CAPOW Series – Sciatica

Shooting pain down the back of your leg? Weird tingling sensation? You could be experiencing Sciatica symptoms.

The definition of Sciatica “is pain in the buttock and leg, caused by pressure on nerves in the lower back.” which is why another name for Sciatica is Lumbar Radiculopathy.  Therefor, this means ‘true’ Sciatica is when the nerves are affected by conditions in the Lumbar Spine.

This may lead to the feeling of pain, burning, weakness or pins and needles (neurological symptoms).  This sensation can radiate from your buttocks, down the back of your thigh,  your lower leg and in your foot.

Some causes can be:

  • Herniated Discs (‘slipped disc’, ‘bulging disc’)
  • Radiculopathy (‘pinched nerve’)
  • Forms of arthritis or bone degeneration.

The Sciatic Nerve is made up of spinal nerves that exit the spinal column at different levels.  Usually from L4 (4th Lumbar Vertebra) to S3 (3rd Sacral Vertebra). The different paths that this nerve travels is why you feel symptoms in the different areas that you do.

This is why I ask my clients if there is a radiating pain and where it travels.  It helps me to identify areas I may need to concentrate on.

Possible Culprits

Although as massage therapists we cannot directly affect the the spinal column.  We can work on muscles that may be indirectly affecting it.  We do this by working on patterns of compensation.  However, there is one condition i do want to focus on called ‘Piriformis syndrome’. 

‘Piriformis Syndrome’ or ‘pseudo-sciatica’ is where the Piriformis Muscle, impinges (pinches) the sciatic nerve leading to those neurological symptoms we mentioned above. Although it has very similar symptoms, the pressure on the nerve does not originate in the spinal column – hence the name “Pseudo-sciatica”.

Here you can see that they sciatic nerve passes under in (in some people it actually passes through the middle of the muscle). Any tension of dysfunction of this muscle can put pressure on the sciatic nerve.

What causes Tension in the Piriformis?

There are a few causes, but specifically to Office Workers it is most likely during to prolonged sitting, postural strain and inefficient bio mechanics.  Things like different leg lengths, injury or scoliosis and affect the way we use this muscle.

The piriformis assists in external rotation of the thigh at the hip joint. Most commonly when people are not conscious of the way they are sitting, their knees begin to turn outward.  This can lead the piriformis sitting in a shortened position putting pressure on the nerve. The piriformis muscle could also be working inefficiently because our ‘glutes’ aren’t ‘firing’ correctly.

There can be many different reasons, and through assessment we can help to identify contributing factors.

How can you tell the difference?

We use a range of physical assessments and tests to help identify what could be contributing to your lower back pain before we even start the treatment.

There are a range of special tests that can help us to differentiate between many of the causes of Sciatica.

These tests ensure that we only apply safe and appropriate techniques.

Sciatica or Pseudo Sciatica, rather than being a condition itself, is more a symptom telling us that something else is going on.

Stretching / Strengthening / Recommendations:

First and foremost, of you have neurological symptoms like I mentioned above go and get it checked. There is nothing worse than doing exercises or stretches that may make matter worse.

Whilst most pain will resolve itself, that can take weeks  or months and impacts on your quality of life and well-being.   You have many different options for treatment available to you, explore them to find what works for you.

Secondly, try to reduce the number of hours you spend at your desk and be mindful of how you are sitting when you are there.  I always tell my clients that they know their body better than I do.

Your body gives you many different signals and by listening to them, you can explain what you are feeling to your practitioner with more clarity.

But here are some stretches you can do for Piriformis Syndrome from Dr Jo.

Also here are some great ‘glute activation’ exercises from Tim Keely.