Butthurt
I’ll preface this article by disclosing that I’ve been fortunate enough to not experience sciatica first hand. However, following many hours of academic research, coupled with witnessing and managing (reminder: very important word for this article) numerous clinical cases, it is something that can not only impede performance in whatever physical activity you do, but also activities in everyday life. This article is not going to provide all the answers you need for sciatica, but hopefully give you a flavour of what sciatica is and where the current evidence stands with, so that you can apply your own thoughts and interpretations onto sciatica management.
If you’re unfamiliar with sciatica, here’s a definition by Fernandez et al. (2015):
Sciatica is a complaint believed to arise from a disorder related to the spinal nerve or nerve root, characterised by radiating pain in one or more lumbar or sacral dermatomes and is often accompanied by sensory and motor changes
Translated, it reads:
Sciatica is a condition caused by pressure or injury to the sciatic nerve or the roots of the lumbar nerves (L4, L5, S1, S2, S3), or narrowing of the intervertebral canal from enlargement of vertebral structures (otherwise known as ‘stenosis’). What you will feel is pain radiating around the glutes and back of your legs, and/or impairment of muscle function which the nerves are connected to – depending on the severity and location of the injury.
Anatomy
If you are unsure of the anatomical terms there, think of your home energy provider as your central nervous system, which is your brain and spinal cord.
The nerves branching from the spinal cord act as the electronic cabling that runs across the floors in your flat/house to supply power to several devices such as laptops, lamps, television, etc. These devices are the structures, such as skeletal muscle, skin, and many other soft tissues, that your nerves innervate to – to not only send signals to these structures but to receive signals to send back to the CNS.
Now think of how these will cease to function because their cables have become damaged because some unruly pet decided to chew through these cables near the socket and miraculously live another day. That, in my personal anecdote, is sciatica.
Unfortunately, there are numerous causes which result in sciatica. In the review by Fernandez et al. (2015), the condition is usually attributed to herniated intervertebral discs, but can be caused by lumbarspinal stenosis, spondylolisthesis (an anterior displacement of a lumbarvertebrae body from the vertebrae or the sacrum that lies below it).
However,the nerve can also be injured along its long course, where it travels from the glutes, behind the thigh, through the popliteal fossa behind the knee. The nerve then branches into the tibial and fibular nerves. The tibial nerve travels down from the calf region to the bottom of the foot and the fibular nerve travels around the neck of the fibula and the anterior compartment (figure 1).
Figure 1. Adapted from: Premkumar, 2004.
The signs and symptoms largely vary and are dependent on the location and severity of the injury. When the injury occurs near the spinal cord, the following voluntary actions can become compromised throughout the leg:
- Hip extension and abduction, via muscle atrophy and decreased tonicity.
- Knee flexion, via loss of innervation to the hamstrings.
- Dorsiflexion and plantar flexion, via loss of innervation to the tibialis anterior, peroneal muscle group, gastrocnemius and soleus. This may cause the foot to swing and drop, otherwise known as ‘foot drop’.
- Toe movement, via loss of innervation to toe extensors and flexors.
To add to this, there may be reduced superficial sensations in the outside of the leg, below the knee and at the foot. There may be a loss in proprioceptive function of muscle, tendons and ligaments at the joints, coupled by loss of autonomic functions such as temperature regulation.
Now that we have some background on sciatica, what do we do with it now?
The important point, as mentioned before, is to manage sciatica as best as possible so that you can live as pain-free as possible. There are numerous treatment interventions, such as anti-inflammatory medications, relaxation, immobilization, massage, exercise (WHICH DOES NOT ANGER AND IRRITATE THE SCIATIC NERVE), soft tissue mobilization and traction, which MAY permanently rid the symptoms of sciatica after treatment – but these are really case dependent.
Fernandez et al (2015) suggests both invasive (surgery) and conservative (massage, manipulations, anti-inflammatories, medications, exercise, etc.) interventions are suitable for treating sciatica. However, the findings from the meta-analysis suggest that surgery is better for providing short-term relief for disc herniated related sciatica than exercise-based interventions. However, exercise-based interventions are better for long-term and 2-years post-surgery for spondylolisthesis and stenosis related sciatica.
As a Propane Fitness reader and avid iron-enthusiast, what do you do?
If you do have sciatica…. While this may seem like a cop-out (and in some ways, it is – but hear me out), it’s best to have a professional in your local medical practice diagnose and identify the problem.
As I’ve mentioned before, the best interventions are case-dependent and having a professional address all components related to your injury (cause, location, severity, duration, etc.) will make your life much more manageable.
After you’ve done so, because you’ve already developed a sense of body awareness via RPE based training and nutritional interventions, you will most likely find ways to supplement your rehab program.
Recommendations for self-therapy
- Assess your posture. Posture is dynamic. Try to find what movement involved in your daily irritates your sciatic nerve.
- Assess your activity levels. Obviously, being involved in exercise, there’s some capacity of physical activity involved. You will also be aware of the activity levels required in both of your daily lives and occupations. This ties in with point 1. In short, don’t do too much but don’t stay sedentary. Find your Goldilocks-mode and go for a happy medium. A good rule of thumb is to ask: am I sore because I: trained today AND worked, didn’t train and worked, didn’t train or worked but walked, spent my day in bed and watched Netflix but rolled around the bed, or stayed in one spot all day?
- Don’t foam roll or perform any deep tissue work yourselves. If you were to seek some professional help, find a qualified massage/sports therapist who knows their anatomy and pathologies. Don’t be afraid to grill them on the subject – it’s your money that you’re parting with so spend it wisely. Musculoskeletal physiotherapists can perform the job as well – however, this is dependent on their history, knowledge and experience of the conditions.
- Fernandez, M., Ferreira, M., Refshauge, K., Hartvigsen, J.,Silva, I., & Maher, C. et al. (2015). Surgery or physical activity in the management of sciatica: A systematic review and meta-analysis. European Spine Journal, 25(11), 3495-3512. doi:10.1007/s00586-015-4148-y
- Prem kumar, K. (2004). The massage connection anatomy and physiology (1st ed.). Philadelphia, Penns.: Lippincott Williams & Wilkins.
About the Author
After being educated in Sports Therapy and Sport and Exercise Science (Sports Injuries), Chris is about to enter into a Masters in Physiotherapy. During his time in university, Chris has taken full advantage of opportunities to work with numerous professional clubs and national teams such as Edinburgh Rugby, Scotland Sevens and Academy age groups – alongside Sunday league and University sports clubs.
Chris is also a trained massage therapist and has worked with numerous private clients. He is currently an intern with the Scottish Rugby Union as a performance analyst – where he hopes to develop his love for Excel formulas, charts and other visual data skills. Chris is also a part-time athlete with the university ice hockey club and a former fat kid.