Sciatica pain screams, "Pay attention to me"

by Gray Kimbrell

Sciatica is something most of us have heard about or experienced. Sciatica is really a symptom rather than a diagnosis. It may show up suddenly or gradually as pain in the low back, hip or buttock area. It may also present as pain, tingling and numbness down the back of the leg. What you want to know is what it's coming from and how do you get rid of it!

Typically, the symptoms are pain radiating from the buttock and posteriorly and laterally down the back of the leg, usually on one side. Traditionally, sciatica was thought to result from pressure/compression on the nerve root, as it exits the spine and sacrum, and this can indeed be the case if the nerve root is compressed from a disc lesion. It can also be compressed by inflammation, when there is swelling in the area where the nerve root exits the spine. A third possibility is that it may be caused by trigger points in the muscles through which it passes along its route of travel.

Clinical experience demonstrates that posture is often associated with sciatica, such as maintaining a poor posture either at home or work for long periods of time, i.e., sitting on your wallet in the car for hours on end (wallet syndrome), or sitting in front of a computer all day. A sub-luxation, (misalignment of the joint) and resultant loss of motion in a joint complex may also trigger pain as well as spasms/strains of muscles through which the sciatic nerve passes. Anything that impedes the flow of signals along the nerve or irritates it may contribute to symptoms. It's like a water hose. If you kink the hose it impedes the flow of water, right? Same thing with the nerve, if we get rid of the source of irritation, we get rid of the pain.

The sciatic nerve also glides as we move. If there is impingement of that gliding/sliding as we ambulate due to adhesions within the muscles, sciatica is a real possibility.

As mentioned before, one possibility is disc derangement. The disc may be bulging and pressing on the nerve or there may be a true hernia-tion. That means there is a tear in the outer fibrous ring of the disc, with the inner disc material extruding from the tear and pressing on the nerve. This latter is sort of a worse case scenario. The good thing to know is that in most cases the body will heal itself given time.

Studies have also shown that many people over 30 have one or more discs bulging and no symptoms!

Normally there is plenty of room for the nerve roots here and .elsewhere in the spine to exit through the intervertebral foramen (a foramen is just a fancy word for a hole). The nerve root takes about a third of the space.

That leaves two thirds for the blood vessels and fatty tissue, which cushion and protect the nerve root. If you add in inflammation, you may get pressure on the nerve root itself, which it doesn't like. The symptoms follow.

Trigger points in muscles associated with the sciatic nerve as it passes through the hip and buttocks may also cause symptoms. One such muscle, the piriformis, a lateral (or outward) rotator of the hip is one of the more common offenders. As the sciatic nerve passes through the buttock it goes through, within or under the piriformis. Contracted areas (trigger points) in this muscle can exert pressure on the nerve leading to sciatica. If the range of motion of the SI Joint (between the spine and pelvis) is hindered due to sub-luxation this will affect the biome-chanics of the pelvis, and can also be a contributor.

It is important to distinguish whether the source of the pain is coming from the piriformis, the SI joint(s) or a combination of the two. Since the piriformis inserts onto the front side of the sacrum (the triangular bone on the back of the pelvis), it may cause dysfunction in the joint complex if it is held in sustained contraction. That may also lead to symptoms.

OK, so how do I deal with this!? The first logical step is to take care of the source of the problem. Given this, the body will usually take care of the rest.

A good first step would be manual medicine such as chiropractic and/or deep tissue work (massage). This works the affected area to release myofascial adhesions/tension so that the involved muscles can be restored to their normal resting length, and so that they can glide and slide over each other as they are designed. This also should address any joint play restrictions in the pelvis or lumbar spine that cause mechanical low back pain and sciatica. Stretching and icing the affected body parts would also be an important self-care part of this treatment plan.

A good practitioner may be able to work with you in restoring your structural health through several visits over a two- to three-week period, depending upon the severity of the condition. If after a reasonable trial of manual therapy such as this, the issue is unchanged, imaging such as MRI may give a more definitive diagnosis. Research has also shown that even if it is a disc lesion, the body can heal itself over time without surgical intervention. There are of course exceptions. In some cases surgery may be necessary, but it is valuable to know that three of the primary considerations for surgery are: intractable pain, loss of bowel or bladder function, and muscle weakness (loss of strength in the
affected limb).

This is a common ailment with many different manifestations, from mild to severe. If yoi start to experience sciatica, pa] attention to it. Your body is telling you something. If it is addressee early on, it will be resolved much more quickly. Stop doing thing! that aggravate it, do some stretching and ice the affected area three to four times a day. If that doesn'l take care of it in short order, get in and get some work on the area to get the muscloskeletal system normalized. It's just like your car (except you can't trade it in for a new one). When it isn't running well you take it to the mechanic, right?

Gray Kimbrell, DC, is a Certified Advanced Rolfer.