Sciatica is nerve pain due to compression of sciatic nerve. Sciatic nerve originates from L4 to S3, exits through greater sciatic foreman, passes below the piriformis muscle and is deep to gluteus maximus and hamstrings. At popliteal fossa, sciatic nerve divides into two branches which are tibial nerve and common fibular nerve.
- Bulging or herniated disc
- Bone spur
- Tumour in spine
- Prolonged sitting which causes nerve impingement by tight piriformis
- Nerve compressed by gluteus maximus and hamstrings muscles.
Sign and symptoms
- Pain in lower back, hip, back of the leg and foot
- Numbness and tingling sensation in hip and back of the leg
- Aggravated by prolonged sitting
- Muscle weakness
- Straight Leg Raise https://www.youtube.com/watch?v=LdAD9GNv8FI
- Slump test https://www.youtube.com/watch?v=HFGfP84uwEo
- Piriformis test https://www.youtube.com/watch?v=zha5jIv4_44
- Strength exercise on lower back, gluts and hamstrings
- Hands on technique on piriformis, lower back and gluts
- Stretch on gluts, hamstrings and calves
Sciatica is a quite prevalent and well-known condition in the clinic. However, people do not know much about it. Patients often complain about pain in lower back and lateral side of thigh which is not the symptoms of sciatica as sciatic nerve runs back of the leg (not lateral side). However, I do see patients with lower back pain and tight lateral side of thigh (ITB, vastus lateralis, gluteus medius and minimus.
In that case, Gluteus med and min might be tight and causing referral pain on the lateral side of the leg (Trigger Point). Also, practitioners may need to check connection of fascia or anatomy train line (spiral line or lateral line).
- B W koes, M W van Tulder and W C peul Diagnosis and treatment of sciatica 2007 the bmj 334(7607) 1313-1317