Sciatica. Yes, I’ve definitely got sciatica!!!
Well….maybe not.
Let me explain.
At least 10 times a week a patient will come into our office and say, “Doc, I looked it up on Google and I’ve got sciatica.” Then they point to an area that is at least 2 feet away from their sciatic nerve. I’m being somewhat silly here but the truth is that most people think they know what Sciatica is and 99% of them are…well…wrong. I’d like to take a second and define what sciatica is (maybe more importantly, what it isn’t), how you may have gotten it and what best to do about it.
First, what it is. The Cleveland Clinic defines Sciatica as: “Nerve pain from an injury or irritation to the sciatic nerve, which originates in your buttock/gluteal area.” I encourage patients to think of their nerve systems like a river. There is a main source (in this case, the brain), which allows nerve impulses to flow down a main channel (in this case, the spinal cord) and then branches off into smaller creeks and streams and sometimes converge back into bigger rivers. The sciatic nerve has 3 main “contributories”…the lowest 3 nerves in your low back (L4, L5, S1). Sometime you can have a “jam up” at one of these 3 contributories and sometimes the jam up occurs at the main river. Another possibility is that you may have a condition known as piriformis syndrome…which in an of itself can lead to or happen at the same time as sciatica. The trick is sorting out which one is which and what is the best course of action. That’s where a professional partner who knows what to look for AND care for it is a must. Several things can cause this but most often it is some form of trauma. Whether that be from micro- or macro- trauma or poor ergonomics. Runners tend to be the one of the highest frequency sufferers of sciatica as the hip muscles in that area of the body act as a stabilizer during running, Other risk factors for having sciatica are:
Being overweight
Weak core muscles
Sedentary lifestyle
Just living life
Next, what sciatic is not. NOT all pain that radiates from somewhere to somewhere is sciatica. I once had a patient that told me they had sciatica and informed me that it stared in the base of the neck and ran down their arm to their finger tips. They thought this because they were TOLD that anything that runs down you arm or leg is sciatica. That just simply isn’t true. Remember, the definition of sciatica is irritation or trauma to the SCIATIC NERVE (which is near your butt). Be sure not to confuse all “radiating symptoms” with sciatica. They are not the same!
Now, what to do about it. If you are already under regular chiropractic care, mention it to your chiropractor and they will take appropriate action. If you’re not under regular Chiropractic care (and for the record I believe everyone should be) seek the care of a professional. My preference would be for someone who practices “physical healthcare/medicine” (IE a chiropractor, physical therapist, physiatrist, etc.) My short rule of thumb is that if your symptoms haven’t subsided on their own in about 48 hrs, they’re probably not going to. So, professional help is necessary. While you’re waiting for your appointment to happen, I recommend cold packs to the lower back and buttock area. Apply for 20 minutes, leave off for 40 minutes. Skewing towards the side with the symptoms or both if you pain is on both sides. This is hotly debated topic (pun intended) as SOME practitioners advocate for moist heat packs. In my professional opinion, most root causes of sciatica have inflammation at their core. Heat will often amplify the inflammatory effect. I like to say that heat plays a trick on you in the sense that it WILL feel good while you are applying it, but after it’s removed you will not feel a continuous improvement in symptoms over time because the inflammation is left to linger around. Cold, on the other hand doesn’t feel so great when you’re applying it (especially in the winter…in New England…. when it’s -5 degrees outside!) but it does provide improvement as the inflammation begins to settle down. You can take any OTC (Over the counter) anti-inflammatories that your MD has cleared you to take, but I am a minimalist when it comes to those type of things. They can wreak havoc on your GI tract, lead to bleeding if you’re predisposed to that and have to be cleared from your entire system by your liver or kidneys, depending on the type. Also avoid trying to aggressively stretch the area. Your instinct maybe to really give the muscles a good stretch or workout but remember they are potentially inflamed and they will not enjoy being tugged and pulled and asked to do a bunch of work. Stretching out the muscles in that area should NOT be done until acute pain is gone. At that point, start begin with gentle stretching. I can’t stress the gentle part enough. A cross body stretch while pulling up on the knee to the opposite shoulder is a good one. Give the area a rest for about 48 hrs. It’s ok to move around some…we’re not talking house arrest here, just take it easier than you have been. I wouldn’t recommend running, long walks or leg workouts for about 2 days either. You should notice increased muscle pliability before returning back to a running or walking routine.
If you are suffering from sciatic pain and live in the greater Plymouth, MA or South Shore area…I would be happy to see if I could help you out. Give us a call or click the big red button at the top of the page and set up an initial consultation.
Be well.