Thursday, October 29, 2015

Understanding Sciatica

Chances are...  you or someone you know  has experienced Sciatica. It's a very common problem! 

All pain, injury and chronic conditions are caused by a variety of factors such as: genetics, environment, lifestyle and emotional, spiritual issues. I’m going to say a bit about each of these levels.

First,  its important to understand what and where the Sciatic nerve is and how it becomes injured.

Pathway of the Sciatic Nerve

The Sciatic Nerve is one of the longest nerves in the body. It is also quite large-as big around as your little finger! 

It attaches to the lumbar vertebrae of the low spine (L3,L4). It travels downward, underneath,around and through the Piriformis muscle in the buttocks. It then travels  down the leg and out the foot.  For some people, the Sciatic nerve also passes through the Psoas muscle (one of the hip flexors.)

Any nerve can be compressed by tight muscles, and/or entrapped(pinched)  by our skeletal system. A nerve can also be overstretched. 

The Sciatic nerve has the ability to stretch 5 inches! When it becomes overstretched from injury or postural imbalances such as one leg longer than the other, we experience pain.

Nerve pain is tricky because where the pain is is usually NOT where the injury is. The pain you experience with Sciatica is actually below the level of the problem or injury.

The Sciatic nerve can be injured in two places:

1.   The Lumbar Vertebrae: This kind of Sciatica is called Appendicular Sciatica. It is caused by the lumbar vertebrae pressing on the nerve, which  causes it to become irritated and inflamed. The vertebrae can bulge which can may press on the nerve root. 

The nerve root at the vertebrae can also be injured directly by physical trauma.

It can also be effected by tight low back muscles that are compressing the nerve. 

If you are experiencing this kind of Sciatica you will experience the pain in your low back, and/or buttocks or anywhere along the pathway of the nerve. It is also possible to vertebrae problems and have no low back pain, but pain in the buttock, leg or foot.

There may be numbness, tingling, and weakness in the leg on the effected side with this type of Sciatica. 

Other causes of Appendicular Sciatica are:
-Alignment issues in the spine such as vertebrae moving anteriorly to the one above or below
-Tight Psoas muscles (only true for some people)
-Postural alignment problems

 2..The  Piriformis muscle: The other place the Sciatic nerve can be injured is at the Piriformis muscle. This kind of Sciatica is called Appendicular Sciatica, or Piriformis Syndrome or False Sciatica. Altho if you are in pain, there is nothing "false" about it!

   If the Piriformis  becomes tight and inflamed, it can easily press on the Sciatic Nerve.  If you have this kind of Sciatica, you most likely will not experience low back pain. Or if you do, it is probably from another cause. 

You will  experience pain in the buttock that may or may not radiate down the leg and and/or into the foot. 

This kind of Sciatica is much more common and luckily is easier to treat. It occurs much more commonly in women than in men. Men tend to suffer more from disc issues.

This kind of Sciatica is caused by:
-Tight inflamed Piriformis muscles
-Sitting too much
-Sitting with your wallet in your back pocket
-Injury to the Piriformis muscle
-Pelvic misalignment
-Driving with your seat too far back. If you have to point your toe to press on the gas or brake, and you drive a lot or for long distances, this can overstretch the Sciatic nerve

So what can you do about Sciatic Pain?

First of all, its important to differentiate between Acute Sciatica and Chronic Sciatica. 

Becoming injured is part of being human! An acute condition is one that has a discernible cause and gets better with time and care. 

We’ve all had the experience of lifting something too heavy, helping a friend move, dancing all night, skiing all day (my personal favorite!) and waking the next morning with low back pain or pain in the buttocks and legs.

If this occurs, the best course of action is to rest, apply ice and take anti inflammatories for 24-48 hrs. Massage can really help at this stage!
However, it is very important to not apply direct pressure to the nerve as this can further irritate it. So it is important to have a therapist who understand this and knows the path way of the nerve.

After a day or two of rest, its time to get moving! For most people gentle exercise really helps with Sciatic pain. Gentle walking is probably best at first and just engaging in your daily activities.

The most important thing to know about acute Sciatica is the the body knows how to heal! Most injuries resolve by themselves over time.

If you experience numbness, tingling or sharp pain and the pain does NOT diminish over time you should see your doctor to determine if there are disc injuries or other problems.

Chronic Sciatica pain is pain that does not go away with good care and time. Or the pain reoccurs regularly without there being any apparent cause. Often, an acute condition becomes chronic when we ignore the initial pain and don't rest. By rest, I mean to stay off your feet for a day or two. 

 With any chronic condition, emotional, mental and spiritual factors come more into play both on the causative level and as a result of pain that is unresolved.

Massage can be a big help with any kind of chronic pain. A good massage not only works on the muscles of our body but also works directly on the nervous system. When a doctor or anyone tells you, "Its all in your head." That is not helpful at all! But it is true that much of the pain we experience is in our nervous system rather than our muscles, ligaments, and/or tendons. 

Our nerves learn! 

When we are in chronic pain, the communication between the damaged nerve(s) and the brain becomes faulty. Its like a conversation where only one party is listening, or what is being said is misinterpreted.

