Sciatica is a condition that is poorly understood and often ties people in knots with the pursuit of symptomatic relief in the leg at the expense of the lower back, where the cause of symptoms reside. When symptoms of sciatica can be so incredibly intense in the thigh, leg or foot, it is understandable that one will do whatever they can for a moment’s relief, however if we take a brief step back and understand the problem of sciatica better, results and relief will be forthcoming and long lasting. Today our aim is to help give you a complete understanding of sciatica so you can take steps to rid yourself of this horrible leg pain for good and not be fearful of the return to the pain at any moment.
What Is Sciatica & What It Is Not
Once you understand what sciatica is, it is very easy to see why previous attempts to treat or relieve the sciatic leg pain have not had results. This misunderstanding is at the root of all unsuccessful attempts to relieve sciatic pain.
What sciatica Is Not
Sciatica is not a leg, a thigh, buttock or even a foot problem. To help illustrate the truth here a great example is found in the “funny bone” in your elbow. We’ve all been there, banging our elbow on the table and we hit the exact spot that gives terrible tingling in the forearm and hand but what is really happening here?
Firstly, sensations do not shoot down the hand, what actually happens is that signals from receptors in the hands and arms where you feel the tingling send signals to the brain to tell you that something is happening there, like a warning sensor. The problem in this scenario is that nothing happened in the hand. It was the elbow. You see, the brain only knows that this specific cable (nerve) that goes to the hand brings signals and updates on the status quo in the hand and fingers ONLY.
In the funny bone however, there has been a force that has hit the nerve half way along the cable, at the elbow, that force has been enough to “hijack” the nerve that goes from the hand to the brain, and send a signal along it. The brain only knows where the signal should have come from and so you “feel” where the brain “thinks” the signal came from, the hand.
When this happens you know very well that the elbow was the cause of the pain you’re now experiencing in the hand and fingers, the terrible tingling, because you saw it, you did it, consciously or accidentally. It is not a hand and finger problem.
Sciatica is exactly the same!
What causes sciatica
Hopefully the above example helps you better understand sciatica, because of the way our nerves work, we have the same experience as the funny bone. The nerves that go down the back of the leg and foot, that branch off the main Sciatic nerve send signals back to the brain. When a lower back injury takes place, for example a herniated disc, it is like banging the elbow!
The disc or inflammation in the lower lumbar spine irritates the nerve that is sending signals back to the brain from the leg. The brain only knows that those signals “should” come from the leg, it does not know that there is a pesky disc bulge squashing the nerve in the lower back.
What sciatica is and why this matters
The best way to categorise sciatica and think about it in your mind is to refer to it in the following way:
Lumbogenic Leg Pain
Lumbogenic meaning “generated in the lumbar spine” and an acknowledgement that the symptoms are in the leg. This could be pain, but often it is burning, tingling, tightness, tension, or a dull ache. Additionally you might find that there are areas of weakness in the muscles of the back of the thigh and leg, as well as the buttocks.
This matters because if you understand what you’re dealing with you can start making wiser decisions about what sort of issues your body is facing, and what needs to be done to remedy the sciatica symptoms.
Sciatica is a bad diagnosis but why?
Fundamentally sciatica is banded about as a diagnosis but it is not really a diagnosis in many ways. Or at least, it is no more a diagnosis than back pain, leg pain, arm pain or a headaches are. It is a statement of symptoms, hence why we suggest the re-framing of sciatica into “lumbogenic leg pain”. This prompts the follow up question of “so what is causing the lumbogenic leg pain?” Whereas when people are diagnosed with sciatica they often feel like that is the diagnosis and therefore treat the leg pain or symptoms as leg pain.
This “wrong think” about sciatica results in the classic mistakes that lead to worsening symptoms and an increasingly frustrated individual that feels like they’re going in circles.
Sciatica mistakes that perpetuate your leg pain
This “wrong thinking” about sciatica leads people to engage in practices, often recommended by health care practitioners of varying professions. We’ll cover the first category here.
Endless stretching to relieve sciatica
Hamstring stretches, calf stretches or even buttock stretches are frequently prescribed, with individuals working tirelessly to try to stretch and relieve the pain in the muscles. We explore why stretching is bad for back pain in another episode of the podcast but suffice to say short term, i.e. maybe minutes to hours of relief might be possible, but the issue arises in the way that these stretches are done. So frequently, these stretches involve rounding of the lower back and severe flexion.
Considering that flexing the lower back is going to enlarge the spaces where the nerve is being irritated it is no wonder it feels nice in the moment, perhaps this instant alleviation of the “pressure” on the nerve is what contributes to the alleviation, which is wrongly attributed to the stretching of the muscle. But just like movements such as the child’s pose stretch or knee hugs, this is fundamentally making the “cause” of the sciatica worse as we will explore a little later.
