By Pulasta Dhar
The longest nerve in the body starts at the lower back and reaches all the way to the foot. It is a mixed nerve, meaning it has both motor and sensory fibres, which allows you to feel and utilise the lower limbs. It helps movement, lifting, climbing, and even standing. It’s called the sciatic nerve, and when it gets impinged or irritated, it can lead to any or all of the following: pain, tingling sensations along the course of the nerve, stiffness, and immobility.
Sciatic nerve pain is unique in the way it runs down the back of the buttocks, hamstrings, calf, and in severe cases, all the way to the foot. This pain is not muscular, and is most usually the nerve is being unnaturally stretched due to another issue in your posterior chain. A few days ago, I was performing a set of heavy squats. I just knew that I shouldn’t have attempted the last rep of that move, because it triggered sciatic pain for me. So I deep dived into the causes, the anatomical effects of the nerve, and ways to recover from this injury. The most important thing I needed to find out, however, was whether this pain meant that I was suffering from sciatica.
While sciatic pain can be very unique, it is uncommon for it to happen in both legs at the same time—which is what I had. After consulting a couple of physiotherapists, it became clear that a muscle spasm deep in the posterior chain can also cause the same kind of irritation that sciatica will. It was exactly like what Adriene of Yoga With Adriene said in one of her YouTube video (see below) on sciatic pain relief: “Remember that sciatica is mostly a symptom of something else (in the posterior chain).”
Identifying the point of origin of the pain is a big step in how you treat this: any attempts I had made at sciatic correction stretches would be only temporary, since, for me, it did not originate in my lower back. Instead, I could feel the origin more in my buttock: which explained why I wanted to sit in pigeon pose all the time!
A spine-health.com article titled Is My Pain Sciatica or Something Else? gives an ominous but important reminder on the importance of diagnosis: “A lumbar herniated disc and lumbar stenosis can cause similar sciatica symptoms; however, physical therapy for each condition can be different—while bending forward at the waist may be comfortable if you have spinal stenosis, it can cause increased pain if you have a lumbar herniated disc.”
One of my physios asked me to get my piriformis muscle checked, which eventually turned out to be the cause of the sciatic pain (which is why all the other stretches I was doing didn’t help). This is called piriformis syndrome which is sciatica’s sly henchman when it comes to pain.
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“While both conditions interfere with sciatic nerve function, sciatica results from spinal dysfunction such as a herniated disc or spinal stenosis. Piriformis syndrome, on the other hand, occurs when the piriformis muscle, located deep in the buttock, compresses the sciatic nerve,” writes Choll W. Kim in a spineuniverse.com article. She is a spine specialist and associate clinical professor at the department of orthopaedic surgery at the University of California San Diego.
If you have a fitness routine, chances are you may have piriformis syndrome over sciatica, because the former is caused more by inflammation of the soft tissues, or a muscle spasm that might compress the nerve which runs down the back of the leg. Long distance running, prolonged standing and sitting without stretching, and even an imbalance of muscles which have been overloaded and tightened over time may cause the same kind of symptoms as sciata.
Which brings us to the treatment, for both these conditions. Sciatic pain relief is more immediate and can be dealt with when following a daily stretching routine. Most medical experts I spoke with say that sciatica usually goes away at a younger age with rest and pain relief exercises which allow the nerve impingement to ease. But any sciatic pain that refuses to go away could be piriformis syndrome, which will need a more careful assessment to find out why the muscle is tight in the first place.
My treatment has and continues to include releasing the muscle spasm using cupping along, hot packs and a manual release done by the therapist. It has included a focus on training the core and the glute so that both sides of the body take an equal load (one side of the body being weaker than the other is not unusual), and a series of physiotherapy exercises to stretch and strengthen.
There are ways to avoid sciatic pain from either a herniated disc or piriformis syndrome. Maintaining a good posture and reducing sitting hours are high on the priority list. When it comes to lifting weights, do so with a slight bend in the knees and a straight back. Focus on core and balance exercises. And lastly, choose a sleeping position and surface that doesn’t put unnatural pressure on your lower back, because deep in its recesses lies a nerve that is as thick as a thumb at its widest, but can cause a ridiculous amount of pain.
Pulasta Dhar is a football commentator and writer.
FIRST PUBLISHED21.10.2021 | 10:00 AM IST