Sciatica, Pain Relief and Prevention

If you’ve ever experienced it you don’t need anyone to describe the pain of sciatica.  If you’re reading this, either you or someone you love suffers from it.  In fact, it’s a virtual certainty that at some point in their life, everyone will at least temporarily become personally familiar with the term "sciatica."

     Near the tendinous attachment of every muscle of every living thing is a group of nerve receptors called the golgi tendon organ.  When this bundle of specialized nerves senses that one of your muscles is being stressed almost to the breaking point, it will block signal to the motor nerves that power the muscle, in effect saying, "This far, and no more."  Ideally, the entire muscle will relax when you give up the stressful effort.  Ideally, but not always.  Sometimes, the system malfunctions, and a few motor neurons within a strand of muscle doesn’t receive the command to relax.  This knot of taut tissue is what medical practitioners call a trigger point.  Because the muscle can’t relax, it can’t receive oxygen or nutrients.  It can, however, still let the body know that it is hungry.  This asking for attention is what we call pain. 

     Sometimes, the request is a whisper…a nagging ache, an aggravation you’ve lived with for years.  Sometimes, the demand is a scream of agony, as intense as a bee sting or a toothache that will not be ignored. 

     Sciatica, pain that radiates down the leg into the feet, can be a combination of the two.  Too often, it feels like pins and needles prickling your calves or toes; at other times, the pain is a knife stabbing your hip or thigh or calf every time you lift your foot off the accelerator.  You intend to have it taken care of someday, when you have more free time…when you’re a few hundred dollars ahead of your bills…when you can afford to take a few weeks off.

     However, all sciatica isn’t created equal.  Axial sciatica arises from compression of the sciatic nerve before it leaves the spinal column; appendicular sciatica is pain caused by nerve entrapment by muscles deep in the posterior hip or the posterior thigh. 

     Chiropractic manipulation of the offending vertebrae can often eliminate the need for back surgery– in fact, surgery isn’t required in 95% of cases.  And a single session with a massage therapist will usually relax the hypertense muscle responsible for compression of the nerve.

    

 

ASSESSMENT TESTS

    

Straight Leg Test

     The Straight Leg Test (SLT) is a reliable method for identifying lumbar spine compression of the nerve root, and determining whether you should visit a specialist.  

     Here’s how it is done.  Sit on the edge of a chair.  With the knee extended, lift the foot off the floor.  The test is considered positive, but not definitive, for lumbar spine nerve impingement if:

1.     Sciatic pain is felt between 30° and 70° of hip flexion.

2.     Pain worsens with ankle dorsiflexion (i.e., toes are brought toward the body), slumping of the spine, or dropping the head toward the chest.

3.     Pain is relieved by bringing the knee toward the chest.

    

Piriformis Test

     Regardless of the result of the SLT, you’ll want to check for muscle impingement of the nerve.

     While still seated, pull the knee of the affected leg to your chest, and across the body to the opposite side.  Pain created by this hip flexion and adduction of the knee indicates that the sciatic nerve is being compressed by one or more of the six adductor muscles of the hip.  The most likely culprit is the piriformis.     

 

TREATMENT OPTIONS

     As previously mentioned, if the result of the SLT is positive, you should be evaluated by a chiropractor or a neurologist.  If, however, the SLT is negative for axial sciatica and the Piriformis Test is positive for appendicular sciatica, self-treatment might provide significant relief. 

 

To Treat the Piriformis

     The piriformis originates on the sacrum and attaches on the femur, making it roughly 3-4" long.  In about 25% of the population, the sciatic nerve passes through the piriformis on its way into the leg; in everybody else, the nerve passes beneath the piriformis.  When overstretched or overstressed, the muscle can develop one or more of the aforementioned trigger points and become hypertense; it can compress the sciatic nerve and interfere with nerve conduction and create the sometimes debilitating and sometimes merely aggravating, persistent pain of sciatica.

