Sciatica

​People with pain, tingling and/or numbness which extends into one or both of their legs will often be told that they have sciatica.  Actually, sciatica is not all that common a condition.  More often than not, what’s really going on is some sort of muscular or soft tissue complaint.

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Nerve impingement in the gluteal area

So what is sciatica really, and how can you tell if you’ve got it?  The answer to the first question is that sciatica is condition where the sciatic nerve is pinched or impinged somehow at or near the nerve root.  This is where the nerve emerges from the spine in the lumbar area.  The sciatic nerve is one of the body’s longest and enervates the back of the leg and foot.  When it is pinched symptoms can be felt anywhere along its length but typically occur in the lower back, the back of the thigh, behind and just below the knee and (less commonly) the bottom of the foot.

It is also possible for the sciatic nerve to be impinged lower down, in the gluteal area.  More than one muscle in your bottom can press on the nerve but the one which is typically associated with sciatica is called “piraformis”.  

But here’s where it gets tricky: these same gluteal muscles can also develop persistent knots or spasms which produce symptoms just like sciatica.  So can your hamstring muscles.  And muscles in your lower back often have to be playing up in order for bony structures in and around the spine to actually interfere with the sciatic nerve.  In this latter case, the sciatica is essentially a side effect of muscle dysfunction.

Going back to one of the original questions above, how do you know if you have sciatica or just a muscle problem?  The only way to be absolutely sure is if your symptoms specifically include numbness, an area of skin somewhere on the back of your leg or foot which is insensitive to touch.  That is only present when the sciatic nerve is impinged.  Anything else - pain, tingling, heaviness - can be entirely or at least partially caused by soft tissue dysfunction, by the knots or spasms referred to above which are normally called “trigger points” (See previous posts about trigger points).
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This is good news because there are any number of bodywork techniques which can be used to address the problem.  Some you can apply yourself like heat or gentle targeted stretching, others will require the use of a trained therapist.  When it comes to sciatica, there are usually many relatively safe and inexpensive treatment options that can be tried before resorting to strong painkilling drugs or invasive surgery.