A Sciatica Solution

spinal stenosis

Because people frequently think they have sciatica, when actually, what they have are painful muscle spasms -- a different problem -- I'm going to describe the symptoms of sciatica.

The typical sciatica sufferer has radiating pain that starts at the buttock (usually one side, only) and that may extend down the back of the thigh as far as the foot. Sensations may include numbness, burning, or the feeling of a hot cable (or poker) going down the buttock or back of the leg. Back pain often precedes and accompanies sciatica.

If you have pain going down the front of your leg, you probably have muscle spasms of the quadriceps muscles; if down the side, it's probably contracted muscles that attach to the ilio-tibial (IT) band. Less common is entrapment of nerve roots other than those of the sciatic nerve -- but that's not sciatica.

In this paper, I will briefly explain the origins of sciatic pain, the three types of sciatic pain, and a reliable remedy for two of the types.

Origins

Sciatica falls into the category of pain known as "referred pain." Referred pain results from pressure on a nerve. The brain registers the pain as coming from the place where the nerve goes, even though the pressure may be at the origin of the nerve where it exits the spinal cord or someplace along the nerve's length.

The typical cause of nerve pressure is muscular tension maintained as an involuntary, constant action by the brain, the control center for all but the most momentary muscular activity. This brain-level control, in turn, is acquired by a kind of learning set in motion by repetitive use, stress, or sudden injury. As a learned action pattern, muscular activity can be changed by new learning, so sciatica can be relieved and ended by developing sufficient control of the involved muscles to be able to relax them and make them more responsive to voluntary control.

The Three Types of Sciatica

There are two most-typical types of sciatica: common sciatica and "piriformis syndrome." To understand these two types of sciatica, it helps to understand the path of the nerve from spinal cord down the leg.

The sciatic nerves have nerve roots that exit the spinal cord at the levels, L3 - L5 - the lowest three vertebra of the lumbar spine (low back). The nerves pass in front of the sacrum (central bone of the pelvis) and then behind the pelvis and down the backs of the legs. They divide approximately at the knees and pass down the calves to the feet.

Common sciatica results from a combination of excessive swayback (lordosis) and side-tilt (scoliosis). The combination of swayback and side-tilt reduces the space through which the nerve roots pass and squeezes them.

Piriformis syndrome is much rarer than common sciatica. A medical writer at mednet.com writes of piriformis syndrome as follows:

... irritation of the sciatic nerve caused by compression of the nerve within the buttock by the piriformis muscle. Typically, the pain of the piriformis syndrome is increased by contraction of the piriformis muscle, prolonged sitting, or direct pressure applied to the muscle. Buttock pain is common."

Piriformis syndrome comes from contraction of the piriformis muscle of the buttock (usually one side, only), through which the sciatic nerve passes in some people, and around which it passes, in others. Mere passage through the muscle is not enough to cause symptoms, but if the piriformis muscle is held too contracted for too long, sciatica results.

A third form of sciatica occurs when a spinal disc has ruptured, causing nerve root pressure from the extruded disc material (nucleus pulposus) or entrapment between the lower lumbar (low back) vertebrae (L3 - L5) that have collapsed. This form of sciatica is rare, but due to the painful nature of sciatica, many people fear that this is what has happened to them.

Even more rare is a condition in which the passageways through which the nerve roots exit the spinal column (foramena) narrow because of bone growth -- another surgical situation.

Generally, these last two forms of sciatica are surgical situations, although some therapists claim to be able to cause the re-uptake of extruded disc material and so alleviate symptoms. To be successful in the long run, therapy must also deal with the muscular contractions that led to disc breakdown or that likely formed if a violent injury caused the rupture.

Because of the rapidity of results available through the method described below, surgical interventions are properly the last resort.

Help for the Common Types of Sciatica

Where nerve pressure has muscular origins, the remedy is, in principle, simple, and in practice, easily achievable by clinical somatic educators, whose specialty is training to improve muscular control. As the basic function of muscular control is movement, clinical somatic educators teach a way to improve control of the movements caused by the muscles involved in sciatica.

The movements involved are (1) inducing swayback, and (2) inducing side-tilt.

The muscles of the back are like the string of an archer's bow and the spinal column, like the bow, itself. As tension of the bowstring causes the bow to stay curved, tension of the back muscles causes the low back to bow forward (inward - the swayback). Tension of the muscles along ones side cause side tilt. The combination of swayback and side-tilt traps and puts pressure on nerve roots where they exit the spinal column. Result: sciatica. So the movements retrained are those of going into swayback and leaning to the side.

In piriformis syndrome, the action retrained is that of tightening the buttock and turning the leg knee-outward. Relief of either of these forms of sciatica occurs within moments of the relaxation and, for all intents and purposes, is permanent. Usually, two to four sessions of clinical somatic education are required to obtain these results. The client typically learns certain movement patterns to rehearse to prevent the possibility of recurrence or, in the event of recurrence, to correct the problem themselves.

First-Aid for Sciatica -- Relax Certain Muscles

The problem with most methods used to relax muscles -- mental methods, manipulative methods, muscle-relaxant drugs, therapeutic methods in general -- is that they may not, and generally do not, adequately improve muscular control. Muscular control has two parts: the ability to create muscular tension and the ability to relax muscular tension. Both abilities are needed; otherwise, you are either musclebound (and prone to cramping) or weak. Such methods also often neglect an important part of control: sensory awareness. Too often, people are given therapeutic exercises but no instructions in how to do them; they're told, "These are strengthening exercises," so people go for strength instead of control; they go for effort instead of sensory awareness. If you can't feel how to regulate your muscular tension, you can't feel how to relax your muscular tension. You feel pain with no connection to the sense of contracting those muscles to the point of fatigue. Progress comes slowly, at best, from working too fast and too mechanically.

So you need to improve both muscular control and the ability to feel your muscles.

At the end of this article, you see a link to a page where I present First Aid for Sciatica -- somatic exercises that can start you on your recovery.

NOTE: If your problem is severe, (numbness or tingling in your extremities) you should have seen your doctor to rule out a medical emergency, such as a ruptured (not bulging or herniated) disc.