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What is sciatica and what can be done about it?

At any one time approximately 3-5% of people may be suffering from nerve pain in the leg. Sciatica is a term for this type of pain that gets thrown around quite a lot but its meaning may not be exactly clear to a lot of people. What do we mean when we say you have ‘sciatica’, and better yet, what can be done for it?

Many people use the term sciatica to refer to any pain in the leg of unknown origin that they believe is coming from the back. Actually, sciatica refers to pain that is generated from the sciatic nerve, which is the big nerve that originates from five nerve roots in your back and travels down from your butt along the back of the leg. It splits behind the knee to form the tibial and fibular nerves. Pain on the front of the thigh is not sciatica. But pain on the side or back of the thigh, calf, shin, or foot could be.

The nerve can be made painful by a few different mechanisms. Compression can lead to inflammation within the nerve, making it very sensitive to movement. Or compression and/or inflammation can lead to damage to the sheath that surrounds the nerve, which exposes a new sensitive part of the nerve that can be easily stimulated. The compression can come from herniated disc material that presses on the nerve, narrowing of the spaces around the spinal cord due to bone growth, or from muscles that press on the nerve persistently, such as the piriformis. The pain can feel like burning, tingling, or electric shocks, and it is usually felt in a narrow band.

Although sciatica can be extremely painful, it generally does get better. One study reported complete resolution in 88% of people by 6 months. Another showed 67% having “good” outcomes by 1 year. And another showed 92% reporting “excellent” outcomes after 31 weeks. Nevertheless, it hurts and 6 months is a long time to simply wait and hope. In addition to taking medication prescribed by a doctor there may be a few exercises you can do in order to reduce your pain and get moving again.

The first step is to keep moving. Prolonged bed rest is no longer recommended as a treatment for back pain or sciatica. Do your best to avoid it, as prolonged bed rest can actually worsen symptoms and make them last longer.

Along the same lines, I recommend taking frequent short breaks to move your back around. Remember, the pain is due to compression and/or inflammation. Certain movements will be helpful in taking compression off of the sciatic nerve, and movement will also help to disperse some of the inflammation within or around the nerve. We’re looking for movements to reduce the leg pain or at least not reproduce it, even if it hurts your back. I usually recommend starting with 10 backwards bends every 30-60 minutes, but you may find forward bending works best for you. If neither seems to help, try the side glide.

Nerve mobilization exercises may be helpful also. They are meant to help the nerve move freely through and around tissues and within its own nerve sheath. They can also help disperse inflammation. There are a few choices, but in general we want to increase tension on the nerve in one area while reducing it at another. This will “floss” or “glide” the nerve. Here’s a few choices.

Slump slider

Supine nerve mobilization

“Retlouping”, named after the PT David Poulter

If you can weather the early pain of sciatica, it should continue to get better and these exercises can help reduce symptoms or take the edge off. Seek out a physical therapist to help you reduce your pain and determine which exercises are best for you. However, if you experience numbness, tingling, or muscle weakness that doesn’t improve after 4 weeks, you should see a physician.