NOTE: Please be aware that causes of sciatic pain are numerous and some causes may be serious. It is best to have a licensed physician diagnose cause of sciatic pain before seeking treatment.
What is Sciatica?
Sciatica is not in and of itself a singular pathology. Sciatica or, more appropriately, sciatic pain is an uncomfortable nerve pain in the low back or posterior hip. The pain can travel down the back side of the leg and may extend all the way to the foot. The pain may be described as a burning or sharp pain, as a shooting pain, or even as an electric shock. Very often, sciatica produces muscle weakness, numbing, or tingling. Interestingly, pain, weakness, numbing, and tingling, may not be continuous all along the nerve path. Some parts of the nerve may not display any symptoms at all, yet may appear again further down the leg. Typically, sciatica occurs on only one side of the body. However, sciatic symptoms may be occur in both legs at different times for different reasons.
An assessment must be made by a qualified physician to determine the cause of sciatic pain. Often, this includes radiologic imaging — Xray, CT scan, or MRI — to determine the condition of skeletal framework of the lumbar spine. An in-depth history is taken, some orthopedic testing may be done, some form of functional movement screen may also take place. How the pain acts is often used to assess sciatic pain. From an orthopedic viewpoint, the further the nerve pain travels, the more serious the cause is likely to be. However, this is a simplistic statement and is oftentimes not very reliable for assessment purposes.
Conventional medicine usually looks at the condition of the vertebral bodies and discs of the lumbar spine (see “Anatomy” below) as the cause for sciatica. Doctors look for bulging or herniated discs, bone spurring, stenosis, and lysthesis to cause damage to, inflammation of, or compression of the sciatic nerve roots.
Other causes generally turn out to be compression or entrapment of peripheral nerves by muscles, tendons, and other soft tissues along the nerve path. Most often, this turns out to be the piriformis muscle, located deep in the buttock. In most people, the sciatic nerve passes beneath the piriformis. In a minority of the population, the nerve actually pierces through the piriformis. If the piriformis is tight, inflamed, or in spasm, it can compress the nerve and cause sciatic pain. In this case, the pathology can be termed “Piriformis Syndrome”.
Roots of the sciatic nerve originate in the central nervous system descending the spine. These roots exit the spine through several outlets, from the L4 vertebrae in the lumbar spine to S3 in the sacrum. Sciatic roots then bundle together deep in the buttock, then run outward and downward. The sciatic nerve then runs beneath or, in some people, through the piriformis muscle. Piriformis itself attaches at the side border of the sacrum and again at the greater trochanter of the femur. Below the piriformis, the sciatic nerve exits the pelvis through the greater sciatic foramen, then proceeds beneath the gluteus maximus and down the back of the leg between adductor magnus (on the inside thigh) and the hamstrings before splitting into two large branches just above the knee — the tibial nerve and common peroneal nerve.
What Can Be Done?
True sciatica will likely require invasive surgery, although which surgery depends on what injury or abnormal growth has taken place within the skeletal structure. Other causes of sciatic pain may be approached by manual therapy to loosen tight structures, downregulate overactive neural activity, align the skeleton and pelvis through soft tissue and spinal segment manipulation, and muscle retraining.