Experiencing sciatica can feel lousy and frustrating. But don't feel like all hope is lost! There's quite a lot you can do at home to manage it. Let's go through the basics of some sciatica presentations and then we can discuss how to treat it. Sciatica is essentially when the sciatic nerve is under tension causing pain down the back of the leg. The two most common places for this to happen are where it travels past the hip muscles or at the nerve root of the lumbar spine. Bear in mind, you can have a combination of the two. This blog will be focused more at the hip as this is far more common. There has been a huge paradigm shift in physio and medicine that has shifted from blaming 'disc bulges' for everyone with sciatica because 50% of people over the age of 40 have a disc bulge without even realising it.
There is a little window in the pelvis where your sciatic nerve runs and there's a muscle called the piriformis that shares this 'window' with your nerve.
When this space gets narrowed, sciatica can be the result. Easy to understand right? So the question you should be asking is what are the main factors that could cause a narrowing of this window? This is where it's a bit harder to give a straight answer but I'm happy to explain some of the common drivers.
YOU MIGHT BE TUCKING YOUR PELVIS
Your pelvis works with the rest of your spine. When you have an extended/open torso, the pelvis will sit in its natural position and have a nice open window for your sciatic nerve. However when your torso is flexed, the way the body keeps you upright is by tucking the pelvis under you which can thereby narrow that window. This is really common in truck drivers or people who spend a long time sitting. If this sounds like you, you can stretch/massage your hip but it likely won't have much effect until you look a bit higher up.
2. TOO MUCH TONE IN THE BACK OF YOUR HIP
When the hip muscles have too much stress placed through them, the tone of the muscle can start to trigger the sciatica. This is a common problem when people have been told to 'tighten their glutes' or may have been using power lifting lifting styles at the gym which focuses on 'clenching the bum'. If this sounds like you, your first port of call will be to go and lie on a spikey ball to work on some hip mobility. You'll then need to work on keeping your hips wide when you squat or train. This is common with strength training, ballet and Pilates. This can feel weird at the start but I promise if you keep using your hip muscles they'll keep getting stronger (just in the right way).
3. IT MIGHT BE COMING FROM YOUR FOOT
When your foot and ankle gets stiff it changes how your hip moves. What often happens is the body will start to turn the leg out and bring the hip forward to compensate. This can then shorten the piriformis and trigger sciatica. This can be common if you've had an old knee, ankle or foot injury on that leg.
But what if it is coming from your low back?
Don't get me wrong, nasty cases of sciatica can definitely stem from the low back. If you've had an MRI or CT scan done and there is a disc bulge impinging the nerve root this can definitely be the cause. If this sounds like you, it generally resolves within 12 months naturally as the body naturally resorbs the disc. There's a small percentage of people where the disc can calcify which complicates the recovery. Cortisone injections can serve as effective pain relief in this case and I'd highly recommend reading this blog to understand how to manage a low back injury. The cause for worry is if you get weakness in the leg (ie. you start tripping over objects or can't walk up stairs) as this is when you might need an appointment with an orthopaedic surgeon. However, if there's a disc bulge without nerve root impingement you're probably in the 50% or so of people with normal age related changes. I'll add the statistics below.
If you'd like to learn more about integrative physio watch this quick video.
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Brinjikji et al (2015)