Is It Really Sciatica? Focus on a Diagnosis, Not the Symptom.
“I hurt my sciatica.”
“Doctor says I’ve got a sciatica.”
“I know this pain, I used to have sciatica”
Sciatic nerve pain is among the most over, and often self, diagnosed of common aches and pains. Because I often hear some variation of the above, I want to share why sciatic pain is so misunderstood, what causes it, and how “sciatic-like pain” can be corrected.
First things first, everyone has a sciatic nerve, it runs from the middle of the glute all the way down into the foot. But sciatica is not a diagnosis, it is a symptom of an underlying problem. Those problems are most often in the lower back and caused by slipped or herniated discs (L4, L5, S1).
When someone typically describes “sciatica,” they are explaining a pain, numbness, or tingling sensation running down one or both of their legs (but most commonly one). What’s happening is a nerve root in the person’s back has become unstable or irritated. The sciatic nerve then allows this sensation to travel. When there is degeneration in the discs affected, there are also inflammatory proteins released that can further irritate the nerve.
In short, Sciatica is not something you “have,” it is a symptom of a greater issue.
Sometimes the greater issue is a slipped or herniated disk. Other times, it is an issue that is mimicking sciatic, like Piriformis Syndrome.
The piriformis is a small muscle deep in the glutes that attaches to the base of the spine and high into the femur. It functions to assist with hip rotation and helps turns the leg externally. The sciatic nerve runs along and beneath the piriformis, and in about 15% of people the nerve actually runs through the piriformis.
Piriformis Syndrome is caused by tightness of the muscle, muscle spasms, tightness as a result of injury, RSI (repetitive strain injury), or when there are muscle imbalances and altered arthrokinematics that result in less efficient movement patterns that put additional stress on secondary postural muscles.
It is important to be able to tell the difference between mimicking syndromes like Piriformis and sciatic nerve issues caused by lower back disk injury.
There are a few tests that you can conduct at home to decide what your best course of action is. But, I offer these as something that should convince you to go see a physician, not as reason to “tough it out,” take a muscle relaxer, or otherwise self-treat or medicate.
The straight leg test is a primary evaluation often used by physicians to diagnose issues that would cause Sciatica.
First, lay flat on your back and have a friend or family member slowly lift the affected leg upward while keeping your knee straight. If there is pain down the back of your leg, specifically below the knee, that is considered a “positive” test.
To confirm this, repeat this test on the opposite (unaffected) leg. If you are still getting pain down the affected leg, this is only more evidence that there is a sciatic nerve problem. It is indicative of a larger issue in your lumbar and you should contact your physician.
If You Pass the Straight Leg Test….
Just a reminder, I’m not a doctor. If you feel pain and are worried that something is wrong, I encourage you to seek out the advice of your physician!
However, if you pass the straight leg you most likely have something like piriformis syndrome or even just tight hip flexors.
For that, I recommend a gentle stretching routine. This will help loosen up and mobilize the surrounding tissue to restore pain-free motion.
The first movement I suggest is a glute stretch. You may do this on your own or with assistance.
First, lay flat on your back and bend both knees so your feet are flat on the floor. Take one leg and place the ankle over the opposite knee. Now lift your leg and pull the knee toward your chest. You should feel a nice stretch in your glutes (your butt). Hold this for about 15 to 30 seconds. Switch legs and repeat two to three times.
The next movement is another glute stretch. Sit on the floor and extend both your legs out to the front. Cross your affected leg over the unaffected leg and hug it to your chest. Once you are hugging the leg, sit up straight lifting your collarbones. You should feel an even larger pull in your glute. Hold this for 15-30 seconds, switch legs, and repeat 2-3 times.
I am not going to recommend any foam rolling for those with “sciatica-like” symptoms. Foam rolling risks putting extra tension on muscles that are irritating nerves.
Again, I can not emphasize this enough — please be careful and consult with your physician before you commit to any specific workout program or rehab protocol. Be upfront and objective about the issues you are facing. Do not let anyone jump into rehab protocols that does not fully understand what is happening.
There must be open and clear lines of communication between yourself, your doctor, and your trainer/therapist. But that is a two-way street — they are not mind-readers. Feel confident and empowered to discuss the issues facing your body.
Helpful tips to avoid sciatic/piriformis irritation:
- Stretch your glutes, hamstrings, and hip flexors regularly
- Be sure to keep up with your shoes, it is recommended that you change your shoes every 6 months depending on use.
- Do not leave your wallet in your back pocket when sitting down
- Use your legs when lifting, never your back
- Change your postural position frequently (If sitting, stand. If standing, sit. Rinse. Repeat.)
Have “a sciatica” or sciatic-like pain? Schedule a free fitness evaluation and one of our trainers can determine if corrective personal training could alleviate the issue.