What exactly is sciatica?
Sciatica is typically poorly understood because it is poorly defined. The classic definition of sciatica is pain or pins and needles along the length of the sciatic nerve. Where exactly does the sciatic nerve run, you ask? Great question!
Where is the sciatic nerve?
Your sciatic nerve arises from the last two nerves in your lower back (L4-5) plus the first three nerves in your sacrum (S1-3). It is the longest nerve in the human body! So it basically covers territory from the lowest portion of your lower back, into your buttock, and down the BACK of your thigh. (I emphasize the back of the leg part, because if you have shooting pain down the front of the thigh or leg, it’s not sciatica by definition.) Then, just before the back of your knee, it divides into a few different nerves that travel down the back of your calf and bottom part of your foot (to be technical, one of these nerves does feed the outer calf and outer portion of the top of your foot).
So, “sciatica” just tells us that the sciatic nerve is irritated somewhere along its path. It doesn’t tell us where or why the nerve is compressed, or where exactly you are feeling your symptoms. It’s kind of a catch-all term for pain radiating down the back of the leg. And, spoiler alert, many times this name is given to pain in the back of the leg that isn’t actually coming from the sciatic nerve at all!
Where can the sciatic nerve become pinched?
There are many structures in your back and leg that can compress the sciatic nerve. Here’s a short list:
Lower back disc bulge. This is the most common reason for sciatica, estimated to be around 85% of cases. However, the majority of the time disc bulges do not cause sciatica, and many times don’t cause any pain at all. So there has to be another factor here to produce sciatica, likely inflammation, which can have numerous causes in the body. Or, more likely the disc bulge is a red herring, and trigger points or a different source below are the cause of the pain itself.
Trigger points. Knots or trigger points in your lower back and buttock muscles can also send pain down the leg in a sciatic fashion. However, this would not be “true” sciatica, since there is no compression of the sciatic nerve. If you think this may apply to you (and even if you don’t!) check out these common trigger point spots for buttock & leg pain here and here.
Piriformis. The piriformis muscle is deep in the buttock and can be responsible for a fair amount of buttock/hip pain, and many times is a contributor to lower back pain. The sciatic nerve runs just underneath the piriformis on its way down the leg, and in about 10% of people actually pierces through the piriformis (Giuffre 2023). The idea that tension in the piriformis may compress the sciatic nerve is often called “piriformis syndrome,” although such a condition isn’t well-defined in medicine or research. However, of course for anyone in whom the sciatic nerve actually runs through the piriformis, they would be more likely to have tension or spasm in the piriformis muscle be the cause of their sciatica.
Hamstrings. Your hamstrings are the muscles in the back of your thigh. The sciatic nerve also runs RIGHT next to your hamstrings, in particular deep to the hamstrings in the outer back leg (biceps femoris). So for people with really tight hamstrings, and especially for those with a “high” hamstring strain or tear that has produced some scarring, the hamstrings can either irritate or actually entrap the sciatic nerve.
Greater trochanteric pain syndrome, aka “bursitis” of the hip. While this does mostly present as outer hip pain, it can radiate into the lower back, buttock, outer thigh, and sometimes even back of the thigh.
How do I know which structure is the real issue?
You probably won’t, unfortunately! That’s where programs like MommaStrong can help, because we have options for addressing the majority of these issues. So if one video doesn’t help, another one most likely will, and we do have a whole series of videos focused on sciatica. Or, seeing your friendly neighborhood physical therapist can be incredibly helpful to diagnose the root of the problem.
If you have pins and needles, or feel like a part of your foot or leg is numb, that is a pretty certain sign that you do have a pinched nerve somewhere (from the lower back or piriformis, most likely). In this case, it’s always best to see your doctor or PT to get more individualized exercises. And of course, nerve compression is nothing to mess around with! If you are noticing any leg weakness along with your symptoms, definitely call your doctor ASAP.
What if I’m pregnant and have sciatica? This is miserable!
I feel you! Pregnancy brings up a whole other can of worms, since that does take some treatment options off the table, plus adds a whole other factor into the cause(s) of pain (where the baby is sitting inside your pelvis, postural and pelvic changes from pregnancy, etc). And sciatica is a relatively common phenomenon in pregnancy, affecting 10-25% of pregnant people (Aparicio 2023).
Fortunately, there was a really great randomized controlled trial published in 2023 looking specifically at what types of exercises can help pregnant people with sciatica.
What types of exercises are best for a pregnant person with sciatica?
The authors Aparicio et al found that a mix of aerobic exercise and strength training is best. The authors compared a group of pregnant people who followed an exercise program regularly (3 days/week) to those who didn’t exercise, but still got some education. And, they found that the group of exercisers improved both their pain and their ability to complete daily tasks as compared to the control group. While of course both groups reported more pain and difficulty sleeping, etc, as they reached the later stages of pregnancy, the exercise group reported their pain & other limitations did not increase as much as the control group. The authors also speculated that they may have achieved better results as compared to similar studies in the past due to focusing more on resistance training in pregnancy, and from having the participants exercise for the majority of their pregnancies (from 17 weeks until birth).
So, while it can be hard to get moving during pregnancy especially when you are in pain, more movement is typically better than less. Exercise is not only good for you but for your baby too, especially resistance training like weight training and using resistance bands! If you have questions about the safety of exercise in pregnancy, check out this guidance from the American College of Obstetricians and Gynecologists.
You can see what types of exercises the study participants did in from the authors’ paper, available in this supplemental Word doc.
References:
Aparicio, V. A., Marín-Jiménez, N., Flor-Alemany, M., Acosta-Manzano, P., Coll-Risco, I., & Baena-García, L. (2023). Effects of a concurrent exercise training program on low back and sciatic pain and pain disability in late pregnancy. Scandinavian journal of medicine & science in sports, 33(7), 1201–1210. https://doi.org/10.1111/sms.14353
Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482431/
Ingraham, P. (2021, November 19). How to treat sciatic nerve pain. PainScience.com. https://www.painscience.com/articles/sciatica.php
Photo by Elina Fairytale: https://www.pexels.com/photo/hands-pressing-lower-back-3822716/