Approximately 70-80 percent of the population will experience at least one instance of low back pain in their lifetime. Others face sciatica, a term used to describe symptoms from the irritation of the sciatic nerve, the longest and widest single nerve in the body. It runs from the lower back, through the buttocks and into the lower limb. The sciatic innervates the entire back of the leg, from the hip to the toes.

The problem with the sciatic nerve from the anatomical perspective is that a large portion of it comes from the last two lumbar segments of the spine, near the two most frequently injured intervertebral disks (L4 and L5). When one of these two disks is injured, causing it to bulge out, it will commonly make contact with the nerve as it exits the spinal column. The L4 and L5 nerves supply feeling to areas of the lower legs and feet. Therefore, irritation of either of those nerve segments causes pain, numbness and/or weakness (the most common symptoms of sciatica). 

Tightness or overstretching of the piriformis muscle (located on the back of the hip where the nerve crosses under the deep hip muscles) can also cause irritation of the sciatic nerve. The problem most patients face when experiencing sciatica is determining where the nerve is being irritated. Further complicating the diagnosis, the piriformis itself can be injured or inflamed by various causes such as common muscle strain, injury to the sacroiliac joint, or even direct pressure from sitting on a wallet or falling.

Sciatica is often indicated by a pain that starts in the buttocks and shoots directly down the back of the thigh. As the symptoms worsen, the pain tends to go further down the leg and may progress to numbness, then to weakness or loss of reflexes in the Achilles tendon. The pain feels deep and sometimes throbbing. Treatments vary. Consult a range of medical professionals, including massage therapists, chiropractors, physical therapists and physicians. Possible treatments include:

  • Stretching or massage of the piriformis
  • Exercises for the treatment of disk issues
  • Manipulation of the sacroiliac joint
  • Electrical stimulation to decrease nerve symptoms
  • Oral or injected medications
  • Surgery (should only be considered as a last resort)

Again, I cannot stress enough that the most important step in treating sciatica is determining the cause of the symptoms. Signs of improvement include symptoms not going as far down the leg or a decrease in intensity.