Firstly Sciatica is a symptom not a diagnosis. It is a non-specific term commonly used to describe symptoms of pain in the lower back, glutes and various parts of the leg and foot.

The most common cause of Sciatica is a herniated or slipped disc in the spine. When a disc herniates, its gel-like inner material protrudes and presses against the nearby nerve roots, including the sciatic nerve. In addition to pain, which can be severe, there may be numbness, muscular weakness, pins and needles, or you may even have difficulty in moving or controlling your leg. In most cases the symptoms are usually only felt on one side of the body.

These symptoms can vary from feeling extreme pain in the lower back which radiates into your glutes and down the leg, to a mild sensation which is just a nuisance. You may even develop a numbness in the area, or a weakness in the leg. Pain often increases on exertion or bending forward, and has also been known to be triggered by coughing or straining. Some people’s pain is so severe that their lower back becomes locked in a sideways bending position caused by a strong contraction.

Alternatively, in some cases it may only come on when sitting or standing in a certain position with poor posture. Some symptoms are also associated with other conditions and syndromes which is probably why the the term ‘Sciatica’ is often misused as a catchall word for any pain affecting the glutes or other parts of the leg.

WHAT ARE THE CONDITIONS THAT HAVE SCIATIC-LIKE SYMPTOMS?

Piriformis Syndrome

As the sciatic nerve passes through the glute it goes through, or under, a muscle called the Piriformis. This muscle lies deep in the large glute muscles (Maximus and Medius) and is classified as a lateral rotator of the hip. It also plays a restraining role by controlling medial rotation during the initial phase of walking or running.

Tension in the Piriformis causes the muscle to press against the sciatic nerve which results in symptoms that are easily confused with those of a herniated disc. Such as pain and pins and needles in one or more areas of the lower back, groin, glutes, hips and hamstrings. There is also a chance that swelling can occur in the painful leg.

Piriformis syndrome can be aggravated in numerous ways such as sitting, standing, lifting or lowering heavy weights, even long drives in a car, all of which can result in the tightening of the muscle.

Iliopsoas Muscle Tension

I can’t think of other muscle that has so many different functions and that can cause so much pain!

It’s actually made up of two different muscles. The Psoas Major, which runs alongside the lumbar spine to the hip, and the Iliacus, which runs from each side of the pelvis joining the Psoas at the hip. Their main function is to flex the thigh, although the Psoas also assists in lumbar extension and spinal stability.

Tension in the Illiopsoas often causes pain in the lower back, either alongside the spine or across the back, and it’s often also felt in the front of the thigh. In general pain is worse when standing and remains as a nagging pain when you are lying down.

Prolonged sitting is attributed with being the main aggravator, but also sleeping with the hips flexed in the fetal position often has the same effect of shortening the muscles. Any rotation and side bending particularly when your core stability muscles are weak will also cause tension, as will tightness in the Rectus Femoris (quads) as that will prevent hip extension, which in turn will generate that unwanted tension.

Hamstring Syndrome

The hamstrings run from the crease of your bum to the back of the knee, with their role to extend the thigh at the hip joint and flex the leg at the knee joint. During standing and walking they work indirectly to help maintain an upright posture.

If you experience pain whilst walking, or pain in the glutes, upper thigh and back of the knee whilst sitting you may be suffering with Hamstring Syndrome. It’s mainly caused by constant pressure on the hamstrings, and it’s particularly problematic for people with short legs sitting where their feet don’t touch the floor. Children placed in high chairs without a foot rest can also experience the same problem. But unfortunately because the distribution of pain often follows the path of the sciatic nerve, many people are often misdiagnosed as having Sciatica.

Pseudo Sciatica

The Gluteus Minimus is the smallest and deepest of the gluteal muscles. It lies beneath the Gluteus Medius with its fibres running from the pelvis to the hip. Like the overlying Gluteus Medius, the Minimus has a split role in its function. The anterior fibres medially rotate the thigh whilst the posterior fibres assist in lateral rotation. All of the fibres contribute with each when it comes to abduction of the thigh. Whilst they also help to stabilise the pelvis.

The Gluteus Minimus lies close to the Piriformis, so the pain patterns are often similar, but pain in the Minimus will also pass down to the thigh and calf where as if you suffer with Piriformis Syndrome the pain will generally stop at the knee.

Doing too much too soon, such as walking or running too far or too fast, and even overuse injuries in sports such as tennis can cause pain in the Gluteus Minimus. Having a blister which alters your gait pattern can also cause issues, and if you drive a lot constantly holding your foot over the accelerator this can result in hip immobilisation, which again will also cause pain in the muscle. As will prolonged standing. Effectively any impingement or tension in the Gluteus Minimus will produce pain in a Sciatic like pattern.

IN SUMMARY

Symptoms of Sciatica vary from person to person, but more often than not simple treatments such as rest, gentle stretching and physical therapy can help. In more severe cases, medical interventions and surgical procedures may be required.

Once you understand where the pain is radiating from you can then decide on the appropriate course of action. But importantly, if you are experiencing persistent back or leg pain and no amount of rest or stretching is helping, it’s advisable that you consult with a healthcare professional for an accurate diagnosis, appropriate treatment and a plan tailored to your specific situation.

In a future blog post I’ll discuss the exercises and strategies that I’ve used personally, and with clients, to help them come out of the other side pain free so they can continue their hopefully, active lifestyles.