressed, however. Again, being more common later in the pregnancy, women change their postures to accommodate the growing baby. This includes the low back (women tend to lean backward, especially when they are carrying multiples), and their pelvis changes (both in rotating to help them balance, and it expands to get ready for childbirth). Massage and physiotherapy can give temporary relief for this condition, but will not be able to be resolved until after the baby is born.

Spinal curvature dysfunction or injury:

Herniated discs, DDD, and scoliosis, that affect the lumbar spine can cause Sciatica. This is because either the vertebrae is rotated, causing the nerve to be compressed where it exits from the spinal column, or the disc between the vertebrae is bulging or wearing down and can put pressure on the nerve. If there is only a rotation of the vertebra, a chiropractor can do an adjustment, depending on the type of compression there is on the nerve, as they will not do an adjustment if there is a chance that they could further damage the nerve. Then exercises or further treatment by a massage therapist or physiotherapist, is done to make sure that the vertebra will not rotate again, which can happen if the muscles that attach to that vertebrae are tighter on one side versus the other. As for a herniated disc or DDD, it will depend on how advanced the condition is, as to whether or not you will always have minor symptoms of sciatica, to being symptomless.

Joint injuries:

this is especially true for knee injuries. This happens often with sports injuries, and may not be concentrated on as much, as there is more of a concern with a torn MCL or ACL. Though the pain or numbing won’t start at the low back, it would start at the knee and move downward. However, when there is a knee or an ankle injury, the way that you walk will be altered, causing there to be a shift in the hip and pelvis, which can cause the pain to run up the leg as well due to another compression of the nerve.

Muscular imbalances:

the most common muscle to compress the Sciatic nerve, is the piriformis muscle. This is because of a few different reasons. 1) a lot of people tend to toe out when they walk. This toeing out posture doesn’t start at the ankle, rather starts in the hip area, which activates this muscle. When it gets tight it can push on the muscle from being overused. 2) for some people, not everyone, the piriformis muscle splits into 2 portions, allowing the sciatic nerve to pass through the 2 different muscle bellies. When the muscle contracts (that same motion that was mentioned in the first possibility), it pushes against the nerve, both from the top and the bottom. Like a piriformis and sciatic sandwich. Stretching, relaxing the muscle, and walking with the toes pointing forward greatly improves the symptoms.

Sciatica Pain Treatments using Massage

Most massage treatments will focus on working on trigger points and tight muscles in the low back and glute area. This means that you will be laying on your stomach or side-lying if you are pregnant, to treat these areas. Unless it is known that the compression is in the knee, the rest of the leg is treated in a relaxation context, as well as trying to promote circulation and body awareness if there has been numbing to the lower limb. If muscle weakness is present, then the therapist will include muscle resistance work into the treatment, while stretching out the muscles that are too tight, so it gives the weaker muscles a chance to strengthen without exhausting them.

Other conditions will also be treated at the same time. This includes compensating structures and swelling. For more information on treating this as a secondary condition please read my articles on Pregnancy; Herniated disc; PNS; Compensating Structures and Postural Imbalances; DDD; or Spinal Curvature Dysfunctions.