Sciatic Nerve problems
This issue is a lot more common than many people realise and can be debiliatating when it occurs
Is the Latin word for "Pain down the back of the leg" Sciatica is referred pain usually caused by trapping the sciatic nerve in the lower back, normally the Sciatic nerve gets compressed (trapped by the Piriformis muscle. (please see our page Piriformis for further details and exercises that can help)
In laymans terms, the sciatic nerve runs from the lower back (L5 /S1 region down through the buttocks and along the back of each leg. Sciatica is pain along this nerve and is a relatively common form of back pain and is usually caused by pressure on the sciatic nerve from a herniated or bulging disc. The pain from sciatica can be anything from infrequent and irritating to severe and debilitating. Usually, it affects only one side, the pain radiating through the buttock and down the leg and is often associated with a constant pain on one side of the buttocks, pain in the leg and/or buttock that may be worse when sitting , burning or tingling down the leg, weakness, numbness or difficulty moving the leg or foot or a shooting pain that makes it difficult to stand up. While sciatica can be extremely painful and uncomfortable, it is rare that permanent nerve damage (tissue damage) results. Most pain is due to inflammation and will improve within a period of time. Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centred on relieving both of these conditions.
A more detailed view - Sciatica is pain running down your leg in a pattern determined by the sciatic nerve. The pain often starts in the low back - (due to a herniated disc or similar problem) - or in the buttock - (due to piriformis syndrome) - and extends as far as your toes. It can be accompanied by numbness, 'pins and needles' ("paresthesias") or, in more severe cases, actual weakness affecting the ankle or toes may accompany the sciatica.
One way to determine what is causing Sciatic pain is a couple of simple movements, if lying flat causes no discomfort and raising the straight leg upwards can reproduce the pain then it is more than likely related to discs ie herniated or bulging disc etc, but if there is pain and it is relieved when the leg is stretched over the other leg then it is more than likely going to be the piriformus, which is a muscle in the glute (buttock).
Sciatica is a form of pain that is called a "radiculopathy" in medical terminology. This means
that it often follows the path of a single spinal nerve root such as the Lumbar 5 (L5) or Sacral 1 (S1). This is often the case when sciatica is due to a herniated disc or bulging disc. If the cause is in the lumbar spine, the sciatica - or leg pain - is often accompanied by back pain.
Some patients also experience sciatica pain affecting all the dermatomes in the sciatic nerve, L4, L5 and S1. This sort of "pan-sciatic syndrome" may be due to piriformis muscle
syndrome. This condition is due to a muscle in the buttock that goes into spasm and pinches the sciatic nerve.
When the sciatica symptom is due to a herniated disc, it often affects a single strip of skin or dermatome. A far lateral herniated disc affects the exiting nerve root – in the picture at the top on the right, the L4 root is compressed by an L4/L5 lateral disk herniation. More commonly, however, the disk bulge is close to the body’s midline. The illustration shows an L5/S1 disk herniation affecting the transiting S1 root but leaving the L5 root undisturbed. The patient’s detailed distribution of symptoms must match exactly with the MRI findings in the spine before a back surgery can be recommended.
Sciatica and pregnancy - The symptom of sciatica can be triggered during pregnancy for three
reasons. The added weight and bending stress on the spine can worsen a bulging disc. The expanded uterus in the pelvis can press on some of the lumbar and sacral spinal nerves that help form the sciatic nerve. (Additional stresses from the weight of the pregnancy can trigger a piriformis syndrome, please see piriformus page).
Sciatica and Back Pain - Radiating pain down the leg often occurs along with back pain, however, the two symptoms are not always linked. In piriformis syndrome, there may be buttock and leg pain without back pain. Also, a herniated disk will occasionally cause buttock and leg pain with virtually no back pain. When you have back pain alone but no sciatica, then your problem is generally something other than a herniated disk. Back pain alone can even have it's roots in life stress, however sciatica is almost always an indication of a specific nerve related problem.
Sciatica Treatment: Massage, Exercise, Accupuncture, Phsyio- When sciatica is due to the muscle spasm of piriformis syndrome, specialized deep tissue massage and very specific exercises - often directed by a physical therapist - can be helpful, but exercises can make sciatica worse if it is due to a herniated disc (a phsyio will be able to give exercise relevant to your problem and that will strength your core which over time can be come weak).
Accupuncture makes it easier to tolerate the pain but more often than not doesn't fix the problem.
The details of sciatica are a good example of the localization process. Sciatica refers to a pain in the leg which follows a particular pattern that is related to the course of the sciatic nerve: starting in the low back, running down behind the buttock and leg, then down the side of
the leg and reaching around the ankle into the foot.
One of the most common causes of sciatica is a herniated lumbar disk at either the L4-L5 or L5-S1 level. These two herniations occur with about equal frequency. When the L4-L5 disk ruptures, it tends to rupture in a particular location on the posterior and lateral corner of the disk (toward the back and to the side), on either the right or the left. This disk extrusion doesn’t
actually pinch the L4 nerve in the foramen or nerve canal at the L4-L5 level; instead, it usually pinches a nerve in the main spinal canal, the L5 nerve, that’s headed out through the foramen below at the L5-S1 level. That pinch almost invariably causes sciatica that runs all the way down the leg into the big toe. Similarly, an L5-S1 disk herniation usually pinches the S1 nerve
and the resulting sciatica also runs down the leg, but it goes out to the little toe .
A pinch of the L4 nerve is far less common and is more complex to diagnose. It can be caused either by an L3-L4 disk herniation, which is relatively rare, or by an L4-L5 disk herniation that happens to point out laterally into the nerve canal. When the L4 nerve is pinched, the pain runs down the leg and may reach the ankle but not necessarily the toes. The other trick to an L4 nerve pinch is that the resulting pain can have a more prominent presence in the knee and on the anterior thigh. That’s because the L4 nerve doesn’t run into the leg entirely with the sciatic nerve; instead, part of it runs along the front surface of the thigh with the femoral nerve.
What about when both the big toe and the little toe are having sciatica pain?
It could be that both your L4-L5 and your L5-S1 disk herniated at the same time; however, the chance of two disk failures happening exactly the same way and at the same time is very small. This symptom pattern tends to lead to the question of whether the whole sciatic nerve is being pinched somewhere along its course from the sacrum to the knee rather than one of the spinal nerves that leads into it.
One place where the entire sciatic nerve is pinched most commonly is in the pelvis, where the nerve exits from the inside to the outside of the pelvis through the sciatic notch and passes under a muscle called the piriformis muscle. Tension and spasm or increased muscle tone in the
piriformis can cause a sciatica that affects the buttock and the leg, and reaches down to the level of the ankle but doesn’t go to any one of the toes in particular. A doctor can use physical exam maneuvers or tests to distinguish between the lumbar and pelvic forms of sciatica. The two also have some different features: piriformis sciatica tends to be worse with sitting but
relieved by standing or walking, whereas the sciatica from lumbar disk herniation can often be relieved by sitting in certain positions.
Seek immediate medical help if you experience all of the following symptoms:
Numbness in your bottom, lower back and leg
Loss of bladder and/or bowel control
Feeling of weakness in your leg and foot
These symptoms may be signs of a rare condition known as cauda equina syndrome.