Sciatica Pain and Sciatic Nerve Pain Treatment
Sciatica pain treatment, prevention and rehabilitation guidelines for sciatic nerve pain relief.
by Brad Walker | First Published April 18, 2007 | Updated May 23, 2019
If you are reading this article you have probably experienced, or want to avoid the experience of sciatica pain. With the proper treatment and rehabilitation guidelines, sciatica pain does not have to linger.
What is Sciatica?
Sciatica is a name given to pain caused by pressure placed on the sciatic nerve. When a nerve is placed under pressure it sends out pain signals. It may radiate down the length of the nerve or be focused in a specific area. The muscles innervated by the nerve may or may not be directly affected.
Sciatic Nerve Pain Anatomy
The sciatic nerve runs from the lower back, down through the hips and buttocks, and along the back of the leg into the foot. It originates from the L4 through S3 spinal nerves. It innervates the deep muscles of the buttocks and hips. It also serves the muscles of the hamstring group, the lower leg, and some of the muscles of the foot.
It runs directly under (or in some cases around or through) the piriformis muscle, but it does not innervate this muscle. Any of the muscles that are directly supplied by this nerve can become affected.
Both the sciatic nerve and the piriformis muscle can be seen in the following diagram: The sciatic nerve is the yellow nerve running vertically down the middle of the leg; while the piriformis muscle is the horizontal muscle at the top of the sciatic nerve.
What Causes Sciatica Pain?
Sciatica has several possible causes. Any condition that puts pressure on the sciatic nerve can result in pain in the lower back, buttocks and back of the leg. The pressure may come from vertebral discs, bones or muscles. The causes of sciatica pain may be acute or chronic. A traumatic event may result in injury to the lower back or hip area causing pressure on the sciatic nerve through misplaced bones, spasm of a muscle or inflammation from the injury.
Chronic causes of sciatica may be due to muscle imbalances, misaligned bones, or narrowing space in the vertebrae. There are four conditions that most commonly cause sciatica.
- Piriformis syndrome is one common cause and is the result of the piriformis muscle putting pressure on the nerve. This may be caused by misalignment of the pelvis and/or hip joint, which changes the position of the piriformis, placing pressure on the sciatic nerve. This misalignment is often caused by muscle imbalances.
- Herniated discs in the spinal column can also put pressure on the nerve. A herniation, or protrusion, of the disc can result from a traumatic event or from years of pressure from muscle imbalances.
- A third possibility is Spinal Stenosis, or a decrease in the space between the vertebrae. This reduced space compacts the nerve where it leaves the spinal column. The narrowing is often caused by compression on the spine due to muscle imbalances.
- The fourth cause is Isthmic Spondylolisthesis, which is a condition where the vertebrae slips or moves out of position, pinching or placing pressure on the sciatic nerve. This may be caused by a traumatic event or a chronic muscle imbalance.
Muscle imbalances are a common thread through the four possible causes listed above. This makes treatment and correction of the muscle imbalances paramount in the recovery and prevention of sciatic nerve pain.
Sciatica Signs and Symptoms
Coughing, sneezing, squatting or extended periods of sitting can cause an increase in pain. The muscles that are innervated by the sciatic nerve may also spasm or cramp, causing additional pain. The pain in the lower back and hamstrings can also lead to inflexibility in the back and hips. Pain and stiffness in the opposite side may also result over time.
Common signs and symptoms of sciatica include:
- Pain – This pain can vary from dull, aching pain, to sharp, burning pain anywhere along the nerve pathway. It may be focused in one area or it may radiate the entire length of the nerve. It is often felt in the lower back and buttocks region, and often spreads down the back of the leg. The pain is usually only felt on one side.
- Numbness – This can also occur anywhere along the nerve pathway. Pain may be experienced in one area with numbness below it.
- Weakness – The muscles innervated by the sciatic nerve may become weak due to a decreased ability to send signals along the pathway.
- Tingling or “Pins and Needles” – This may be felt in the lower legs and feet.