When communication breaks down, the  body may begin to be hypersensitive to any sensation: interpreting light touch, or even temperature changes as pain. 

Massage provides a non noxious stimuli that is comforting and positive. As the nerve gets new info that is not painful, it begins to adapt to the new stimuli in positive ways. Its kind of like rebooting your computer!

Treatment for Sciatica with Vertebrae Issues:

If you are experiencing Sciatica pain at the nerve root caused by a herniated disc or other vertebral problems its important to get his evaluated by a doctor. You may suspect this if you have low back pain that does not go away, along with  numbness, tingling, weakness or very sharp pain along the nerve path. It is possible to have a disc issue but have no low back pain, and instead experience pain in the buttock or leg or even foot. 

If you have a skilled massage therapist, she can carefully decompress the vertebrae allowing for more freedom for the nerve. Its important to note that direct pressure on the vertebrae or nerve can make the condition worse. So know your therapist!

Chiropractic adjustments can work for some people to realign the vertebrae.
Acupuncture can help with any kind of pain.

Treatment for Piriformis Sciatica:

A skilled massage therapist can massage the attachments sites of the piriformis to allow the muscle to relax. It is important not to just mash the piriformis into the nerve, as this may cause more irritation. Rather lifting and separating the piriformis from the other muscles and off the nerve may be helpful. 
Gentle stretching of the piriformis can provide relief as well. But the key word here is gentle!

A massage therapist can also massage the hamstrings, working to separate the muscles to allow more freedom for the nerve. The nerve can also be released at the back of the knee.

If your Sciatica does not go away with time, rest, massage etc. it may be time to look more deeply

The body and mind are in constant communication with one another. There is an ever changing very sensitive flow of information. I have already mentioned that chronic pain can cause this information to become faulty and that massage can help with this. It's as if one side of the conversation breaks down and mis communication occurs. 

It is also true that every thought we think has a bio chemical effect on the body. This is both a scary and amazing fact! Its not as if  one negative thought will necessarily impact us on a physical level. 

But….a pattern of stressful or negative thinking and emotions will impact  most people  physically at some point.  

Of course, the same is true the other way as well. The state of our physical body effects our mood, emotions and even thoughts. Its like a conversation. Both the body and the mind get to talk!

There are schools of thought that feel that where pain occurs is significant. 

In other words, if you have Sciatic pain, there is a different emotional, mental thought pattern associated with that pain, than if the pain were somewhere else in your body.  

Two  good questions to always ask when experiencing chronic pain are “Why here? (meaning this location in the body) and “Why now?”

Emotional Pain Chart

It is often said that Sciatic pain and low back pain in general is indicative of feeling that there is a lack of support in your life. 

I would suggest that you evaluate this in a curious, open minded way. It may be true for you, or somewhat true or not at all true. It is, however,  a good place to start your inquiry.

It is in our wonderful human nature to want to categorize, and pigeon hole all of our experience. It is my belief that you if you have ten people with Sciatic pain, you will have ten different reasons for that pain. But..there most likely is some commonality as well. 

It is also to helpful  differentiate between a lack of support and perceived lack of support. If you really don’t have support in your life, you can begin to cultivate relationships that do provide you with support. And often to become more  supported, it is good idea to begin to be more supportive of your family, friends and loved ones.

We get support by being supportive!

For some of  us, however, we give more support than we get, simply because we don’t ask, or don’t become vulnerable enough in our relationships to reveal our wants and needs. Or we simply we may not how to ask for support.

So ask for help, appreciate the help you have, cultivate gratitude and appreciation for all the ways you actually ARE supported.

You can begin to cultivate spiritual resources to begin to build a place of love and support within that is relatively free from external circumstance

Many of us, myself included, actually do have all the support we need. But we forget that it is there! Then it may become more important to notice, appreciate and call upon the support that actually exists for us. And that is especially true of spiritual support. 

The positive energy of life, healing and love is always there for all of us. We just need to be aware of it and use it!

In order to realize and appreciate the support we have, it is important to have a calm, stable mind. 

Meditation is an excellent way to do this! I suggest beginning with a general meditation approach that can allow you to connect more deeply with your mindbody. An excellent app I have found for this is

It is also helpful   to engage the unconscious mind in the process of healing. The body is the unconscious mind and the unconscious mind is the body.

We visualize and affirm the positive change we want to see in our body and with time and practice it becomes so! For guided meditation that helps heal any issue you may have click here

The most important thing to remember if you are experiencing Sciatic pain is that you have all the tools you need to heal. It may be helpful to get massage from a skilled therapist to help you along your path to healing. 

Chiropractic and acupuncture can also be helpful. And if all else fails, surgery can and does fix vertebrae problems.

One thing I see constantly in my practice is that people with many structural, organic, physical injuries experience little or no pain. While people with little or no discernible physical causes of pain, suffer greatly.

We can retrain our nervous system to process pain differently. Massage is especially good for this. 

We can learn to be more at peace, happier and more stress free through meditation which will  have a positive effect on the degree of pain we experience.

I hope you have found this article helpful! 

Let me know about your experience of Sciatica or any low back pain and what you found to be helpful.

 What helped you may help someone else!

Be Well,

Sue Schmidt CMT,

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