     To self-treat piriformis entrapment of the sciatic nerve, you can employ either a golf ball or a tennis ball (a golf ball, being harder and smaller, is preferable).  Lie on the floor with the ball positioned in the middle of the gluteus maximus (the butt) of your affected leg, and roll around on it.  When you find a tender spot, press into the ball and maintain the pressure until the spot is no longer tender.  Now roll the ball around until you find another tender spot– if there’s one piriformis trigger point, there’ll be at least one more (one close to the sacrum and two near the big bone in the thigh.  It is important that you remember this: to achieve relief, you must maintain the slightly painful pressure on the tender spots until they are no longer even slightly tender, which can take anywhere from a few seconds to a minute or so.

    

A BETTER CHOICE

     Rather than lying down on the floor, take your muscular aches and pains to a professional…to a board-certified, fully licensed massage therapist.  You needn’t suffer till you’re home for your days off.  To find a qualified therapist within driving distance, google AMTA and/or ABMP, and search the website for therapists who specialize in NMT/trigger point therapy.

    

 

PREVENTION

     As with all illnesses, treatment plays second fiddle to prevention.  You prevent colds by keeping your hands clean; by eating more of the right kinds of foods and less of the bad; by not allowing your body to become run down.  You prevent sciatica, which tends to restrict your movements, by moving more.

     The sciatic nerve passes through your posterior hip.  That sitting for long periods on your tush is bad for you is a fact attested to by desk jockeys, horse jockey, truck jockeys and the elderly the world over.  Try this experiment: Wrap your right hand around your left wrist, and squeeze.  Within a minute or two both of your hands will begin to complain (both, because both are being compressed).  You can’t sit on your hands and surf the internet, obviously.  But the big, round thing that holds up your pants in the rear and provides you with a soft cushion upon which to sit is also living tissue. 

     Prolonged compression of your wrist cuts off nerve and nutrients to your hand.  Likewise, as anyone who has ever been wheelchair bound for longer than a day can attest, prolonged sitting seriously interferes with blood flow into your legs and feet.  There’s a lot of padding back there.  So, you can sit around doing nothing for days, months, years without noticeable harmful effect. 

     Then one day you notice a little pinprick tingle in your lower body. You’ve noticed it before, certainly.  But a wiggle, an adjustment of your seated position, and it went away.  This time, it doesn’t.  Over the next weeks and months, the tingle gradually increases in intensity; it doesn’t go away even when you’re lying down and trying to sleep. 

     If you are sedentary and aren’t experiencing sciatica yet, it is a virtual certainty that it is in your future.  So, how can you prevent it from occurring?  You prevent colds by avoiding exposure; you prevent hypertonicity that limits the free flow of oxygenated blood into your bottom by getting off of it.  IOW, get of your butt, get out of your truck, and walk.  Walking is a great exercise.  A few minutes of Army basic training calisthenics is much better, but, seriously, is that something you will get into a habit of doing?  So, do get outside and walk…get to know your neighborhood.  

     And employ your imagination.  If bringing your knee to your chest or bending over to tie your shoelaces painfully stretches your hamstrings and hips, then you obviously need to stretch every day slightly beyond the onset of pain.

     Stretch tight muscles.  Stretch your shoulders in doorways, stretch your legs and hips by bending over to touch your toes, stretch your forearm muscles and your wrists and fingers.  Stretch and strengthen the piriformis muscle by extending your leg out to the side, as wide as possible several times per week.

     Those exercise bands sold on TV and in department stores? Use them to perform biceps curls, some knee extension– be creative.  Before you know it, the bands won’t be enough–you’ll get stronger.  Don’t throw them away: make then harder to pull by tying knots in them, making them shorter.  Be inventive.

     The important thing is that you get off your buns and MOVE.  And keep this in mind.  If you always stop after doing five push ups, the sixth one will always be killer-difficult; but when you can do ten, you’ll perform the sixth with ease. 

     You’ll own several computers, several automobiles in your lifetime.  You can’t trade your body in for a newer model: you must take care of the one you’ve got.