The term “sciatica” has been around since the 1400s. Most people use it to describe pain that begins in the lower back and travels to the lower hip, thigh, leg and foot of one or both lower extremities. The common expression now can mean all leg pain, so it is not very precise and doesn’t tell us where it started. However, it will usually produce the sympathy we need because it is known to be miserable when it happens!
What you need to know first is how nerves work. Structurally, individual nerves exit the spine at the level of the disc between the spinal bones (vertebrae). Once out in free space, they send portions to intertwine with other nerves in a bundle. From there, combined threads from the bundle travel together as they supply muscles, blood vessels, skin and other tissues. This is designed so that injury to one segment exiting the spine will not completely disable the function of a particular muscle; a built-in, overlapping of the nervous system.
One of these combined nerve bundles is called the sciatic nerve. It is usually the largest nerve outside the spinal cord — about the thickness of your thumb — and services a large portion of the hip, thigh, leg and foot. The largest contributor to the sciatic nerve is from the individual nerve known as S1. Through the sciatic nerve, S1 services the gluteal, hamstring, and calf muscles principally. Pain that radiates through the lower back, buttock, thigh and calf is generally what most will align with the term sciatica.
There are many reasons that you may have radiating pain in the back or lower extremity. In nerves higher than S1, irritation can cause pain in the side or front of the thigh, groin or pelvic areas. Increasing abdominal pressure, as in coughing, sneezing, laughing or a bowel movement is fairly reliable as an indicator that your spine is causing the pain. There are several conditions in the spine that also can cause the pain but are not provoked by abdominal pressure.
The nerve may not be irritated as it leaves the spine, but at points further down the leg from muscles or tightened ligaments. There are also times when chronically inflammed muscles will produce a referred pain that seems to travel like a pinched nerve. Inflammation in the hip joint can cause pain in the groin, buttock and thigh. And kidney stones are famous for creating inner thigh pain. So you see, to use the term sciatica for radiating pain doesn’t really help us get to the problem — or fix it!
The most important part of eliminating pain is diagnosing its source. I take great pleasure in identifying the culprit in these cases, because it’s complicated. Most of the time, ice usually will calm the irritation of the inflammed tissue (nerve or otherwise). Try a bag of frozen peas with a paper towel over what seems to be the sorest point or the area closest to the spine that has pain. Use the cold for twenty minutes, then off for twenty minutes, and cycle it like that until you notice a change. Typical non-steroidal anti-inflammatory medications [called NSAIDs; ibuprofen (Advil) and naproxen (Aleve) are most common] are also helpful.
If the pain worsens in intensity, duration, frequency or area involved, call your local chiropractor. They will know what to do as this is what they treat on a daily basis. And, since surgery has not been shown to out-perform conservative measures in most cases (1), chiropractic represents the best diagnosticians combined with the most forms of effective, conservative treatment. Call today, and I can probably help you sort out your “sciatica” over the phone.
- Bruggeman, AJ; Decker, RC (February 2011). “Surgical treatment and outcomes of lumbar radiculopathy.”. Physical medicine and rehabilitation clinics of North America 22 (1): 161–77.