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The Spine Pain Series – Sciatic Pain

Welcome to the Spine Pain Series, where we’re going to talk through all things spine pain, spine injuries, spine rehabilitation, and how to help prevent spine pain and injuries! 

Most people at some point in their lives have experienced some nerve pain, however mild. This blog is going to explain one of the more common types of nerve pain, sciatic nerve pain. We’ll look at what causes nerve pain, what is sciatic pain, where does the sciatic nerve run, what can cause sciatic nerve compression, how to ease sciatic pain and treatment for sciatica leg pain. 

While sciatica impacts between 10 to 40% of the Australian population, the term “sciatica” or “sciatic pain” is NOT a medical diagnosis. The sciatic pain is actually a symptom of the underlying medical condition, Lumbar Radiculopathy. Radiculopathy is the medical definition for a Nerve Root irritation/injury, and the “Lumbar” infront is simply determining the location for the irritation, the lower back.

Sciatic Nerve Anatomy & Function

The Sciatic Nerve, or sciatic nerve root, is actually the culmination of 5 different nerve roots – L4,L5,S1,S2 & S3. Each of these individual nerve endings have their own distributions, and innovate different muscles and areas of skin in the lower limbs. 

The main function of the sciatic nerve is to carry the impulses from the spinal cord to different muscles and areas of skin in your legs. 

The sciatic nerve innervates the hamstring muscles (posterior thigh), calves, muscles in the front of the shin, and the muscles in the feet. Because of this distribution, the most common areas for pain are; nerve pain in the lower leg; nerve pain in the leg and hip; or even sciatic nerve pain in the foot.

Human spine segmented into each differentiation of the spine, cervical (neck), thoracic (chest), lumbar (lower back), and sacrum (tailbone). 
Diagram of the spinal vertebrae features, transverse process, spinal process, vertebral disc, vertebral body.

As you can see the anatomy of a nerve is very complex. Due to the complexity of the anatomy of the neural system, when two people experience a nerve irritation or injury, they may display very different symptoms. 
As you can see in the image, the variance in symptoms can be explained by the area that might be injured, as the different aspects of the nerves carry different information.

Diagram of lower lumbar spine and sacrum, highlighting the spinal column and the anatomical features of the intervertebral discs.
Cross sectional area of intervertebral disc with the nucleus pulposus and annululs. 
Side-view of the vertebral body, outlining the facet joint. 
Diagram showing the nerve root beginning point at each level of the spine.

Common Sciatic Nerve Injuries

As “Sciatica” has previously been explained as a symptom of the underlying medical diagnosis of a lumbar radiculopathy, the most common injuries for the sciatic nerve eventuate at the spine itself. With most people referring to having a “pinched sciatic nerve”. 

The most common way the sciatic nerve becomes injured or irritated at the spinal column level is when the space in which the nerve roots travel from becomes narrowed. The narrowing of this foramen (hole), is usually cause by only a couple of reasons;  

  • Facet Joint Irritations
  • Bony growth 
  • Disc injury / loss of disc height

Facet Joint Irritations

The facet joint in the spine is the location where two bones meet, and articulate or move against each other to produce a more global movement. 

When the areas where the two bones meet become irritated, or inflamed, that is a facet joint irritation. 

The inflammation and irritation that then builds within this space, this inflammation is what closes down the foraminal space leading to nerve root irritation and pain. 

When the inflammatory response is relatively small, there may only be lower back pain radiating to the hips, rather than a full nerve root irritation resulting in sciatica pain symptoms.

Bony Growth (Stenosis)

Foraminal Stenosis, or bony growth within the foraminal space is one of the more commonly known & spoken about causes of lumbar radiculopathy, and sciatica pain.

Foraminal Stenosis is where the bone will grow a small spur within the space where the nerve root travels. This growth is what narrows the foraminal space, therefore irritating the nerve root, causing sciatic pain. Depending on the size of the bony growth will partly determine the style of symptoms from; lower back nerve pain, nerve pain in the calf, or numbness in the leg.

Lumbar Disc Injury / Loss of Disc Height

Generally when people hear about degenerative disc disease, they head to their GP for some sciatic nerve pain medication, or sciatic nerve pain relief medication, without actually knowing what the underlying pathology is…

Degenerative Disc Disease is the medical term and diagnosis for your spine dealing with gravity for however many years you have been on this planet. More simply put, degenerative disc disease is the natural spinal changes that occur throughout life. 

Because the discs in your spine are fluid-based, they slowly lose this fluid overtime, leading to a reduction in their overall height. This reduction in overall height is what leads to the nerve root irritation, and therefore sciatic pain. 

