Treatment of sciatica

“True” sciatica

‘True’ sciatica is caused by nerve compression or irritation at the nerve roots, due to a herniated disc or wear and tear in the lumbar spine. A herniated disc can result from prolonged misalignment and wear or trauma. When the vertebral column is misaligned, the disks between the vertebral bodies can deform, causing one disk to break and its softer core to bulge and press on the spinal cord or a nerve root. This can cause irritation and severe pain, starting in the lower back and radiating down the leg and into the foot. A sudden, intense cutting pain may come and go, but also a constant aching pain. The pain is often worse when you sit a lot. There may also be numbness, loss of sensation, muscle weakness in the leg, foot and toes, as the nerve supplies muscles, tendons, skin etc. down the whole leg. Standing on your toes or heels can be a problem and cause numbness in the skin along the leg.

“True” sciatica is thus due to nerve compression, at the top of the “nerve roots” and thus the vertebrae and pelvis must be corrected to balance the load, and thus be able to relieve the pressure, which causes the pain. This type of sciatica is a more serious condition, as herniated discs in the back take longer to heal, and it is important that the vertebrae and pelvis are evenly loaded in order to heal. As the disc heals together, the bulging nucleus will dry out, allowing the bulge to disappear and the pain to stop.

False sciatica

False sciatica is instead caused by compression of the peripheral parts of the sciatic nerve, not at the nerve roots themselves. It can be caused by a rotated pelvis, cramping glutes, a locked sacroiliac joint or other muscular problems in the back and glutes with impaired circulation and oxygen supply.

A common cause is a cramping of the gluteal muscles, including a cramping of the piriformis, a small muscle that helps the gluteal muscles to extend the hip joint. The sciatic nerve passes near or through the piriformis (in 20% of the population). A cramping piriformis, the piriformis syndrome, can occur, for example, with oblique loading, oblique rotated pelvis and a too short hip flexor, which overstresses the piriformis.

The hip flexor muscles, the iliopsoas, are powerful muscles that are often shortened when you sit a lot and when you do not stretch them in between. The extensor muscles are then easily overworked as they need to work extra hard to stretch the hip, (push) because the hip flexor then does not want to give in properly. This in turn results in the sciatic nerve being pinched in the gluteal muscles.

Sciatica symptoms

The sciatic nerve becomes problematic when the nerve starts to cause pain. True sciatica occurs when the nerve becomes pinched at the nerve roots, between the vertebral bodies, with the nerve coming out on either the right or left side, usually only one side. The disks between the vertebrae consist of a harder ring with a softer core. If you then have a prolonged/constant misalignment, the vertebrae will be loaded more to one side, so that it folds and forms a wedge, which means that they do not lie straight across the right or left side so that the disks are not parallel. The disk will then be squeezed and there may be a crack in the shell of the disk so that the nucleus bulges out and will press on the spinal cord or nerve roots. Irritation and inflammation can occur, causing pain to spread down the nerve towards the bone, giving rise to unpleasant and radiating constant pain, numbness, muscle weakness and loss of sensation.

Sciatica test

If you suspect you have sciatica, there are a number of tests you can do to find out the origin and cause of the pain. For example, you can test which sciatica you have and which nerve roots (between which vertebrae) are pinched. The pain can thus vary and cause different symptoms and nerve loss in different parts. It is therefore important to do tests to see where the nerve is affected and thus between which vertebrae the nerve is pinched. For example, between vertebrae L4 and L5, the problem lies with the toes, which can be tested by standing on the toes and reading strength and balance. It is thus possible to test where it pinches and examine the balance and posture, as well as see how the back is balanced to see if there is an oblique load. It is then possible to read whether the spine or pelvis is rotated and imbalanced.

Sciatica exercises

If you have sciatica and a herniated disc, sitting down for long periods is less helpful. On the other hand, standing up or lying down straight, with your legs at a 90° angle, is much better for reducing pressure on the vertebrae. It’s also important to consider your sleeping position when you have sciatica to relieve pressure on the sciatic nerve. However, if you have false sciatica, it is not enough to just correct the distortion, but the tension in the gluteal muscles also needs to be treated, to release the cramping condition. In addition, the hip flexor needs to be treated, stretched and relaxed so that the muscles can rest. Any locking in the SI joint must be relieved.

Slow and prolonged stretching exercises in the form of a type of yoga, such as yin yoga, are beneficial for the hip flexor to give way. In addition, the treatment is an essential part of preventing and counteracting false sciatica.

Treatment of sciatica

Initially, the key to treating sciatica is to prevent misalignment, i.e. to correct the pelvis and vertebrae so that the body is in balance. However, it is important not to do this too quickly if the body has been adapting to a misalignment for a long time. Therefore, the person suffering from sciatica needs to repeat the treatment over a longer period of time or combine the treatments with controlled rest, usually in combination with different types of exercises and also supplements to strengthen the fascia. If the main problem or cause is a herniated disc, it is important to be very careful throughout the healing process and make sure that the body is balanced so as not to overload any part. Sitting usually exacerbates the pressure on the vertebrae and causes more pain, and the hip flexor is also kept short. Walking is beneficial in this way because you then put an even load on the body. Lying down with your legs up at a 90° angle (e.g. with a box under your calf) can relieve pressure between the lumbar vertebrae. In addition to this, you promote improved mobility by consciously thinking about ergonomics, such as how you sit or carry grocery bags, to minimize the risk of overloading on any side.