The Gist: What is sciatica?
Also known as: Radicular leg pain, sciatic neuritis, or lumbar radiculopathy
Sciatica is the back and glute pain caused by a compression of the sciatic nerve. Symptoms often include a pain in the low back or buttocks that shoots down the back of the leg into the back of the knee or down to the foot, often like a lightning bolt. You may also experience numbness, tingling, or burning down the back of the leg.
The anatomy of sciatica
The sciatic nerve is the primary nerve that carries signals from the spinal cord to the back of the lower extremities. Nerve roots exiting the lumbar/sacral spine (L4-S3) come together to form the sciatic nerve, which, at its thickest, is about the size of a piece of string cheese. It then dives under the piriformis muscle, which is a thin, often tight muscle in the buttocks, before splitting around the hamstring and supplying the nerves to the rest of the posterior leg.
Sciatica is caused by compression of the sciatic nerve somewhere along its path. It can be compressed at the nerve root (ex. a herniated disc in the low back), or at the nerve itself under the piriformis.
Who gets sciatica? When does it occur for women?
During pregnancy and breastfeeding, a woman's hormones change. This can affect the laxity and stability of the joints, including those of the low back and pelvis. When the muscles in the hips and pelvic girdle are not strong enough to support the ever increasing load on the now loose pelvis, other muscles around the pelvic girdle, like the piriformis, will compensate and often go into spasm. When the piriformis spasms, it can put pressure on the sciatic nerve, causing traditional sciatic symptoms.
Women can begin experiencing sciatica as early as the first trimester, but we typically don't see it arise until the mid-second trimester or later.
During pregnancy, the arch in your low back naturally increases as your belly grows. If you have a history of disc herniations or sciatica, this gradual change in posture may aggravate your symptoms.
The Origin Way: Physical therapy for sciatica
At Origin, we look at the whole body from head to toe. If you are pregnant, we will develop a plan of care that will grow and change with you. We will talk about your sciatica, but we will also talk about your core, posture, and pelvic floor because they are all very closely connected.
Treatment for sciatica typically involves manual therapy techniques to the glutes and low back to loosen up the tissues. It also includes exercises to improve core, glute, pelvic girdle, and pelvic floor strength, as well as stretches and mobility exercises for the hips and sciatic nerve. Your Physical Therapist will also review strategies for movement that are particularly challenging when pre or post natal, including how to get off the couch and roll in bed.
How long does it take?
Sciatica tends to flare up occasionally even after it has resolved, so we will typically see you in some capacity until you deliver on a cadence that meets your needs and schedule.
What to expect in the future
Our goal for you always is pain-free movement. We want you to be able to walk, stand up, and live your life easily and comfortably. We will give you the tools to manage your symptoms over the long term so if your sciatica starts to return, you know exactly what to do to alleviate the pain.
Additional Reading and Sources
Al-Khodairy, Abdul-Wahab T, et al. "Sciatica in the Female Patient: Anatomical Considerations, Aetiology and Review of the Literature." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Springer-Verlag, June 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2200714/
Katonis, P, et al. "Pregnancy-Related Low Back Pain." Hippokratia, LITHOGRAPHIA Antoniadis I.-Psarras Th. G.P., July 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/