Updated: Feb 12, 2020
Sciatic nerve pain can emanate from anywhere between the top of your bum and the lower back side of your leg. This pain is erratic and comes and goes unpredictably. Most people experience it as a deep, persistent dull to bright pain stemming from the back of their hip or, as in one of my recent cases, a pain deep in the hamstring muscles. Harvard Health Publishing estimates that “as many as 40% of people will get [sciatic nerve pain] during their life, and it becomes more frequent as you age.”
The sciatic nerve is one of the most prevalent “long track” nerves descending through multiple joints in the posterior side of our body. Originating as a spinal nerve at the nerve roots of the lower lumbar processes, it branches to the right and left as it emerges from the lower spine, descending down to either side of our holy sacrum and piercing through the distal piriformis foramen (a gap between the piriformis and superior gemellus muscles in your hip). At this point the nerve’s diameter is about as big around as your pinky finger. Traveling further down through the buttock and into the posterior leg, it innervates the semimembranosus, semitendinosus, and adductor magnus muscles before splitting off behind the knee into the tibial and fibular nerve (a.k.a. the common peroneal nerve) to innervate the muscles of the lower leg and foot.
There are many reasons that people encounter sciatica, and any motion that leads to sciatic nerve compression anywhere along the nerve’s length produces discomfort and pain. Active Release Technique®, a.k.a. ART®, has developed protocols to differentiate adhesions and promote gliding motion at the tissues that are adjacent to the nerve along its route, which can relieve this pain. In our Long Track Nerve Treatment protocols, we floss the nerve using palpation to treat the areas of stiction, taking our contact at junctions along the way. I often get great results from these techniques with only one or two treatments.
Like Sacroiliac Joint (SI) pain, the ultimate culprit is overactive stabilizing muscles and ligaments that are trying to protect you and save your pelvis. The piriformis is often to blame. Piriformis is the biggest and strongest muscle of the hip because of its meeting of origins from deep within the skeleton joining the more superficial bony landmark on the outside of the top of your leg. As described in a previous article, piriformis is not just a strong lateral rotator, it is also a savor of sort and responsible for the perseverance of your SI joint. Because piriformis is so frequently involved with sciatic nerve issues, many refer to sciatic pain as Piriformis Syndrome which serves as a “catch all” for the forces at work.
Will the pain return after treatment? Without structural body work, the answer is almost certainly “yes!” After getting you out of pain, reading your posture is a great place to start. A thorough investigation of the tensional imbalances going on above — in your back — will likely reveal the answer. The sciatic pain might be a result of shifting or tilting in the opposite shoulder, or a bend and rotation in the spine. Shortness on one side of your back can cause the opposite hip to respond. You might not be aware of the state of your shoulder or back (or perhaps you are and are ignoring it ¯\_(ツ)_/¯). Episodes can come and go and last for days, weeks or months unless addressed. Tensional imbalance and the interplay between fascial planes may be causing nerve entrapments at the hip or in the route down the leg. Alternatively, disc degeneration, a herniated disc, pinching or narrowing of the vertebral foramen that permit passage of the nerves from the spinal connection, can all cause painful episodes at the nerve roots. Indications for nerve root compressions are usually felt in both the sciatic and femoral nerve tracks. Regardless, postural intervention is necessary before it becomes chronic and a daily discomfort.
So, give your hip a big hug and be grateful, knowing that these patterns are changeable. Adopting a stretching ritual and myofascial release practice will pay off. I have heard that a “wine and stretch” is a great way to melt the tension, but I wouldn’t know ;). To help with your journey to a pain free and mobile body, I am building a library of stretching and strengthening prescriptions for you to try. I also prescribe targeted rehabilitative movements at each of my appointments.