Bones, joints, and muscles

Sciatica: what causes it and how to treat it effectively

By Robert V. Duvall, DPT, MPT, ATC, MGFI
www.losethebackpain.com

If you're reading this article, it's a good bet that you have a radiating pain running down the back of your leg that just won't go away. If what I'm about to tell you sounds familiar, don't worry, help is on the way.

I guarantee you that what you are about to read will likely be far different than what you have read or heard anywhere else!

First, let me tell you why today's traditional treatment methods for sciatic nerve pain just flat out miss the boat. The medical community is often times so conditioned and focused on treating only the symptoms that they fail to address the cause of the problem. That is why I wrote this article, the more educated you are about your body, the more likely you are to get the best results and the fastest relief.

To get rid of your sciatica once and for all, you must first know what is causing your pain. There are four primary conditions that can cause sciatica. But, just knowing your condition is not enough, you need to dig down one more level of reasoning and that is to find out why you now have one or more of the four conditions.

As you read on, you will note a common theme. That common theme is the key to your success for quick and lasting relief.

Piriformis syndrome

The most common cause of sciatic pain is created when pressure is placed on the sciatic nerve by the piriformis muscle. Muscle imbalances ull the hip joints and pelvis out of place and this changes the positioning of the piriformis muscle, which then places pressure on the sciatic nerve.

Simple right? So, if you believe that, than I ask you what good does treating the symptoms do to get lasting pain relief? In my opinion, none, and most likely that is all you have done. Just one more quick question did any of your health care providers check you for muscle imbalances? If not, the help I promised is here.

Through defining Piriformis Syndrome, we have identified the first mention of muscle imbalances and what I believe to be the root cause of Sciatica.

What the heck is a muscle imbalance anyway?

When one muscle overpowers the opposing muscle or when there is a difference in flexibility of opposing muscles or a combination strength and flexibility, a patient is said to have a muscle imbalance.

Think Tug-of-War.

When your muscles are out of balance, they pull your bones and joints out of their normal position and this places your muscles, bones, and joints under constant stress and uneven pressure.

For example, the proper position of your hips and curvature of your spine are determined by numerous muscles and whether these are balanced. There are over 640 muscles in the human body, and everything we do affects them, from sitting too much to playing the sports we love, and if just one of these muscles is out of balance, you're in trouble.

Let move on to the other three conditions and let me show you more of the common theme.

Herniated discs

Pressure caused by a herniated or bulging disc can cause sciatica. A herniation is when a disc protrudes from between the vertebrae and this can either be caused by an event like a car accident or by months or years of uneven pressure due to muscle imbalances. This can sometimes cause sciatic pain, but it is also important to note that many people with herniated discs don't even experience pain or symptoms and many don't know they have the condition.

Strange but true, I believe that is has to do with the degree and extent of their imbalances.

Spinal stenosis

Pressure caused by Spinal Stenosis, which is a narrowing of the space within the spinal canal. If you have sciatica from spinal stenosis, there is a good bet that your muscle imbalances are pulling your hip and spine into an abnormal position causing the contact which cause the pressure.

Isthmic spondylolisthesis

Pressure caused by Isthmic Spondylolisthesis, which is simply when a vertebrae slips or moves, can sometimes pinch the sciatic nerve but often times people who have this condition don't have any sciatic pain, symptoms, or even know they have it!

As you can see, there is a trend here...

In nearly every case of sciatica, muscle imbalances are the primary cause of the pressure being placed on the sciatic nerve.

But how do muscle imbalances develop? They develop as the result of either a traumatic event, through a long process of lifestyle choices, or through a combination of both.

The event scenario is most likely the catalyst for sudden onset of sciatic pain. So what happens? When there is undue stress on the piriformis muscle, that stress causes the muscle to go into spasm: you have pain due to the piriformis muscle's putting pressure on the sciatic nerve.

In most cases, people go to physical therapy or minimize their physical activity to break the pain-spasm cycle and in most cases, their symptoms subside. However, the event will also set them up for a lifetime of sciatic pain if the piriformis muscle does not recover 100 percent in both strength and flexibility.

When you have an injury to a muscle, both strength and flexibility are compromised. If your recovery ends (meaning your effort) before strength and flexibility return, you may never be 100 percent again and will likely struggle with the problem throughout your life.

Lifestyle and habits influence the way sciatic pain creeps into your life, and that is what we like to call the process. The process can be described as a prolonged onset of symptoms based on your everyday activities.

However, from a technical standpoint, the process really describes the development of the muscle imbalance in your hip. The piriformis muscle is responsible for external rotation (moving your leg so your feet point outward). So over time, that muscle gets tight from the positions you put yourself in and it weakens from lack of use.

Let me give you some examples of what I mean:

1. If you sit on the edge of your chair with your legs separated and your feet pointing outward you are keeping your piriformis muscle in a shortened position. That's how it gets tight, and with extended sitting in that position, it gets weak form lack of use. Hence the imbalance!
2. Another example are the runners and bikers who actually work very hard; they tend to get sciatica because they fail to keep a strength vs. stretch balance in their workouts. The imbalance creates a greater pull toward external rotation and the result is a tight piriformis and an irritated sciatic nerve that causes pain.

These are just two examples of how muscle imbalances can affect the piriformis muscle and cause sciatic pain. You may not be a runner or cyclist, but I'll bet you have muscle imbalances that are causing your sciatic pain!

So how do you get rid of your sciatic pain?

If you are not sure which one of the four conditions is causing your sciatica, I recommend you start with the basics. Most cases of sciatic pain are caused by muscle imbalances, so if you begin to work on correcting any muscle imbalances you have, you should start to see improvement right away and will likely eliminate your sciatic pain in a few weeks or less!

Will learning one new stretch be enough? It very well may be. However, depending on the severity of your condition, you may need to change your daily activities to include new stretches — new exercises that include the use of the hip rotators (e.g. inline skating, basketball, tennis, etc.) and even better, specific exercise intended to correct your imbalances appropriate for your situation.

As always, learn as much as you can about your condition so that you can put the tough questions to your healthcare providers and get the best care possible.

For more information on sciatica and how to treat it effectively, read the latest Sciatica Advisory from The Healthy Back Institute.