The sciatic nerve is the largest single nerve in the body and it runs from the lower back all the way down to the knee before it splits.
It is made up of 5 nerves that converge and merge as they exit the spine and then it passes through the buttock in front of the piriformis muscle and the passes down the back of the thigh and then splits just above the knee into two separate nerves – tibial and peroneal.
The tibial nerve then passes down the back of the calf and into the sole of the foot towards the big toes and the toes. The peroneal nerve wraps around the head of the fibula bone and then passes down the outside of the calf. Nerves supply both the skin (through sensory nerves) and the muscles (motor nerves).
Think of it as one long piece of string that starts at your low back and ends above the knee and it passes through various tissues along the way and in normal circumstances, the nerve moves freely between muscles and soft tissues as the lower back and legs move.
Sciatica is a condition with a number of possible causes but is characterised by pain being felt at some point along the length of the sciatic nerve. Causes in the lower back include disc prolapse (“slipped disc”) and facet joint (joints connecting the bones (vertebrae) of the back) but causes away from the spine include compression or snagging on the sciatic nerve at some point along its course.
If the nerve gets “tethered” or caught, then it causes pain or an altered sensation (pins and needles/complete loss of feeling) in the skin and/or weakness in the muscles that it supplies in the buttocks or legs. As an example, if the nerve is being compressed or caught in the buttock region, then the pain/weakness will be felt at some point further down the buttock and down towards the back of the knee.
Imagine it is like a piece of string running through a long tunnel and at some point, along the way, the string gets caught/stuck/compressed against the side of the tunnel. The effect of this is to increase the stretch of the string further down the line and this is a similar effect to what happens with sciatica.
The amount of pain/weakness depends on how much of the nerve is compressed/caught/tethered (by swelling or muscle spasm or scar tissue etc.) and therefore treatment for the condition is aimed at “freeing” the nerve so that it can run freely again.
Top 5 Exercises/Treatments to Treat Sciatica.
Nerves are very “sensitive” structures (excuse the pun) and therefore they need to be treated with care and attention. In order to “free” the sciatic nerve, it is important to gently move it and stretch it as it moves through the tissues. Sometimes the stretch is too much for the nerve (especially if it being stopped by moving freely and is “caught” as it moves.
Put your foot on top of the other knee and push the knee downwards to stretch the glute muscles and piriformis. Hold this position for 10-15 seconds and then repeat 3 times. This exercise is especially useful if the nerve is getting caught in the region of the buttock.
Put your leg out straight and perform a hamstring stretch. When you can feel the stretch in the back of the thigh, hold that position and pull your toes up towards you and then point them down again.
Repeat this ankle movement 10 times and then release the stretch. Repeat this exercise 3 times.
This exercise can be performed lying on your back or kneeling or in standing with your foot stretched out ahead of you. Be careful not to bend the back while doing this exercise and do not stretch the nerve too much or do too many of these, as sometimes these can “irritate” the nerve and more pain.
Lie on your back and bring your knee up to your chest and then slowly straighten your leg and lower down. Repeat this on the other leg and then repeat 10 times for each leg for 3 sets. Be careful not to push the stretch too hard as this can sometimes “flare” the nerve up.
Although applying heat may feel more comfortable on the low back, (because it relaxes the muscles), sciatica is often as result of inflammation in the low back area and therefore an ice pack should be the treatment of choice, to reduce localised pain and muscle spasm and minimise inflammation.
Follow the guidelines on using ice packs and always put in a damp cold towel and do not apply ice directly onto the skin.
Lie on your front on a bed or floor and push up slowly onto your elbows. Do not push this movement too far and only go to a point that is comfortable. Then lower back down again. Repeat this movement 10 times for one set and complete 3 sets.
Sciatica is often caused by compression on the nerve from a prolapsed disc and this is more apparent when the back is flexed or bending forwards. The reason for this is that this movement “encourages” the disc to push backwards against the spinal cord and nerves of the back.