Pretty much everyone I know has either had, or has known someone who has had sciatica. I’ve certainly treated my fair share of patients with sciatica, also known as sciatic nerve pain. And if you’re reading this, you likely know how debilitating the pain can be. Not only is the pain bad, it’s also unnerving to have it run down your back of your leg.

So what is Sciatica?

Sciatica refers to irritation of the sciatic nerve, which can cause pain in your backside that can run down the back of your leg. The sciatic nerve is the largest nerve in the body. There are a bunch of nerves in your lower back that come from your spine, and combine together to form the sciatic nerve. Basically, the sciatic nerve is largely responsible for the muscles in the back of your thigh and leg, and for the sensation to those areas also. The irritation can be from anything, but if the sciatic nerve is irritated, you get sciatica.

What causes Sciatica?

So we know that sciatica means that the sciatic nerve is irritated, but what causes it? Well, anything that can compress the nerve as it leaves your spine and goes through the muscles in your backside can cause it. 

A herniated or slipped disc can put pressure on some of the nerves leaving the spine that form the sciatic nerve, and cause sciatica.

Arthritis of the lumbar spine, also known as spondylosis can compress the nerves leaving the spine that form the sciatic nerve, and cause sciatica. A similar term that you will hear is spondylolisthesis, which is just a fancy way of saying that one vertebrae is slipping out of place with the vertebrae either above or below it. Spondylolisthesis can also cause sciatica.

The sciatic nerve travels right underneath the piriformis muscle. A tight piriformis muscle can squeeze the sciatic nerve and cause sciatica, this is also known as piriformis syndrome.

One of the nerves that make up the sciatic nerve travels right near the Sacroiliac joint, which is the joint where your spine connects to your pelvis. If there is inflammation in this joint, it can affect the  nearby nerve and cause sciatica.

Very rarely, a tumor or mass could be pressing on the sciatic nerve and causing sciatica.

What can you do about it?

Sciatica is a symptom, so to treat it, you need an accurate diagnosis as to what exactly is irritating the sciatic nerve, whether it be from a herniated disc, arthritis of the spine, a tight piriformis muscle, or an inflamed sacroiliac joint. Your doctor can help you figure out what is wrong so you can target your therapy, so you can get better. If the cause of sciatica is from a tight piriformis muscle or from irritation of your sacroiliac joint, then the first step is to work with your physical therapist to do piriformis stretching, core strengthening, and sacroiliac joint stabilization exercises. If you don’t have access to a physical therapist then you will want to do these exercises and stretches on your own. If the cause is coming from a herniated disc, just know that discs most resorb with time, so this may be something that you can wait out. If the cause is from arthritis of the spine or spondylolisthesis, then you should exhaust all non-surgical options before considering surgery, which is a big deal. Lastly, anti-inflammatories such as ibuprofen and strategically placed steroid injections may give you good relief, and can compliment any treatment plan.

If you have any questions that I didn’t answer, feel free to contact me to learn more about your sciatica, and what you can do about it.

-Written by Dr. Daniel Paull