Sciatica – a real pain in the ….leg

Sciatica has troubled human beings as far back as recorded history goes and is a term first used by the Ancient Greeks.

It is defined as a pain which goes from the buttock down the back of the leg which follows the course of the sciatic nerve. Its causes and exact nature of symptoms are very different, and I really want to highlight how complex an issue it can be.

It has also become a misnomer; used to describe a variety of back and leg symptoms that may or may not be related to the sciatic nerve.

My main concern is that there is a lot of potentially dangerous advice out there in the form of seemingly helpful articles.

Articles titled ‘the top 5 poses for sciatica’, telling people to roll their buttocks on golf balls. I have mentioned it before in a previous blog post and I always discuss this on my training courses for Yoga teachers, but you cannot prescribe Yoga poses for sciatica without first understanding what is going on. In fact, I don’t believe you should prescribe Yoga at all on the internet.

There is not a one size fits all solution to pain as we are not an off the shelf species.

Rolling your buttock on a golf ball is not going to be helpful for an inflamed sciatic nerve, even if the piriformis is tight. Pigeon pose may stretch the gluteal muscles but if you have a grumbling disc or cyst on your facet joint or a spondylolisthesis it’s not going to help. The result of these articles is that even though some people may benefit from following their advice someone at some point is going to make their symptoms worse and potentially going to hurt themselves more and then Yoga gets blamed for being dangerous. When it could have really helped if it was applied appropriately.

To highlight how complex this diagnosis could be, I have summarised some information from a very informative review article from The New England Journal of Medicine in 2015, I have tried to put in layman’s terms as much as possible.

The sciatic nerve is the largest nerve in the body (think the size of your thumb) and a disturbance anywhere along the route of the sciatic nerve can cause sciatica; starting from where the nerves leave the lower part of the spine (at several different levels), the pelvis, the buttock, the crease of the bottom and the top of the back of the thigh.

This can be caused either by mechanical deformation (so something physically pressing on the nerve) or inflammation of the nerve.

Symptoms can vary a lot… the nerve is made up of four nerve roots (L4, L5, S1, S2) which combine to form two nerves (peroneal and tibial) and leave the pelvis as a big trunk wrapped in a single sheath.

The exact location of the symptoms in the leg will vary depending on which part of the nerve is being affected. You don’t always get back pain even if there is a spinal cause of sciatic pain and peoples experience of the severity can be very different. Sometimes posture is altered as the body tries to relieve pressure off the nerve, sometimes there is change in sensation in the leg and foot, sometimes the foot drops. But not always…

The most common cause (85% of cases) is from an issue with a disc in the lower back. However, it’s not the only cause: –

Spinal Causes

· Disc rupture with compression of L4, L5 or S1 nerve root

· Arthritis causing narrowing of bone which presses on nerve or spinal cord

· Cyst in a facet joint or spinal cord lining

· Spinal column or nerve lining tumour

· Inflammation sheath of spinal cord

Non-spinal causes

· Pelvic and gynaecological conditions including cyclical sciatica due to endometriosis

· Piriformis syndrome and ‘back pocket sciatica’

· Pregnancy and labour

· Shingles

· Diabetes

· After an injection in the gluteal muscle

· Inflammation of the nerves

· Blood vessel pressing on Vascular impingement on sciatic nerve

· Hip or pelvic fracture

· Hamstring bruising, strain or tear

· Idiopathic causes in young persons

If you or anyone you know if discovering from sciatica it is important to discover the cause before deciding on a treatment.

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Aimee Newton

Aimee Newton is a Tutor and Assessor for Friends of Yoga and has been teaching for 16 years. She is also a Registered Osteopath and runs popular CPD days for Yoga Teachers on Anatomy and Physiology both face to face and online.

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