It’s ok to admit it, we’ve all been there. With today’s technology it’s so simple to type a question into google and find a plethora of information at your fingertips. Knowledge is power, and it is definitely a helpful resource, however oftentimes we need reminding that it is supplementary information and we should use it wisely. One prime example is medical conditions, specifically musculoskeletal injuries. It can be important to use research articles and websites to increase your knowledge, expand your understanding, and better equip yourself for asking questions, however it can become problematic when it is used as a tool for self diagnosis. In this article we will discuss potential causes of sciatic pain but we always recommend that you seek qualified advice from a medical professional to discuss a formal intervention strategy.
You have likely heard the term sciatica used in reference to back pain, typically when that pain is also experienced down one leg. In some cases this description would be correct, however it is often misused. There are many causes of back pain, and believe it or not, sciatica is actually a symptom of an underlying condition, not a diagnosis in itself.
Sciatica refers to pain or neurological discomfort (ie.numbness, tingling, burning etc) experienced along the sciatic nerve. The root of the sciatic nerve branches out from the lumbar vertebrae in the lower back, joining into one thick cord that extends down deep to the muscles of the buttocks, travelling down the back of the leg to the heel and into the foot. This nerve pathway is the same on both sides of the body, however, typically only one side is affected at a time.
Your nerves are the muscle’s connection to the brain and this channel is needed for your brain to tell your muscles what to do. If the channel is disrupted, your muscles cannot function properly which may cause a decrease in muscle strength, reflexes, range of motion, and muscle size. True sciatica is caused by a disruption at the root of the sciatic nerve. This may cause pain, numbness, tingling, and loss of sensation down one leg, potentially all the way into the foot.
The lumbar spine is the lower portion of the spine. There are 5 vertebrae in the lumbar spine with discs acting as shock absorbers between each vertebrae. Vertebral discs are made up of a tough outer fibrous ring with a soft jelly-like center called the nucleus pulposus. A disc herniation is when the soft jelly center escapes through cracks in the tough outer ring. Herniations typically occur due to repetitive poor posture and improper bending and lifting techniques over a period of time.
Imagine a paperclip bent back and forth repetitively, what will eventually happen? It will break in half. Torsion through the discs has a similar effect, creating cracks of the outer ring, forming a pathway for the nucleus to be squeezed out from the centre of the disc, toward the back, with the potential to place pressure on and disrupt the nerve root.
It is important to know that only approximately 5% of individuals with a disc herniation become symptomatic. What this means is that many people may have a disc herniation that isn’t pushing on the nerve root yet, but are potentially one improper bend or lift away from sciatica. Additionally, 90% of patients have improvement of symptoms within 3 months of nonoperative care.
As we age degenerative changes (or arthritic changes) to the body take place at different rates depending on how you have treated your body. Factors such as, past injury, lifestyle, health and wellness, movement habits, posture, bending and lifting techniques, and genetics all play a role in how you age. You may not necessarily feel these changes as they develop slowly over time. Vertebrae themselves experience degenerative changes, as do the discs. Degenerative changes to the disc result in cracking as well as thinning of the space between the vertebrae. This may cause flare ups of back pain from increased load-bearing activities, or repetitive poor postures/movements may result in inflammation of the disc which can easily put pressure on the nerve root causing sciatica pain.
Lumbar spinal stenosis refers to narrowing of the spinal canal. The spinal canal is the space along your spine that the spinal cord travels through. A narrowing of this space can put pressure on the spinal cord itself, as well as the nerves as they exit the spine to supply muscles and organs of the body. Spinal stenosis can be caused by disc herniation, degenerative changes and bone spurs of the vertebrae, or traumatic spinal injuries such as fractures or dislocations.
Spondylolisthesis occurs in the lumbar section of the spine when a vertebra slips forward out of spinal alignment. Typically this is a result of either degenerative changes of the interlocking structures at the back of the spine (facet joints), or stress fractures to the boney archway at the back of the vertebrae that creates a protected tunnel for the spinal cord to pass through. When a vertebra slips forward there is decreased space for the nerves to exit the spine, therefore placing pressure on the nerve root resulting in sciatica pain.
There are a couple conditions that can mimic sciatica-like symptoms. There is a difference between nerve root impingement causing sciatica, and sciatica-like symptoms caused by disturbance/aggravation of the nerve as it passes along behind the hip/pelvis, or even potentially further down the nerve pathway. This is referred to as peripheral nerve impingement.
The piriformis muscle functions as a hip rotator and is found deep to the gluteal muscles (buttocks muscles). The piriformis originates along the edge of the sacrum and stretches out to attach to the top of the femur (thigh bone). The sciatic nerve runs under the muscle and compression to the nerve can occur if the muscle is injured/inflamed, with overuse, or increased muscle tension. This typically causes pain in the buttock region, potentially traveling down the back of the leg, generally stopping in the back of the thigh above the knee, but occasionally travelling the length of the nerve pathway. The discomfort may include other sciatica like symptoms, such as burning, tingling and numbness.
The sacroiliac joint (SI joint) is a long narrow joint at the back of the pelvis that connects the sacrum (base of the spine that also forms the back of the pelvis) and the ilium (large bones that form either side of the pelvis). This joint, functioning normally, should have minimal movement. Injury, or dysfunction, occurs when there is either no movement or an increase of movement at this joint.
You may have heard SI joint dysfunction referred to as your “hips being out of alignment”. Technically this is inaccurate. Your hip joint is where the femur (thigh bone) joins with the bottom of your pelvis. The hip joint is one of the strongest and most stable joints in the body and is actually very difficult to move out of alignment. In fact, the hip joint is where you should actually be bending forward from, not the lumbar spine or SI joint.
SI joint dysfunction is typical caused by landing heavily on one leg (either from height or from a stumble), twisting motions of the low back (such as golfing, racquet sports, dancing etc), bending and lifting repetitively through the low back in a C shaped spine, repetitive activities involving only one side of the body.
Irritation to the SI joint results in pain specifically at the SI joint, as well as often radiating pain, numbness, or tingling into the buttock region, or down the same leg/back of the thigh, typically not past the knee. This pain is aggravated by direct pressure along the SI joint, movements involving bending backward and rotating to the sore side, and static positions such as sitting, standing or lying down.
The most common cause of low back pain is muscle strain. Muscle strain or spasms in the back, which can mimic sciatica-like symptoms, are typically a result of poor habits, improper movement, and bending and lifting techniques. Why is this good news? Quite simply muscles have great blood supply and therefore excellent healing potential.
So what can we do about this common theme that typically back pain is a result of poor habits/improper movement and postures? We can train healthy movement habits to reduce back pain and improve your quality of life.
We believe Hinging at the Hips to be a crucial movement to protect and preserve the structures of the lower back. Hinging at the Hips allows you to maintain a neutral 3 curve spinal alignment instead of bending with a C-curve spine that stresses the discs, muscles and ligaments in your back. To perform a hip hinge, bend your knees slightly and push your buttocks back behind you as if trying to close a drawer as you hinge forward from your hips. Lightly engage your core muscles to maintain the 3 curve alignment.
As mentioned, it is always important to consult a medical professional for a proper diagnosis and treatment plan. As you can see there are many different causes of back pain, all with similar symptoms. However, no matter what your back pain and symptoms are, applying ice is a fairly safe and effective treatment. Ice can be a great natural anti-inflammatory. When icing, here are some simple recommendations:
STOP if:
90% of low back pain resolves within one year. Keep in mind that it is never too late to improve, or at the very least maintain your current physical capacity, preventing further discomfort or immobility.
