Sciatica - A Royal Pain! Identifying Causes and Finding Relief

Hi there. I'm Doctor. Keller Wortham coming you with another home edition of house call. And today, we're gonna talk about sciatica.

What exactly is sciatica? I know we all hear the term being thrown around a lot, somewhere in, like, the low back or the butt or the leg, you know, something to do with a nerve, I have a lot of patients that come in, and they're like, oh, yeah, I've got sciatica. I'm always wondered if they really know that they have it, if it was really diagnosed or if it's just something they they felt sounded like a good label. So today we're going to clear up what sciatica is and what it isn't, how to know if you have it, And most importantly, what you can do about it right there at home.

Okay. So a little definition here. Sciatica isn't a health condition. It's actually a symptom and kind of a misnamed one at that. It gets its name from the sciatic nerve, which is the body's largest nerve. It's so large that at one point, it's as thick as a guy's thumb.

The sciatic nerve starts kinda up here at the low back, and then courses down the back below through the buttock, and then all the way down the leg towards the toes.

Now, the term sciatica is often used to refer to pain or tingling along this nerve's course in the buttock and in the lower leg. But sciatica, as a term, doesn't really address the origin or origins of the issue. Only really addresses the symptom.

Pain along the sciatic nerve can result from lots of things. Irritation of the nerve, compression of the nerve, excess stretching of the nerve that can damage some of the fibers, or even stenosis of the spinal bones, basically, basically kind of growth of the spinal vertebrae.

Or herniations of the discs between the different vertebrae where the little roots of the sciatic nerve start.

So the sciatic nerve is formed from these roots coming that emerge from l four, l five, s one, s two, and s three. What does that mean? Well, we have different bones in our lumbar area and then our sacrum. That's where the l and the s come from.

And between each of those bones comes out a little nerve. So there's about five or six of these that are coming together to then make the sciatic nerve, which then threads all the way down through the pelvis under the piriformis muscle all the way down the leg to the big toe. Like all nerves, its job is to get impulses from the body and send them back up to the brain. So what happens with sciatic nerve is any kind of injury along the course or irritation, along the course of the sciatic nerve goes up to your brain, and your brain can perceive it from somewhere along that course.

Which is why sometimes if you have a a problem in your upper back or in the buttock, that pain can per be perceived all the way down the leg even into the calf or sometimes even into the foot. Alright. That that concept is called referred pain. But most sciatic pain is actually caused by problems that affect the L4 and L5 and S1 nerve root.

Way back up here in the lower spine. That's usually because those nerve roots are becoming irritated or compressed Now, when nerve roots are irritated, it's called radiculopathy, which sounds ridiculous, but it comes from the Latin word for root. So what causes this? Well, several causes of radiculopathy are herniated discs.

You know, as we get older, our discs dry health, they become less flexible, and then they can kind of rupture or herniate, or spinal stenosis.

That scary term is basically where the bones of the spine start getting thicker, which means the little holes in them get narrower, and it's in those holes that the nerves come out, or spondylolisthesis, which is a crazy big long word, which is hard to say, but refers to the slipping of one of your backbones, one of your vertebrae on top of another. And that slipping can again put pressure or irritate a nerve root.

Other things that can cause sciatic pain that are not related to the nerve roots are muscle trauma, which is affecting the buttocks or the hamstring, or piriformis syndrome, which is a very tight piriformis muscle, Pyriformis muscle is a really, really deep muscle within the pelvis or pregnancy. Okay. So the good news is that about ninety percent of people with sciatica will get better with home remedies and without surgery.

The first step is like it is for many inflammatory conditions resting and then applying ice and heat. Ice to help reduce inflammation and then heat to help stimulate the muscles to get blood flow and help the muscles relax. The second step for short term relief, using an over the counter anti inflammatory medication. Like ibuprofen to help kind of get the inflammation down. And then the third thing, and my favorite, is exercise.

Movement is so important, you guys. Movement boosts blood flow. It strengthens and stretches the muscles. It improves our range of motion and our flexibility. And it even reduces pain perception. Now, one of my favorite styles of exercise for sciatica and for many conditions were a combination of tightness and weakness is involved is yoga.

Alright. So I'm going to show you some of my favorite yoga based poses that help with sciatica. Now a couple of these we've already used because they're great for multiple conditions. So you get to do a little bit of multitasking here. The first, which we've talked about before, is child's pose.

We basically kinda sit back on our heat We have our knees a little bit separated out in a V, and then we're just gonna crawl our hands out as as we can.

If you can't go out that far, don't worry.

Palms on the floor.

If you can get your head down to the floor, Then do that. You want your butt down on your heels, and then the first position is just straight ahead.

And I call this child's pose three ways because we do straight ahead to really, really stretch out the back. I feel my back kind of sink down here, and it also, like I said, multitasking helps stretch out the shoulder girdle.