- Cramping or Spasm – The muscles of the hamstrings or calves may spasm or cramp as a result of incomplete signals being sent through the nerve pathway.
Sciatica Pain Treatment
When sciatic nerve pain is caused by an acute injury the first step is to treat the injury. The R.I.C.E.R. formula (Rest, Ice, Compression and Elevation, followed by Referral) may be used for the first 48 to 72 hours. Reducing the inflammation caused by the injury will help reduce the pain. After the initial 72 hours heat and gentle massage may be used to warm and relax the muscles around the nerve. Once tolerated, some physical therapy or light exercise to improve the strength and flexibility the injured muscles may also alleviate some of the pressure.
Sciatica caused by a chronic condition requires a correction of the underlying problem that caused it in the first place. If it is caused by a bone displacement, then a correction or realignment of the bones will be required. If the pain is caused by a muscle imbalance the imbalance must be corrected. While the underlying problem is being fixed, non-steroidal anti-inflammatory medications can be used, along with ice, to reduce the pressure on the nerve caused by the inflammation. Later, ultrasound, massage and heat may also help to relax the muscles around the sciatic nerve, reducing the compaction on the nerve.
Correcting the underlying causes and taking the time to fully rehabilitate the muscles will help ensure proper healing. It will also reduce the chance of a chronic condition developing. Since the piriformis muscle is a common offending muscle it is important to work this muscle with physical therapy or strength and flexibility exercises. If the muscle remains tight and/or weak it will lead to additional problems in the future. Strengthening and improving the flexibility of the muscles of the lower back and hamstrings will also reduce the pressure on the nerve, as well.
Surgical intervention is rarely needed with this condition. It may be used to open the space for the nerve, but most people respond to rest and ant-inflammatory treatments within a few weeks to a few months.
Sciatica Pain Prevention
As the old saying goes, “An ounce of prevention is worth a pound of cure.” In the case of sciatica this is very true. Preventing the problem from developing in the first place will prevent the weeks of pain and possible debilitation while you treat and rehabilitate the injury.
- Always complete a warm up before doing any activity or playing any sport.
- Allow time to cool down properly after exercise.
- Strengthening the muscles of the hip will help to prevent injury to these muscles, which could place the nerve under stress. These deep hip muscles pull the leg outward and causes an outward rotation of the foot. Exercises that require the leg to be forces outward against resistance will help strengthen these muscles. Strengthening the lower back and hip muscles will help support the spinal column preventing injury there that might compress the nerve.
- Maintaining a good upright posture will help to relieve pressure on the hips and sciatic nerve.
- Flexibility of the muscles around the sciatic nerve is another common concern. Since these muscles are contracted in everyday activities they may stay shortened. Increasing flexibility in the muscles around the sciatic nerve will reduce the chance of injury. Get videos and photos of sciatica stretches here.
Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Wikipedia contributors. (2019, May 19). Sciatica, In Wikipedia, The Free Encyclopedia.
- Jones, O. (September 27, 2018). Muscles of the Gluteal Region. Retrieved May 16, 2019, from https://teachmeanatomy.info/lower-limb/muscles/gluteal-region/.
- Koes, B. van Tulder, M. Peul, W. (2007). Diagnosis and treatment of sciatica. British Medical Journal, 334(7607): 1313–1317.
- Davis, D. Vasudevan, A. (2019). Sciatica. StatPearls Publishing.
- Boote, J. Newsome, R. Reddington, M. Cole, A. Dimairo, M. (2017). Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro‐discectomy Surgery: A Nested, Qualitative Study of Patients’ Views and Experiences. Physiotherapy Research International, 22(3), e1665.
- Peul, W. van Houwelingen, H. van den Hout, W. Brand, R. Eekhof, J. Tans, J. Thomeer, R. Koes, B. (2007). Surgery versus Prolonged Conservative Treatment for Sciatica. The New England Journal of Medicine, 356:2245-2256.
- Samanta, A. Beardsley, J. (1999). Sciatica: which intervention?. British Medical Journal, 319(7205): 302–303.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.