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What is it? 

Sciatica is a condition in which the individual has a sharp burning pain located to the buttock that may or may not radiate into the upper leg (never below the knee). It is a common ailment that affects approximately 50% of the adult population at some point in their lifetime. It can be a real pain in the posterior. 

What is the cause? 

The sciatic nerve is the large nerve that is formed by the nerve roots of the lumbar spine converging into the sciatic nerve that exits the pelvis in the upper buttock region. It is the largest nerve in the body and controls all the muscles and skin sensation below the knee. “Sciatica” is the term we use when the nerve is inflamed. There are numerous causes to sciatica, but the most common is a herniated disc that is irritating the nerve roots in the spine. Those same nerve roots will converge into the sciatic nerve and will burn and ache to let us know about the inflammation. 

Another cause to sciatica can be as simple as a wallet in the back pocket that irritates the nerve. Also, excessive sitting (especially with your legs extended in front of you) can put a stretch on the nerve and result in an inflamed sciatic nerve. 

In addition, a condition known as Piriformis Syndrome can cause sciatica. The piriformis muscle is located deep to our buttock muscle (gluteus maximus) and is part of our external rotator muscle group of the hip. The relevance of the piriformis is that the sciatic nerve exits the pelvis beneath the piriformis muscle and if the muscle is spasmed, it can pinch/inflame the sciatic nerve. Interestingly, about 10% of the population is actually born with the sciatic nerve not exiting below the piriformis, but actually running through the muscle which greatly increases the likelihood of sciatica.

What is the best treatment for sciatica? 

Surgery and injections are not indicated to treat sciatica. Conservative treatment has shown the best results for treating sciatica. Stretching the buttock (gluteus maximus and piriformis muscles) and lightly exercising those same muscles is a must. Deep tissue massage to those muscles and fascia can also be effective, but be sure to not put pressure on the sciatic nerve, as it may amplify the pain. Chiropractic manipulation will reduce nerve root irritation. Ice or heat application for a timeframe of 15-minute applications may alleviate some pain. 

Lastly, avoiding irritation of the sciatic nerve, by removing a wallet from the pocket, limiting sitting times and avoiding hamstring stretching will help you find relief from the dreaded sciatica. 

Dr. Custer is the owner/operator of Better Care Chiropractic and Physical Therapy. He combines chiropractic manipulation with active rehabilitative techniques to restore pain-free living. If you have questions/comments/suggestions, please feel free to contact Dr. Custer at [email protected].

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