Sciatica refers to an irritation of the Sciatic Nerve as it passes thru the buttock, causing pain down the back of the leg.
The term is often misused to describe spinal nerve irritation causing a similar pain in the back and leg, however this is a different condition.
Severity can vary from an ache that passes in a few hours to a constant and severe nerve pain.
Sciatic nerve anatomy
The Sciatic nerve is the main nerve that supplies most of the leg. It receives sensation signals, and transmits them up to the spine (and on to the brain). It also sends messages down to the muscles.
The Sciatic nerve covers part of the buttock, all of the back of the thigh and everything below the knee (front and back).
It doesn’t cover the front or inner part of the thigh. That’s covered by the Femoral nerve and it’s branches.
The Sciatic nerve originates in the buttock as an amalgamation of several spinal nerves. Spinal nerves are nerves that emerge from each level of the spine, between the vertebrae.
It then passes through the buttock, weaving between the muscles, and into the back of the thigh, next to the hamstrings muscles.
There are smaller offshoots of the Sciatic nerve that split off as it courses down. These supply the hamstrings and surrounding skin with their “innervation” (nerve supply).
Once the Sciatic nerve reaches the back of the knee, it branches into several smaller nerves. These branches wrap around the lower leg, covering the back, sides and front of the calf area and into the foot.
Getting relief from Sciatic nerve pain
Management of Sciatica relies on a combination of approaches as well as finding the optimal intensity for each intervention.
Too gentle and it’s ineffective, but too firm and it’ll flare it up.
Keep active but avoid muscle overload or fatigue by pushing yourself too much.
Remember that your nerve is affected so the muscles in the leg may only be working at half capacity. And tired muscles are more likely to spam and irritate the nerve.
You can ease muscle fatigue and tightness with a foam roller and/or smooth massage ball. My preference is a smooth ball and roller over a spiky version as it’s more comfortable and has a better effect on sensitive muscles.
Focus on hamstrings (without having it in a stretched position – more on that later) and gluteal (hip) muscles. And keep the pressure gentle – this isn’t the time to be guided by frustration.
Exercises to relieve Sciatic nerve pain
Gentle strength training also helps to relieve nerve pain. Aim for high reps and good quality technique.
Some examples of effective exercises include a shallow walking lunge, half depth box squat, kettlebell step overs (see below) and TRX pistol squats.
Exercises to avoid include leg work with heavy loads, full depth lunges or squats, deadlifts and hip focused exercises like single leg bridges. These either stretch and irritate the nerve or add too much fatigue to the muscles around the nerve.
You can monitor your progress by how far your symptoms travel down your leg. As it resolves, the pain moves higher up towards your buttock.
And the opposite is true – if the pain is moving down towards your calf, your condition is worsening.
Stretches, massage, yoga and medication
These treatments get a special mention as they tend to be the most popular home remedies…. and can make things worse!
Paracetamol and anti-inflammatory meds don’t do much for nerve-generated pain. It just won’t respond to them or they only take the edge off the pain.
Meds that can work on this type of pain, such as Lyrica, require a doctor’s prescription and are very strong.
Don’t stretch the muscles in the leg, especially the hamstrings. They may feel tight but stretching will pull on the nerve and flare the symptoms. Try using a foam roller or massage ball instead.
Getting hands-on physiotherapy, chiropractic or massage treatments are great but can only help for a few hours each week. Establish an effective home routine with a trigger point ball and gentle exercise in between sessions to get the best results.
Surgery is an option for the worst cases of Sciatica but it’s very rarely required. Remember that stories of surgery for Sciatica are over-represented on the web and social media. Stories of a short episode of Sciatica that resolves by itself just don’t get posted.
Conditions that feel like Sciatica
- Lower back pain, which can refer down the leg but only as far as the knee
- Lumbar nerve irritation, which produces very similar symptoms but also affects nerve reflexes and muscle activation
- Hamstrings tendinopathy
- Hamstrings tear
- Neural tightness, often made worse by attempts to stretch the hamstrings