Sciatica is when the sciatic nerve becomes pinched either due to a disc herniation or a potential anterior tilt. The sciatic nerve is part of the lumbar plexus, which is a web of nerves (a nervous plexus) in the lumbar region of the body which forms part of the larger lumbosacral plexus. The nerves constitute and embed themselves within the spine; its made up of 33 irregularly shaped bones called vertebrae’s. Each vertebra has a hole in the middle through which the spinal cord runs. The spinal cord can be divided into five different regions, from top to bottom:
- Your 7 cervical vertebrae support your head and neck and allow you to nod and shake your head
- Your ribs attach to your 12 thoracic vertebrae
- Your five sturdy lumbar vertebrae carry most of the weight of your upper body and provide a stable centre of gravity when you move
- Your sacrum is made up of five fused vertebrae. It makes up the back wall of your pelvis
- Your coccyx is made up of four fused vertebrae. It is an evolutionary remnant of the tail found in most other vertebrates
Signs and symptoms of a sciatic nerve pathology are; Lower back pain, pain in the rear or leg that is worse when sitting, hip pain , burning or tingling down the leg, weakness, numbness, or difficulty moving the leg or foot, A constant pain on one side of the rear and a shooting pain that makes it difficult to stand up.
Sciatica can be caused by a number of things which can predispose or increase the risk of further injury. Potentially an anterior tilt, which changes the position of the pelvis moving in a downward fashion towards the ground due to the tightness of the hip flexors which are commonly known as the Psoas major and Iliacus muscle. These muscles either aid the stability of the pelvis or help with flexion at the Hip. However, constant running , lower body weight training or over participation of sports which involve a lot of running.
This could potentially course a change in the positioning of the hips leading to the transverse abdominal (TrA) muscle becoming weak. The job of TrA is to increase intra-abdominal pressure and control the mobility of the lumbar spinal segments. In a feedforward mechanism it switches on a fraction before any elective movement to stabilise the stack of lumbar segments. If this muscle however, becomes weak, the TrA won’t function effective thus leading to lower back pain (LBP) and instability of the lumbar spine.
If the TrA becomes weak, The erector spinae will take over as a back stabiliser. The erector spinae is a muscle group that consists of three muscles, iliocostalis, longissimus, and spinalis. These muscles help us to straighten our back. It extends throughout the lumbar, thoracic and cervical regions and lies in the groove to the side of the vertebral column. Because of the posture change within the pelvis will move the erector spinae and the gluteus maximus upwards the sky, therefore potentially causing LBP.
With the erector spinae overcompensating and being forced on a stretch, the piriformis which functions in lateral rotation of thigh at hip joint. as the pirformis originates onto the lower aspect of the sacrum and inserts onto the greater trochanter of the hip, the pirformis becomes lengthened due to the upward movement of the sacrum. As this begins to become tight, it compresses the nerve branch of the lumbar plexus and therefore causing pins & needles radiating down the leg.
here are some exercises to either aid in the reduction of pain or to potentially fix some predisposing factors;
- Lying deep gluteal stretch- Lie on your back. Place a small, flat cushion or book under your head. Bend your left leg and rest your right foot on your left thigh. Grasp your left thigh and pull it towards you. Keep the base of your spine on the floor throughout and your hips straight 20-30 second hold
- Back extensions- Lie on your front and rest on your forearms with your elbows bent at your sides. Look towards the floor and keep your neck straight. Keeping your neck straight, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles. Breathe and hold for 5 to 10 seconds. Return to the starting position. Repeat 8 to 10 times.
- Sciatic mobilising stretch- Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in. Bend one knee up towards your chest. Hold the back of your upper leg with both hands, then slowly straighten the knee. Hold for 20 to 30 seconds.
- Hip flexor foam roll- Press the foam roller or lacrosse ball into the crease of your hip. Apply pressure as needed and roll the roller or ball back and forth to break up the tissue. When you find a spot that’s tender, focus on it and apply even more pressure to help release the tightness. Hold this for 30-60 seconds going over it 3 times
- Kneeling Hip Flexor Stretch- Drive your hip forward and your knee into the ground. Your iliopsoas muscle, one of the main hip flexors, is a deep muscle that requires isometric activation to stretch it. Hold for 15-30 seconds, repeat 3 times each leg
- Plank- Begin this exercise on your stomach. After hollowing your abdomen, lift your body up onto your elbows and toes. Do not allow your back or pelvis to tilt as you plank. hold for 15-30 seconds repeat 4 times
- Quadruped Lifts- Do this exercise, also known as the bird dog, on your hands and knees. After hollowing the abdomen, slowly lift one arm and the opposite leg into the air. The back and pelvis should not tilt as you move your limbs. hold for 2-8 seconds each leg, 10 reps x 4 sets
- Superman Exercise- The Superman exercise requires no equipment and works the entire spine. Use a slow and controlled motion, and focus on using the erector spinae to power the movement. Lie on an exercise mat on your stomach. Bring your legs together and extend your arms out past your head. Lift your torso and legs off the floor as high as you can. Pause at the top, then return to the starting position. 10 reps x 4 sets
- trigger point work- Lay face-up on a firm bed or the floor, with your knees bent. Using a tennis ball or racquet ball Inbetween the lower part of the sacrum and the greater trochanter. Apply pressure until you feel a bundle of built up/dead tissue. Hold for 30 seconds on that area of discomfort, and repeat 3 times for 30 seconds each.
if anyone would like to research more into the anatomy of these muscles, here is a website below; https://www.kenhub.com/en/start/atlas