Why you have sciatica
Sciatica (sciatic neuritis) is a pain in the butt! We see it in our Boynton Beach office all the time. It involves chemical inflammation of the sciatic nerve which originates in the lumbar spine and runs down the back of the leg, all the way to the foot. The chemical inflammation is typically created through a physical disturbance of the canals in the body that the nerve runs through. The most likely physical disturbances are in one of the two following locations:
- Intervertebral foraman of the lumbar spine (the spot where it exits the spinal column)
- Piriformis muscle in the back of the hip
The physical disturbances can be caused by any number of the following:
- herniated disc
- bulging disc
- sacroiliac joint dysfunction
- instability of the lumbar spine or pelvis
Most of these conditions develop over time as opposed to from a single violent mechanism. It might have been a specific event (picking up a pencil, moving a couch, etc) that pushed you over the edge, but more likely than not, the descructive factors have been building for years.
Sciatica Predisposing Factors
1. Poor Hip Flexibility - Sometimes people are born with poor flexiblity in their hips as a result of their anatomy. The shapes of their hip and pelvic bones just don't lead to great movement. The majority of us, on the other hand, just don't move our hips enough in all the different ranges of motion to maintain proper flexibility. As a result, when you move your body, since the movement isn't coming from the hips, innapropriate and excessive motion will occur in the lower back and pelvis, which will lead to lower back pain.
2. Inflexibility of the Shoulders or Upper Torso - When there is a lack of flexibility in the shoulders or upper torso, and a movement of the arm is made, abnormal stresses are placed upon the lower back and pelvis. The lower torso isn't designed to rotate very much, but in the absence of proper upper torso flexibility it's forced to. That leads to excessive tension and stress on the lower back.
3. Poor Core Stability - Based on the explanation provided for the first two factors, an environment of excessive movement takes place in the lower back. That overburdens the lower back muscles leaving you with a feeling of tension, stiffness, or tightness. In reality that whole environment only occurs because of too much movement in the lower back and inadequate control.
Sciatica Treatment Options
Beyond an orthopedic and range of motion testing to the immediate structures involved in the injury, the second aspect to look at is what predisposing factors are at play. Once found there would be a combination of:
1. Joint Manipulation to any joint restriction in the spine or hips (performed by a chiropractor or trained physical therapist).
2. Soft Tissue Manipulation to any adhesion, scar tissue, or imbalances in the musculature surrounded the hips or low back. The treatment options involve Active Release Technique (ART), Graston Technique, Trigger Point treatment, muscle energy techniques, etc.
3. Exercises aimed at retraining the movement and control of the body at the upper torso, low back, and hips. Typically involving increasing the upper torso flexibility, hip flexibility and pelvic/lower back control.