One of the most common issues I deal with in my practice as a Pilates teacher is that of sciatica. In my experience people sometimes self-diagnose tightness or aching down the leg as sciatica. Aching or tightness comes from the nerve being compressed, which leads to pain, but we need to distinguish between pseudo sciatic and true sciatica. Pseudo sciatica symptoms are caused by tight muscles, joint irritation, and/or poor hip mobility though the discomfort is real. True sciatica however is a beast of a different nature, whereby the sciatic nerve is compressed or irritated at its root, often by herniated discs (where the contents of the disc extrude from the disc and irritate the nerves) or stenosis (where there is narrowing of the spinal canal due to calcification of the vertebrae which irritates the nerves). True sciatica causes excruciating pain. How do we differentiate between the two and how do we treat them? What movement practices are best? Can one lead to another and if so, how can we prevent pain you wouldn’t wish on your worst enemy?
To answer these questions, we need to start by looking at the nervous system itself. The nervous system consists of the central nervous system comprising the brain and spinal cord and the peripheral nervous system, which is a network of nerves that connects the brain and spinal cord to the limbs and organs. This vast system of nerves, approximately 45 miles long if we were to lay it out, is responsible for 100 per cent of our body functions. It is the body’s communication and control network. The nervous system detects the information in our environment, processes it and then sends signals throughout the system that co-ordinate movement, sensation, and bodily functions. It is always listening to the inner environment of the body and detecting the external environment, and it is the nervous system that determines our movement patterns. How we move through the world and indeed how we perceive it, is down to our nervous system.
Our sciatic nerve, which emerges from the spine, is the longest and thickest nerve in the body. It runs from the lower spine through the buttocks and down the back of both legs, terminating at the foot. It enervates the leg and carries the motor signals to the muscles, resulting in our being able to move our legs.
Just like our joints and our fascia, our nerves require movement to stay healthy. Nerve cells, interestingly, are known to be the most excitable cells in the body. They both love and require novelty to be healthy. From a movement perspective this means multi-directional movement is essential. Not only does multi-directional movement excite the nerve cells in the peripheral system, it also lights up the brain, as synaptic activity or signal transmission keeps the brain alert and firing in response to the inner and outer environment. Quite literally, without movement our brains become dull. And we need regular movement in many directions in order to support blood flow and drainage for the nerves. This is an especially important factor in sciatica prevention.
So how can we distinguish the pseudo from the real sciatica?
Real sciatica results from nerve compression in the spine. This can be as a result of injury to the back, herniation of the disc, known colloquially as a ‘slipped disc’ or stenosis. Such impingement upon the discs causes shooting, burning electric pain down the leg with the pain manifesting below the knee as the sciatic nerve doesn’t supply so much sensory function in the thigh. Sciatica usually resolves in four to six weeks, and pain relief may be needed. Pain is often, though not always, worsened by actions such as coughing, sitting, or placing load on the spine. Major red flags for sciatica are if pain runs down both legs, weakness or numbness develops down both legs or there is a loss of continence in either bladder or bowel. These are the symptoms of cauda equina, a rare but serious medical condition whereby the nerves at the base of the spine are severely compressed. It requires immediate surgical intervention to prevent loss of motor function or paralysis.
Pseudo sciatica is a milder creature and manifests more as neural tension and restriction. One sure sign of this type of sciatica is that symptoms will change depending on the limb positioning. For instance, if you pull your foot up towards you, which automatically shortens and tightens the sciatic nerve, you’ll feel an uncomfortable pulling sensation. This condition typically occurs with muscle stiffness or limited movement, but motor function remains intact. Poor hip mobility can also create symptoms of fake sciatica as tight or weak buttock muscles can impinge upon the nerve causing a literal pain in the butt. This condition may cause persistent discomfort, but it does not radiate pain to the lower extremities. Nerves enjoy movement but dislike strain. The brain responds defensively to stretching of major nerves, such as the sciatic nerve, due to their heightened sensitivity. This can result in ‘stuckness’ which can look like stiff ankles, tight hamstrings, hips and lower back.
Managing both the real and fake
With real sciatica, once the episode has passed it is crucial to begin to strengthen the core to support the lower vertebrae and take pressure off discs and nerves especially where there has been a herniation. In the case of stenosis, learning how to move the spine with awareness is crucial. While there is no guarantee that you will not be revisited by sciatica, recovering confidence to move safely is vital. Remember nerve cells thrive on novelty and movement. Because the brain will ‘guard’ tight nerves we can end up limiting our movements to avoid pain and lose so much more in our capacity to experience the world. We must proceed gently but with confidence.
For both, stretching the nerve should be replaced by gliding the nerve. Gentle flexion and extension of the foot (pulling the foot up towards you and then pointing it away, exhaling as you pull towards and inhaling as you point away) is a simple way to start. Avoid doing too much at first, as it can be exhausting and may worsen symptoms. If you experience a flare up, wait for it to subside before continuing.
I would like to recommend a lovely modality called nerve brushing. Stand and place both hands on the abdomen and begin to brush down as though you are brushing crumbs off your clothing. Proceed your legs to your feet then brush down the chest and arms and head. Keep your touch light. Once you have brushed down the body return to the abdomen and proceed to brush in an upward direction through the whole body as before. This has the effect of lightly stimulating and relaxing the nerves and disarming the alarm system in the brain and makes stretching and gliding gentler so you can restore your sciatic nerve to health.
