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A Case of Pain in the BUTT-ock: SCIATICA

Updated: Oct 16, 2019

One of the many possible causes of pain in the buttock or leg is the often term Sciatica. So what is it? The sciatic nerve is essentially a ginormous nerve trunk given birth from (originated) from the L4 to S3 segments of the sacral plexus. Essentially from the sacral part of the spinal cord. The nerve fibres then unite to become this ginormous nerve trunk in front of the muscle piriformis or depending how crazy your anatomy is, may even pierce through the piriformis. Believe me, I've seen it on a cadavre. Now begs the question, how did this nerve ever become a pain in the buttock? There are many other causes that mimic the same symptomatology. Is it still sciatica if it has nothing affecting higher above, such as nerve roots? or should we often times, get over diagnosed sciatica as a means to all buttock and leg pain? Time for your healthcare practitioner to do some investigating!

Here are some causes of buttock, hip and leg pain that should be considered:

1. A common non-complicated cause of sciatic referred pain are muscle knots or active/tender trigger points. When these are fired up, they can hurt like a @#$*! So make sure your therapist work them good. Remember to breathe!

2. As aforementioned, because the ginormous nerve trunk sits in front or sometimes goes through the muscle of the piriformis, it puts itself in a very disadvantage position where it can get impinged, also known as "piriformis impingement syndrome". If the piriformis is shortened enough due to repetitive stress may lead to similar symptomatology of trigger points. Imagine sitting all day, you're basically strangling the nerve!

3. On a more serious neurological note, sciatica can be caused by a disc disorder impinging at the nerve root. In this case, it's usually a more significant factor and prognosis is much longer compared to the first two!

4. Tight hamstrings, hypertonic hamstrings, fibrous hamstrings induced by trauma, repetitive stress from sports leading to increased collagenous tissue known as fascia, can all contribute to strangulation of the sciatic nerve (strangulation isn't really the correct term but allows for more dramatic effect)

Now with that said, I am definitely not one of those Chiropractors out there that would tell you that you are suffering from a diagnosis of sciatica being a symptom of some kind of joint dysfunction, or alignment disorder, or your sacroiliac joint being "out". In most cases, trigger points can contribute as a cause or furthermore act as an accomplice. Trying to target them as first line of offense would be a good game plan to start. Most cases of sciatica that I have experienced with have a very favorable prognosis that will resolve within 3 to 8 weeks. Each individual will be different as genetic make up, age, gender, occupation may all play a role in recovery.

Let's get to the good stuff, how do we combat it?

1. Heat and vibrations

2. Use a lacrosse ball for myofascial trigger points

3. Avoid all bed rest; substitute with pain-free exercise and activity

4. Mobility; self or having a therapist prescribe dynamic stretches which allows your joints through its full range without resistance (Fascial Stretch Therapy)

5. Posture and ergonomics

Here's one of many good stretches out there that you should be prescribed to target sciatica symptoms:

Sciatic Nerve Flossing

While in sitting on a chair/table, place your hands behind you, slump your spine forwards and put your chin on your chest. Pull your toes back towards you then slowly straighten your knee until you feel a comfortable stretch. Hold this position for 10 seconds then relax. Repeat.

Stay tune as we explore more topics that may relate to you, let us know if there's a topic you would like us to touch on, here at Metatherapy we like to keep you at hundo p!

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