Depending on who you ask Sciatica can mean a lot of different things. Some people have a “Sciatica area” of their thigh. Others believe that any time their back hurts, it’s sciatica to blame.
So is it an area of the thigh? Is it back pain?
Kiiiiinda, but not really
Sciatica or Sciatic Neuritis is quite simply inflammation of the Sciatic nerve. The nerve itself comes from your sacrum and goes into posterior (or backside) of the thigh. When it’s inflamed it can cause pain, numbness, and tingling down the backside of the thigh and even down the leg into the foot.
A lot of people misconstrued this because they associate back and thigh pain with the common pop culture buzz word: Sciatica. It’s also medical condition with a mechanical cause, a lot of Medical Doctors are well versed in pathophysiology (study of how disease manifests) and pharmacology (study of medicine and drugs). Unfortunately, many Medical Doctors do not get biomechanical training, and you can tell because their fix is always the same: here’s some pain meds, it’ll go away. If you’re lucky they may refer you to a Chiro/PT who are versed in biomechanical diagnosis and treatment.
Today you’ll learn:
- How throwing pain meds at it will not fix this problem.
- You’ll also have a better understanding of the buzz word (Yay knowledge!)
- You may figure out that “your sciatica” may be something else entirely
- Plus, because you’re awesome I’ll throw in some yoga to help mitigate and ease back pain and true Sciatica.
I hope you’re ready, it’s going to be an Ace Ventura/Woah memed themed post
Sciatic Nerve Anatomy:
Let’s take a look under the hood and actually see a Sciatic nerve.
It’s the biggest nerve in your body, and you can see how it starts at your sacrum and branches off all the way down to the foot.
Here’s the real life context: that fiber their tracing down is the Sciatic nerve in the backside of your thigh. It lies under the hamstrings.
Your face when you saw how HUGE that nerve is.
And then your face when you realized you just looked at the inside of a dead body’s butt 😉
Now that we know what it looks like, let’s talk about what causes it to get inflamed.
It’s actually incredibly rare for the actual Sciatic nerve to be compressed. Most of the time Sciatica is caused by the Piriformis muscle. This poor little external rotator of the hip get’s owned from our sit in a chair all day lifestyle.
- In 80% of the population the Sciatic nerve passes under the Piriformis (left most pic)
- In 14% the Sciatic nerve branches through the Piriformis and under (middle pic)
- In 1-2% the Sciatic nerve just goes straight through the Piriformis (right pic)
(Thank you Ray Long, check out his excellent piece on this condition here)
You read that right by the way. In roughly 1 out of 10 people, the Sciatic nerve passes through their Piriformis. Also women are more commonly affected with a ratio of 6:1 to males.
You’d think that would hurt, but your body is a master at adapting, so this variant of anatomy may not actually bother you.
The Piriformis is a big player in how we walk and in the stability of our hip. When you place a foot forward your leg goes from external rotation to internal rotation, this lengthens the Piriformis. This stretching is followed by reflex contraction. A second contraction in the initially stretched piriformis muscle occurs when the opposite foot swings forward. This leads to Hypertrophy of the Piriformis (or an increased size). The enlarged Piriformis is taking up more space in your butt, which pushes it more into the Sciatic Nerve, which causes the inflammation and pain.
All of that above is just a really elaborate fancy way of saying, you need to use your butt when you walk. When your Glute Max is inactive when you walk (and I guarantee it is) you’re losing out on a huge player in Pelvic stability and now your Piriformis has to work its butt off because your butt is asleep.
How do you know if you’re Piriformis is pissed?
Jam a thumb around the area of those x’s around your butt. Chances are you’ll find a pretty tender spot quick.
Another way to notice is if your foot flares out when you walk.
See how her right foot (the foot on your left) is flared out to the side. If your Piriformis is hypertrophied and shortened in External Rotation, your foot rotate outward and reflect that. You’ll see this on a LOT of people by the way.
Now you know what Sciatica is, and how it occurs, and that was a lot of information so far. I’m also running out of Woah gif’s so let’s wrap this up with some Differential Diagnosis (DDx) and some exercises.
