Many people suffer from sciatica, a painful lower back condition caused by a pinched nerve.
Sciatica can cause severe mobility problems and debilitating pain.
In serious cases, the condition can lead to progressive lower extremity weakness, numbness in the upper thighs, and/or loss of bladder or bowel control (1).
What Is Sciatica?
The sciatic nerve is the largest nerve in the body, extending from the lower (lumbar) part of the spinal column, through the buttocks, down into the legs. That’s why sciatica causes pain that radiates through the whole lower body, typically only affecting one side at a time (2).
There can be a few different conditions that cause sciatic nerve pain, and doctors often miss some of the most common causes.
The most common diagnosed cause of sciatica is a herniated disc that presses on the sciatic nerve. Any pressure or irritation of the sciatic nerve at any point can cause pain whether the source of the irritation is an adjacent muscle, bone, or tumor (3).
Sometimes, though, a healthcare provider cannot pinpoint the origin of the irritation/inflammation, having ruled out the common diagnosis.
The Hidden Cause
In many cases, the cause of sciatica pain is actually a tight or misaligned muscle.
The piriformis muscle extends from the front of the sacrum through the pelvic cavity to attach at the top of the femur and covers part of the sciatic nerve. Because it’s woven through bone and other muscles, it can be missed when diagnosing sciatica.
Piriformis syndrome occurs when the piriformis constricts the sciatic nerve and other nerves in the gluteus. A competent massage therapist, chiropractor or osteopathic doctor is well aware that a misaligned piriformis can cause many types of pain in the lower back and extremities (4).
If the cause of your back pain is due to the piriformis muscle rather than a herniated disc, consider yourself fortunate—it’s treatable without surgery, physical therapy, or pharmaceuticals.
How to Treat Sciatica Pain
Muscles are meant to move—the piriformis no exception.
Stretching does wonders for releasing constriction and tension, thus reducing inflammation and/or misalignment, and relieving nerve pain as a result. Below are two exercises that target the piriformis:
1. Lie on your back with your legs flat. Pull the affected leg up toward the chest, holding your left knee with your left hand and grasping the ankle with the other hand. Leading by the ankle, pull the knee towards your opposite leg until you feel a light stretch—do not force the ankle or knee beyond the stretch. Hold the stretch for 30 seconds, then slowly return to the starting position. Repeat three times.
2. Lie on the floor with the affected leg crossed over the other leg at the knees and both legs bent. Gently pull the lower knee up toward the shoulder on the same side of the body until the stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position. Repeat three times.
1. Devil’s claw is a plant indigenous to southern Africa, named so because of the tiny hooks that cover its fruit. The roots and tubers of the plant are used as an anti-inflammatory painkiller and are very effective on arthritis, headache, and lower back pain (5).
Devil’s claw can be found in natural food stores in capsules or powder form. People suffering from peptic ulcers or taking blood-thinning medication, however, should avoid this herb.
2. Alternating hot and cold compresses can help reduce inflammation and relieve pain. An ice pack held to the affected area, followed by a heating pad, then replaced by the ice pack will enhance blood flow to the area and loosen tight muscles (6).
3. St. John’s wort is a herb known for its ability to ease pain when applied topically. Most grocery and health food stores carry this popular herb, as it’s also a natural anti-depressant. An oil infusion massaged into the painful area can quickly relieve pain (7).
4. Trigger point therapy is a modality employed by professional massage therapists for the release of muscle constriction. It may be a little uncomfortable for the therapist to reach the piriformis because of its location in the pelvis but the resulting pain relief is well worth it (8).
A combination of massage therapy and stretching can put the piriformis back in its place—reducing pressure on the sciatic nerve and alleviating pain. Other useful treatment options include chiropractic care, acupuncture, and yoga therapy.
Gentle pressure is necessary when working with sciatica; anyone who has experienced the pain of sciatic nerve compression will tell you that sudden or rough movement will instigate shooting pain. A combination of the above strategies may work best to provide long-term relief.