There are also ways in which to cause sciatic nerve pain that doesn’t revolve around the spinal column itself, however, they are generally less common – but still worth mentioning. 

  • Neural traction
  • Neural compression

Neural Traction

Neural traction is where the nerve gets stretched beyond its capacity for movement. The traction injury itself can occur in a multitude of different ways, the most common neural traction injury for the sciatic nerve comes through over-extension, or rapid extension of the knee. This over-extension or rapid extension of the knee leads to the hamstring muscles being stretched beyond their capacity, which then loads through the other structures running in the same area – the sciatic nerve.

Neural Compression

As nerves are passive structures, in that they have no way of moving or protecting themselves other than using the muscles and joints to do it for them, when there is a tight muscle – it can lead to compression of the nerve. Because the nerves are innervating the muscles, they are very closely related, along with being physically attached to the muscles. Due to this relationship when the muscles are sitting tight, the nerves are being constantly activated which can lead to an over-activation of the nerve and the muscles that run along the path of the nerve further down.  

One of the most common areas for muscles to become tight enough to compress the nerve is around the pelvis, resulting in a pinched sciatic nerve in the hip – sciatic hip pain, which can actually be experienced as lower back and buttock pain, or lower back and leg pain. Either way, the underlying cause of the increased muscle tension around the hip needs to be solved in order to alleviate all the symptoms both in the back and further down the chain. 

Another common area for neural compression in the leg is due to excessive pressure is in the lower shank of the leg, or the shin / calf area. The muscles in this part of the leg are divided into compartments by their fascial connections. Because of the lack of extra space within each of these compartments, there can be an increase in the intra-compartmental pressure leading to compression of the neural structures within the compartment.

Rehabilitation Journey for Sciatic Pain

The rehabilitation journey for sciatic pain begins with determining the cause of the underlying Lumbar Radiculopathy. Once the underlying cause of the radiculopathy has been determined, the sciatica pain treatment can begin! 

The underlying cause of the Lumbar Radiculopathy will determine the best course of action with treatment. However, along with treating the underlying cause, looking into taking care of the painful symptoms is also a very important factor that needs to be taken into consideration. 

The treatment of the symptoms of sciatic pain will vary depending on the individual and which symptoms are being experienced, and for what reasons. However, if the underlying cause is muscle related, there will be work done to try and release the tension within the muscle (stretching, trigger point, or massage), along with trying to get the muscle to activate in the correct patterns to avoid any further unnecessary tension. 

If one of the underlying causes of the nerve pain and tension is a decrease in overall nerve length, then there will be work done to try and improve this (massage, joint mobilisations), and home neural stretching too. 

Overall, your Physiotherapist will complete a full and thorough musculoskeletal assessment to determine the underlying cause of your Lumbar Radiculopathy and the resulting sciatic pain. From there, they will be able to apply the correct hands-on therapy, where needed, and also prescribe the correct home/gym-based exercise program in order to improve your condition and symptoms.

Bulletproofing your Lower Back

In order to bulletproof your sciatic nerve, you need to bulletproof more than just your nerves!! 

In order to fully bulletproof your sciatic nerves you also need to bulletproof your lower back, hips, and lower limbs! This means that you need to be putting load through your lower body on a regular basis, to keep everything happy and moving well. 

The first step in bulletproofing your sciatic nerve will be to be strong through; 

  • Core
  • Spinal extensor muscles 
  • Spinal movement muscles 
  • Hip flexors
  • Glutes 
  • Deep hip rotators
  • Quads 
  • Hamstrings

The above listed areas are vital to the health of your lower back, and therefore the health of your sciatic nerve! Along with being strong through all these areas, it is also a good idea to be mobile through the sciatic nerve itself! This means doing some specific neural gliding / flossing exercises to keep the nerve moving well and functioning properly. 

Stretching and flossing your sciatic nerve is not something that you should be taking lightly, as over-stretching or irritation can lead to sciatic nerve pain! Due to nerve pain being very complicated and individual, to get the most from your training and bulletproofing attempts, you would be best served seeing a Physiotherapist. 

Your Physiotherapist, especially one that specializes in lower back pain, or spine pain Physiotherapy, will be able to conduct a thorough musculoskeletal assessment to determine the best options for bulletproofing your sciatic nerve! The Physiotherapy team at Leaders Sports & Spine Physiotherapy, in Brisbane’s City, are experts in all things spine, and will be able to perform a thorough assessment to determine the best course of action moving forward for your sciatic pain, lumbar radiculopathy, and bulletproofing your body to prevent any pain!

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