Now first and foremost, I’m describing some of the usual presentations of the following conditions. Please do not use this as a tool to diagnose yourself, you should seriously see a biomechanically trained Doctor (like a Chiropractor or Physical Therapist) to get assessed, properly diagnosed, and treated. Use this as a guideline of understanding, so that the next time your back hurts, or a friends back, you have a basic understanding of what’s going on and can make the proper informed decision on what do with your body. #getwokenotbroke
True Sciatica is nerve entrapment, so that means nerve pain. Nerve pain is usually described electric/sharp & shooting pain, numbness, and tingling. In the case of Sciatica/Piriformis Syndrome this can be the entire back of your thigh and down into your foot. If you feel like the back of your thigh is any of these it’s in your best interest to see someone about it. Nerve pain is pretty serious!
Another cause of numbness, tingling, and electric sharp shooting pain down the back of the thigh is disc hernations. It’s really important you get this kind of pain checked out ASAP to avoid further sensory and motor loss to your body.
If your pain is dull/achy then chances are you have something else going on. Dull/achy pain usually describes muscle/joint pain. It’s entirey possible that you have some Lumbar facet joint inflammation that can be referring pain down into your butt and even into the backside of your thigh.
One thing to have sit in the back of your mind is that pain is almost never the site of actual dysfunction. In your interconnected and beautiful moving body pain usually occurs as a signal for you to change something. Chances are something is going wrong elsewhere along fascial chains and the site of pain is from overstress on that structure from compensation. Find a Doc who will treat the cause, not just the pain.
Alright so now with all that juicy information you have about back pain, let’s do some stuff that will help reduce/keep it away.
Piriformis Syndrome/Sciatica/Back Pain Resources & Exercises:
Step 1: Get up and break your chair, sitting does your body no good and is said to be the new smoking of our generation. Try to get up and walk around for just a minute for every 20 minutes you’re seated. You can tell your boss/teacher your Doctor recommended it.
(Maybe don’t break it on someone though)
Step 2: Remove your wallet from your back pocket. This is a HUUUUUGE one! Ladies this doesn’t apply too often to you, but you if you know a guy who still back pockets his wallet, tell him to stop and get a front pocket wallet. His hips and pelvis will thank you eternity.
Here’s some additional resources:
- Before you do anything, you need to learn how to properly breathe
- Learn how to use your core & strengthen your back: Foundation Training Video
- Remove the restrictions from your Thoracic Spine and Ribs so that your back can better move: 3 Yoga Poses for Thoracic Spine Mobility
- Learn about how to use your butt: Get to Know Your Butt
Walk properly and with your butt:
- Your foot should land in this order: heel, big toe, pinky toe
- You foot should kick off with a heel lift then a press through the big toe
- Squeeze your butt on your back leg (any time your leg goes behind your torso your butt should be active).
To properly stretch your Piriformis and unlock movement in your Hip you need to Internally Rotate your Hip!
Yoga poses with Hip Internal Rotation:
- Active Pigeon (on the back straight leg)
- Deer Pose
- Revolved Triangle
- Supported Bridge (Puts Piriformis into neutral, relaxed position)
- Supine Twist (The Leg that goes across your body gets the Piriformis stretch, especially if you keep it straight and with a strap around your foot)
- Hero’s Pose
You’ll find that when you start bringing more internal rotation to your hips and strengthening your hip rotators in active postures, like Active Pigeon, that your back pain, knee pain, etc will start to resolve.
You can always an internal rotation dance
Sciatica is an interesting buzz word. You now know that it’s a nerve, the largest nerve in your body, and it gets entrapped and thusly inflamed. Most of the time this is because of the Piriformis, which we now know is a little bugger of a tender muscle. You can’t blame him though, it’s your butt and likely elsewhere on your body that are causing your Piriformis dysfunction.
You also know a bit about back pain and how to discern nerve from muscle pain. That way you can make an informed decision on what to do with it when you feel it.
Is it a electric, numb, and tingly like a nerve? Or dull/achy like a muscle?
Plus, you have a bunch of resources and exercises on how to use all your new info. So go out into the world my friends, move your body, and feel good when you do it!
This is the perfect metaphor to illustrate your emergence from back pain
I hope you had fun and learned a little in the process!
Until next time folks,