Piriformis stretch for sciatica pain
An example of a commonly prescribed exercise for sciatica is the piriformis stretch, as piriformis is commonly and incorrectly diagnosed as the cause of sciatica, we go into details on the role of piriformis in sciatica on the dedicated episode of the podcast. Suffice to say, the way in which you do various piriformis stretches involves rounding of the lower back, and again, how much of the benefit comes from stretching the hip muscles (including piriformis) and how much comes from the simple fact that you’re rounding the lower back and making more space?
Flossing the sciatic nerve for relief
Another specific stretch that falls into the same category as the above involves the supposed flossing of the sciatic nerve, if you are particularly interested, you can check out the video of sciatic nerve flossing. However, to save you time, don’t do it.
What do all these stretches, literally all of them, have in common? We’ll explore that now.
Major issues with sciatica stretches
There are a handful of significant issues that occur with the common approaches to sciatica and you may already have your ideas based on what we have covered so far. Not least that all of these stretches involve rounding or flattening of the lower back, eliminating the natural lordosis. Just like a knee hug or child’s pose stretch, these simply make more space where inflammation or disc material is irritating or compressing the roots of the nerve. Now stretching plays a small role in the early days but it is not a strategy in of itself, and stretching in ways such as are commonly suggested for sciatica, is not helpful to your lower back recovery.
The most sinister issue at play here is the fact that by doing the stretches you will become hooked on the momentary relief that obviously comes from doing so. Make no mistake, they often do feel nice at the time. The issue is you fall into the trap of thinking they are actually helping when they are doing just the opposite.
Secondarily, none of these stretches actually address the issue in the lower back in any meaningful way, in actual fact, as we see above, they undermine your lower back recovery by the very movements that are taking place.
Looking at sciatica in a new way to get relief
The moment you begin to look at sciatica for what it is, a back injury, you can begin to formulate a more sensible strategy for relief that is conducive with the way your back works and the challenges it faces. We’ve discussed the stinging nettle example before, but sciatica is very much the same, you feel you want to scratch the painful area, but scratching only makes the nettles penetrate deeper into the skin making the stinging worse. Once you understand this, you can begin to develop the discipline to not scratch, and pursue more fruitful endeavours.
Sciatica is a lower back issue and so, as we look at our lower back we can start to formulate some principles that are universal to good back health, and restoration of that.
Flexion and compression at the root cause
Forward bending and compression through the spine is at the root cause of all lower back injuries, whether they give rise to lower back pain, buttock pain, or full blown sciatic symptoms. As a result strategies to eliminate these are going to be fruitful in the short term.
Three such strategies are firstly, the adoption of good upright posture with core engagement, secondly, the regular and safe unloading of the spine, and thirdly local inflammation control. If we briefly take each one now:
Control the inflammation that is irritating the sciatic nerve
Using icing instead of heat, for 3 to 5 minutes directly on the lower spine, helps control excessive inflammation in the confined spaces of the lower back, we go into detail in the Back In Shape Program, as well as in other videos on our Youtube channel on why the use of ice is particularly important in spine issues so will not repeat things here, but it helps reduce congestion inside confined and restricted spaces. This will also help you complete the wall drill later on, we’ll explain more there.
Unload the lumbar spine with the best stretch for lower back health
Using the towel stretch for the lower back you can directly support the natural lordosis as well as take some pressure off the injured discs in the lower back, be they bulging, degenerative, herniated or just strained. This also helps put your spine into the best possible position for healing to take place, doing so with a small rolled up towel placed under the lower back for 2 to 5 minutes at a time can start to unload the problem area.
Core engagement and the wall drill to help your sciatica daily
Engaging the core properly and utilising the wall drill whereby you stand with your heels, bum, middle back and head against the wall for 5-10 seconds at a time, can dramatically help you reorientate yourself. The big issue with sciatica is that you’re often stuck slightly forward bending, this places more strain on the lower back and the muscles of the back and legs, thereby compressing the issue further. In most cases you will only be aware of this terrible posture when you “try” to stand against the wall like mentioned above. Doing so may cause some pain to begin with and we’ll explain why now.
The reason we recommended the icing to begin with is that oftentimes you’ve been doing so much flexion and rounding of your back, you’re almost stuck in that position, with so much inflammation around the nerves in the lower back. As you straighten up the holes get smaller and the pressure increases and boom! You feel the pain down the leg. By starting out with some of the icing this can really help you at least take the edge off so you can get into this position more easily. Doing so will help you no end as it allows you to reduce the load on the injured part of your spine when you’re upright.
Long term recovery strategies for sciatica
The previous strategies are snippets from the Phase One of the Back In Shape Program, to help target the cause of the sciatica instead of running in circles. They are however incomplete and just to help you stop making yourself worse! Healing and rebuilding resilience requires you to start to rebuild support for your spine, this is where careful and controlled strengthening work comes in.