And then we can go off to the right For each of these positions, I would hold at least twenty seconds.

I can feel that stretch all along my oblique abs and around my shoulder.

And then twenty seconds off to the other side.

Again, keeping my head down. If you wanna rest your head on the floor, you can.

And then I can come back to straight ahead.

I know that looks very easy, but I can't tell you how important child's pose is for just stretching the low back and stretching all the side muscles that we often forget about.

The second exercise, again, we've used a lot, and we talked about low back pain, is reclining pigeon or what I call the figure four pose. Let's look at that.

Basically, you're gonna lie down.

You're gonna put one heel on the other thigh.

I'm kind of making a figure four here and I'm gonna reach through the hole with both my hands and grab the other knee. I'm gonna stay lying down and I'm just gonna slow pull that knee and therefore the foot here towards my chest. You will feel a major stretch all along the glutes, along your butt and the outside of your hip, and you're just gonna hold that. This is a very easy stretch to just hold.

It's good to keep the feet kind of flexed like that. It helps protect the knee. And you're just gonna hold that. You can hold that for a good thirty seconds and then relax and back down.

It's good to let the muscles relax. It helps kind of blood rush back into the muscle and then you repeat that move You see if you can go a little further.

Hold it again for twenty seconds and then relax and then, of course, do it on the other side. The third exercise also very, very important for reducing sciatic pain is the hamstring stretch. Again, I've done this one multiple times when it comes to low back pain. So let's revisit the hamstring stretch as well.

To stretch your hamstrings, you just need a yoga strap, or if you don't have a strap, like I said, you can use a belt or a towel.

And very easy.

You're gonna lie down and put the strap around the ball of the foot that you're working on. You can do this foot and you're gonna lie comfortable on the ground and your mission is to basically bring your leg up towards the ceiling some point, you will have to bend your knee because it'll be tight.

You let your knee bend, and then once you've got a little bend your knee and you're in a comfortable position, you're going to push to open those muscles.

It so important not to lock out your knee and just ratchet this back until you heard something.

Pull back slowly allow a bend in the knee to happen. And once you've got a little bit of a bend, then you use the muscle itself to stretch itself by straightening the leg in that position. Then you relax, you can pull it back a little further.

And then you extend again.


I like holding this for at least ten seconds and then relaxing. And if you can pull it back a little further and then do that again. You can do another ten seconds here and then relax. And then you let it go slowly down, and of course you do the other side.

And then I've got two additional exercises to show you. The first is affectionately known as cat, cat, in the yoga community.

That's basically being on all fours and then just extending your spine this way, holding, and then arching your spine that way.

We typically tend to inhale when we do this, and then exhales, we come here This is a slow, gentle movement that you can do through multiple cycles here, holding each one for a couple seconds.

And this really in help helps improve the flexibility of the the spine, especially in the low back. And like we said, the low back is where your sciatic nerve is coming from. So you wanna pay a lot of attention down there to getting those vertebrae nice and lubricated, and protected by these kinds of movements.

The final exercise here, which helps stretch out the hamstrings, the calves, and even some of the gluteal muscles is known in the yoga community as downward dog.

This exercise is also great for protecting the sciatic nerve. Basically, you can do this probably barefoot normally, but what you wanna do here is just extend your arms out.

Have your feet on the ground, and you're gonna try to do like a v pose. But what you need to do if you can't get there is straighten your legs all the way. If you have tight hamstrings, like I do, you can keep a bend in your knees and just push the ground away from you here. And then get your heels to the ground as best you can.

Okay? You don't wanna straighten them at the expensive kind of arch in your back like this. You wanna kinda push that away, keep your butt up in the air, and then just push your heels down as much as you can. And you can hold that position for maybe a nice fifteen seconds, and then you just put your knees down, you come out of it, you rest, And then you can do that, movement again.

If those strategies are not working, if you've tried the exercises, you've tried the stretches, there are other things you can do, you can get into organized PT or physical therapy. You can try a tens unit, which provides electric stimulation to the muscles and can help some sciatic pain. You can get massage to help loosen up maybe some of the tighter muscles around your core and around your buttock. And if none of that's working, then, you know, talk to your doctor, see if there's something else that may be more serious going on that might require a procedure.

So I'll leave you with just some general health tips that can help with sciatica. Just remember, as always, manage your weight, control your diabetes because these can increase inflammation of any condition, especially conditions with muscles and nerves, work on good posture because alignment is key for the spine health for disc protection and for muscle function. Avoid smoking because that reduces blood flow to the body including the muscles and the nerves. And then when you're lifting things, make sure you've heard this before. I'm sure, lift with your legs and not with your back. Okay? So if you're bending over and lifting up like that and you're at risk of rupturing a disc and no Bueno for your sciatica.

Alright, there. I'm Doctor. Keller Whortham. Thank for hanging out. And I hope to keep you sciatica free, and I'll be back in the future with more exercise videos for you.