Sciatica is a very common condition affecting many people, and frustrating for those with recurrent episodes. Experts have estimated that approximately 80% of Americans will experience Low Back Pain during their lifetimes! That’s a pretty big number. So what is this sciatica? And what causes it?
Sciatica is a broad term for irritation to a specific nerve, called the sciatic nerve. Some people feel the pain just in the low back, but most feel a sharp pain down their leg, sometimes even into their calves and feet. It is usually only one sided. The pain can be sharp, dull or tingly. It is usually always worse when sitting, but can be painful in any position.
It is derived from your low back discs, specifically L3-L4 disc L4-L5 disc and L5-S1 discs. All of these nerves combine into the “Sciatic Nerve”. This nerve can get compressed and irritated in a number of different regions, all along the length of the nerve. One way, is becoming compressed by the discs themselves. We call this a disc “bulge” and puts pressure on the nerve down the line.
But how do the discs bulge? By bending over to grab something and there’s a pop in your back with intense pain, right? Wrong. Unless their is a direct blow or trauma to the region like car accident, bulging discs happen slowly over time, and are a result of improper weight bearing. What do I mean by this. One of the most common ways that discs in the low back bulge putting pressure on the nerves, is through a sprain in the sacro-iliac joint.
You have two of these joints. One on each side of your pelvis. The ligaments that hold the joints together are very easy to sprain, just as if you sprain your ankle. There are muscles all around the joint, but the only thing that connects the two bones the sacrum and the ilium are ligaments.
Take a look at this picture.
The right side is an example of a left sacroiliac sprain. This joint is sprained easily, with too much stretching of it (usually those super stretchy yogees) , having a child, sitting long periods of time, improper lifting techniques, car accidents, ect. When it is sprained, your body is smart. All along your body areas will compensate in order for you to stand up straight. In particular, the low back is a important area of the most compensation. If the sprain is not healed, the low back gets more and more compromised, leading to disc inflammation and injury (bulge), and further more, irritation to the sciatic nerve.
I see this commonly in both genders, but more common in females, and particularly women who have had a child. Or those women who are super flexible. With birth in particular there is always a sprain in this joint, and improper rehab and treatment creates chronic low back and sciatica type pain.
Another way pressure can be placed on the nerves, is from degeneration in the joints of the low back. This means that the joint narrows where the nerves come out, because it is an area that has had constant pressure on it, which further puts pressure on the nerve. It is caused by the same factor. A chronic sacro-iliac sprain that has gone undiagnosed.
When there is no stabilization in the joints because of the sprain, the surrounding muscles start doing the work of the ligaments. The psoas and the piriformis muscles in particular will contract to stabilize the joint, but further create pressure on the low back and the nerve. Usually individuals that have really tight hip flexors, and have to keep loosening to relieve their pain, have a sacro-iliac sprain. When they loosen it, the next day it will come right back. There is ALWAYS a reason a muscle is tight, and it is not always warranted to stretch them out. I always look at the reason a muscle is tight, what is it protecting? Rubbing a tennis ball on your butt muscles or legs is not going to fix the problem, even though it can give you some relief. Very specific chiropractic care, specifically from and SOT practitioner is needed to stabilize the joint, and decrease disc inflammation so that the muscles stop reacting, putting more pressure on the nerve.
A sacro-iliac sprain is extremely common but extremely misdiagnosed. Even within the chiropractic profession, it goes misdiagnosed for many patients.
The third reason for a sciatica type pain, is gut dys-regulation. Yes, that is correct. I cannot tell you how many patients I have had that after taking antibiotics, had a sciatic type pain afterwards. This is because the hamstrings and hip flexors are connected to the gut by the same nerves. These muscles shut off, and tighten when there is dysfunction in the gut. This puts pressure on the sciatic nerve, and also causes an imbalance within the body.
The fourth reason for sciatica type pain can come from dysfunction in the galbladder/liver. These organs are also connected to muscles because of the same nerves, in particular the iliacus/psoas muscles, which are HUGE low back stabilizers. If the gallbladder isn’t functioning because of stress, diet, or needs cleansing, it shuts off this muscle and de-stabilizes the back creating sciatica pain.
It’s important to determine which factor is causing your sciatic type pain. If you or anyone you know suffers from this excruciating pain, please don’t hesitate to let them know about what you have just learned and please refer them to the office. There is no reason someone with disc bulges and sciatic pain should just “live with it”. Fix the actual problem and pain will decrease, it’s that simple.