The bulk of your recovery from sciatica will come from rebuilding the resilience in the lower back through resistance based exercises. These begin with floor based exercises like the dead bug, they are built up into load bearing exercises like the squat and the hip hinge, and these are then enhanced further through increasing the range of motion and the resistances used. This process allows for muscular support to be developed in the early stages which provides you with more protection from daily activities. Let’s face it, as bad as your sciatica is, you’re probably still doing things, even if it’s just hobbling around the house in pain. By carefully starting to build strength you will increase your tolerance for daily life, and therefore aggravate your sciatica less and less.
Recovery from sciatica requires practice and patience
It won’t happen overnight, because sciatica didn’t come on overnight, but learning to do the movements necessary to safely build strength in the lower back is the only way to get lasting results for your sciatica. The only way to rebuild the resilience in the tissues that are injured and the root cause of your sciatica. This is where guidance and support can play a vital role. Having support to make sure you’re doing exercises correctly, and guide you through the inevitable challenges these exercises will pose is essential to long term recovery.
Especially if you’ve had sciatica for a long time, when challenges arise or exercises cause aggravation, it’s too easy to give up. Instead you need support to troubleshoot:
Why did that exercise hurt?
Did I get the technique wrong?
What caused me to falter?
Was it fatigue through the exercises, or just a lapse in concentration?
It is overcoming these challenges that will take you on a journey to recovery from sciatica. Some have the confidence to work through this themselves, others need a little more support on the journey. Know yourself and your needs and of equal importance, that this approach works.
The role of professional treatment for sciatica
Treatment can have a role for those with sciatica, this is obvious, and can work in a couple of ways, however there is a caveat that we will close the article out with.
Firstly, through osteopathy, chiropractic or physiotherapy. These professions can deliver manual treatment to surrounding areas to help improve the overall health of your body, so it can compensate for the injury in your lower back that’s causing your sciatica symptoms. For example:
Chiropractic treatment for sciatica
The chiropractor might work to adjust joints in the thoracic spine and neck as well as using other techniques. These will get the various areas of the spine and body moving better. As these areas function more optimally they can compensate for the lower lumbar injury.
Osteopathy treatment for sciatica
Similarly the osteopath will often use a mixture of joint mobilisations and soft tissue techniques to ensure that the other areas of the body are functioning as well as possible and therefore allowing the cause of your sciatica the respite it needs to optimise recovery.
Physiotherapy treatment for sciatica
Physiotherapists will often work similarly on the soft tissues for example, working into the muscles of the hamstrings and buttocks in a way that does not compromise the lower back.
It is important to note that all these professionals are invariably working to help improve the functioning of other areas. They help loosen, mobilise and release – but that is all. Not to take away from the value it does offer, but you must understand what it is doing and what it is not.
Secondly are other treatment options that can be targeted to the root cause of the issue in a way that the above cannot. Personal favourites here are IDD Therapy and Laser therapy, both of these can work directly to target the injured tissues and contribute to helping healing take place.
IDD Therapy to treat sciatica
This form of spinal decompression is able to take pressure directly off the injured discs in the lower back that are the cause of sciatica, and due to the gentle and focussed nature of the treatment it can be rather effective and pleasant.
Laser Therapy for sciatica
Class IV laser therapy similarly can target the injured tissues specifically to promote healing and recovery in the target area in a gentle way.
Both of these treatment options allow you to target the areas that are injured specifically, and without the requirement for the patient to participate in the therapy, which can sometimes be a flaw in the previously mentioned treatments, especially when sciatica is particularly severe.
However, again there are limitations in so much that these do not rebuild the resilience, which brings us to the close.
Recovering from sciatica for the long term
Ultimately recovering from sciatica, no matter how long you’ve had it or how bad symptoms are, comes down to a couple of simple concepts.
- You have to understand that sciatica is a back problem and work to restore the health of the lower back.
- You must eliminate the bad practices such as rounding the lower back that perpetuate lower back issues.
- Treatments from professionals and technologies alike can play a role and help for those that can afford to do so.
- Only you can rebuild the strength and resilience in your lower back that gives lasting relief from sciatica.
Too often people fall into the trap of thinking a healthcare practitioner, a medical procedure or just someone else, can fix their sciatica, and this is false. I am sorry to say there are no shortcuts and while others can help you recover from sciatica, you cannot escape the need to do proper strengthening work to restore stability and resilience to your lower back. This is the only way to get lasting relief from sciatica.
It sounds bad, but it really is good, because it gives you the power back, the control and puts you in the driving seat of your own pain-free life. If you do the work to rebuild resilience in your spine, you will recover from your sciatica, and you will be better for the long term. If you feel confident to move forwards now on your own, awesome! If you feel you want a little guidance and support along the way with exactly what you need to do to fix your sciatica for the long term, then check out the Back In Shape Program, we’d love to help you reach your goal of being free from sciatica and get back to doing what you love.