Sciatica is one of the most debilitating conditions anyone can experience. It can also be one of the more complicated conditions anyone can experience because of the extreme pain involved.
What is sciatica?
Sciatica most often arises from a pinched nerve in the lower lumbar spine, or the low back. This is significant because the sciatic nerve is formed by the L4, L5, S1, S2, and S3 nerve roots. These five nerves merge together into the sciatic nerve, which passes underneath the piriformis muscle. The piriformis is found beneath the gluteus maximus, and when it tightens, it can compress the sciatic nerve. This is a significant issue for pregnant people. More on this later.
As the sciatic nerve travels down the back of the thigh, it passes underneath the long head of the biceps femoris, one of the hamstring muscles. It branches out into various other nerves, including the tibial and common fibular (peroneal) nerves just before reaching the back of the knee. These nerves then travels down the leg, branching out into the rest of the leg and foot.
True sciatica is often felt from the low back and pelvic area, down one of the legs, all the way to the toes. It can range from a deep throbbing ache to sharp lightning down one of the legs. It’s nearly impossible to get any relief from sciatica, no matter what position you get into.
Why does the sciatic nerve get pinched in the first place?
A pinched nerve can arise from a herniated (bulging) or ruptured disc. If it’s the latter, surgery is often needed.
Intervetebral discs are mostly made up of a gel-like fluid encased by a fibrous outer ring. When one vertebra is unevenly stacked upon the vertebra below, the imbalanced positioning will place more pressure on side of the disc than the other. A water balloon is a good example to understand this concept. If you hold the water balloon in your hand and squeeze, it will bubble out one side of your hand or the other. This is what a misaligned vertebra does to the disc.
But where do the misalignments come from? Bear with me, because this answer is twofold.
First, they can arise from physical trauma or injury, emotional stress, a sedentary lifestyle, and pregnancy.
Trauma and injury are obvious reasons, and don’t need much explanation. Car accidents, sports injuries, slips, falls, even sneezing! (Yes, I once had a patient who gave herself sciatica from sneezing.)
Emotional stress can do very weird things to our body, including weakening the systems in our body. Whether it’s the immune system (weakening the body’s ability to stave off sickness), the cardiovascular system (emotional stress, particularly anger, can cause arteries to weaken and clog, as well as increase blood pressure and pulse), or the muscular system (taut & tender muscles and muscle spasms).
A sedentary lifestyle almost always play a part in sciatica. We’ve all heard the old adage that “movement is life.” That’s because it’s the 100% truth. Less than 24 hours after surgery, knee and hip replacement patients are helped up out of bed to begin walking again. The spine has a natural C-shaped curve in our necks and low backs and less dramatic curve going the opposite way in our upper back.
When we sit at a desk all day, slouched and hunched over, we reverse the curves in our neck and low back and we increase the curve in our mid back / upper back. This is problematic because it causes all of our extensor muscles to stretch and tighten for extended periods of time, weakening them; and our flexor muscles are constantly over-activated, doing no favors for anyone or anything except gravity in its quest to pull us down into an even more imbalanced posture.
An example of this would be the neck muscles. Try looking up while simultaneously jutting forth your chin to stretch your front neck muscles. Feel how tight that is? That’s because you’re probably spending too much time looking down at a phone or a computer screen. That’s not a judgement, it’s reality. I’m as guilty of it as anyone, including right now as I write this.
The problem is that when we look down so much, it tightens up and stretches the muscles in the back of the neck, particularly at the top of the neck / base of the skull. The largest percentage of mechanoreceptors in our body exists here, and these muscles connect directly to the base of the skull, C1, and C2. Tension headaches, migraines, even vertigo can arise from dysfunction of these muscles.
And of course, there is pregnancy. Remember earlier how I mentioned a tight piriformis muscle can compress the sciatic nerve and pose a problem during pregnancy? This happens during pregnancy because of the widening of the pelvic bones to prepare for the baby’s arrival. Tight muscles in the rear end come with the territory during pregnancy, but an imbalanced spine resulting from vertebral misalignments (there are always spinal misalignments during pregnancy as the mother’s body changes, repositions, and prepares for a massive physical event) will exacerbate that gluteal muscle tightness. And pregnant women don’t need any more painful aggravation than they’re already experiencing.
Second, in my experience as a chiropractor, sciatica can be an effect that stems, ultimately, from a cause at the top of the neck.
A misalignment in the low back or pelvis resulting in sciatica is often, if not almost always, compensatory due to the initial misalignment at the C1 or C2 vertebra. A misalignment at this level is called a vertebral subluxation. When a subluxation occurs at C1, C2 will compensate, as will C3, C4, and so and so forth down to the pelvis. This will result in an overall body imbalance giving one the appearance of poor posture, such as one shoulder higher than the other, slight head tilt, pelvic tilt, imbalance of leg lengths, etc.
Remember the water balloon analogy in relation to the intervertebral discs? The spinal imbalance resulting from a C1 and/or C2 subluxation is very often what leads to the unevenly stacked vertebrae lower in the spine. A misaligned L4, L5, or sacrum can directly impact the surrounding tissues, thus increasing pressure against one of the nerves that make up the sciatic nerve, or the sciatic nerve itself.
Sciatica is one of the most common conditions I see in my office, and it is not a condition to be trifled with. It is painful, it can be debilitating, and it is a sign that something is in disarray with your spinal health.
If you’re suffering, there is a strong chance that chiropractic can help.