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Sciatica; a True Pain in the Butt

Up to 40% of us will develop sciatica at some point in our lives. It typically affects people ages 30-50, though I have seen it affect children as young as 12 years of age. Lumbar radiculopathy (condition at the spinal level) and sciatic neuropathy (condition along its body) can present varied symptoms such as a dull ache somewhere deep into the posterior hip or back, sharp, electric pains running down the back of the thigh, numbness, weakness in the thigh or leg, constant tingling, or even pain somewhere in the calf or foot. When the nerve is inflamed it becomes really difficult to work, walk or even sleep. Depending on the cause of the issue, you may be able to manage your sciatica on your own.

The sciatic nerve is the longest, thickest nerve in our body. It is a mix of motor and sensory fibers meaning it sends information to the muscles it innervates when you want to move, and it reads sensation from these same muscles to analyze your current health. It originates in the lumbar spine and sacrum with roots extending from our lowest lumbar disc space L4/L5 and the top 3 sacral openings. In the posterior hip, this nerve is somewhat deep under the gluteal muscles. It passes under the piriformis muscle about 90% of the time though it can grow right through the middle of this muscle about 10% of the time.

It continues down deep in the posterior thigh under the hamstrings. It then branches out in the posterior the knee into the fibular nerve (laterally) and the tibial nerve (medially) before travelling down the calf and top and bottom of the foot. That is a lot of area for the sciatic nerve to get caught, pinched or excessively stretched.

Several conditions at the spinal level can cause lumbar radiculopathy. A herniated L4/L5 disc (bulging disc) can press back into the nerve causing what is called a "pinched nerve." A lumbar stenosis is a narrowing of the spinal canal which can also pinch the nerve at the root. A spondylolisthesis is when 1 vertebra slips forward in comparison to another and pinches the nerve root as well.

When the nerve is affected near the spinal cord, it is often advised to modify or stop bending, twisting and heavy lifting. This will minimize further irritating the nerve root. Decompressing the area may create enough space in the intervertebral space to begin hydrating and allowing the disc to heal. Exercises such as bridging, back extensions and pelvic tilts may help introduce more blood flow to the area by loosening up dense tissue.

The piriformis muscle is often first looked at as the main culprit of sciatic neuropathy since it crosses right over and sometimes around the sciatic nerve. Tension in this muscle puts direct compression onto the nerve and creates either localized pain or radiating sensations anywhere down the thigh, leg and foot. Typical treatments for piriformis syndrome can include figure 4 stretches and self-massage through this area with a tennis ball or other massaging tool.

Tight hamstrings can also put excess compression on the nerve and again create either a localized or radiating pain pattern. General hamstring stretches can help relieve compression over time. A slight rotation of the thigh to either side will a stretch into each of the 3 hamstrings. A pin and stretch of the hamstrings may also be utilized with a tennis ball under the hamstrings while extending at the knee.

The soleus muscle resides in the posterior calf deep to the gastrocnemius muscles. This muscle can pull on the tibia and fibular nerves which branch out from the sciatic nerve itself. Stretching the calf muscles on a stair or wall with a straight knee will give stretch to the gastrocs, though bending and driving the knee forward will stretch more into the deeper soleus fibers of the calf.

Ankle ligaments can also cause some shortening of the tibia and fibular nerves. A common practice will be to perform simple ankle ROM exercises to keep the ankle mobile.

A sciatic nerve floss can stretch all the tissue around the nerve from the hips down to the foot. This will also get you some more length from the nerve root to the nerve endings.

How does Rolfing Structural Integration™ help you quickly overcome sciatica?

Our nervous system speaks the language of either tension or ease. The nerves feel a threat and use tension in our soft tissue to prevent ourselves from more harm. It happens to be so good at it that sometimes we get chronically locked into patterns that may no longer serve us. A skilled practitioner will find areas of tension all over your body and encourage the nerves to let go of their hold. The separate fascial compartments can be differentiated so they are no longer stuck together. What is really fascinating is your sciatica may not come from any of the above-mentioned areas! Sometimes freeing the ribcage to allow an easier breath takes tension out from the sciatic nerve.

A Rolf Movement™ practitioner can help retrain your nervous system to stop offsetting patterns from competing for proper joint movement. This type of movement is a whole body nervous system reeducation to make certain everything from your feet to the top of your neck is coordinated and moving with efficiency.

Don't let sciatica control your life because when you are in pain, nothing else matters.

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