Sciatica pain starts in the lumbar spine or buttock, then travels down the back of a person’s thigh and sometimes into their lower leg. Relieving this often debilitating pain is easier when we understand what causes it. Let’s examine the main triggers of sciatica—and how each of them can be treated for maximum pain relief.

True sciatica is caused by pressure or irritation to the sciatic nerve (in the buttock) or one of its roots (in the low back). However, what many refer to as “sciatica” is usually not in the real sciatic nerve. The more common causes of this “sciatic-like” pain include muscle spasms, weak core muscles, or referred pain from elsewhere in the body. Referred pain occurs when the actual source of pain is different from where a person feels it. One example of this would be left arm pain resulting from a heart attack.  

Locating the Source

Sciatica, and sciatic-like pain have similar causes—for simplicity moving forward, I’ll refer to both as simply “sciatica.” These forms of pain can be caused by repeated strenuous activity, especially lifting. However, the opposite can ironically have the same effect—being too sedentary and allowing the core trunk muscles to weaken can also lead to sciatic pain.  In both cases, sciatica also involves subtle problems with a sense called proprioception.

Proprioception, or position sense, refers to our ability to know where our body parts are in space and how they relate to each other. This sense allows us to maintain our muscular balance, joint alignment and stability, and upright posture.  Most importantly, it allows for coordinated motion—to walk, talk, brush our teeth, and for some of us, do back flips. This incredible and vital sense comes from millions of nerve endings in the body’s fascia, a fibrous connective tissue that covers our muscles, bones, and organs.

In my experience, those who suffer from sciatica often have restrictions in their fascia from past injuries or the daily wear-and-tear of living. These restrictions can cause glitches in the body’s position sense, resulting in joint instability, muscle imbalance, and postural misalignment.  These can cause referred pain to the sciatic nerve area, muscle spasm, or spinal issues that exert pressure directly on the sciatic nerve. To resolve sciatica, we first need to explore its underlying causes of fascia restriction, weak core muscles, and incorrect or excessive lifting.  

Finding Relief

As an example, let’s consider the case of a patient, whom I will refer to as Helen. She had been suffering from sciatica on the right side of her body for over a year when she came into our office. The pain had started after moving some heavy pots while gardening in her backyard.  Physical therapy offered temporary relief, but the pain quickly came back once she finished therapy. She had recently started taking ibuprofen on a daily basis to take the edge off her discomfort, while cutting back heavily on her normal activities. 

Upon examination in our office, I found that Helen had restricted fascia in her lumbar muscles and her right thigh. Her right knee had been injured two years prior in a boating accident, and I found that it also had restrictions. Core exercises that she learned during therapy had left her with a stronger trunk area for the most part, but her lower abdominal muscles were still quite weak. We treated Helen by releasing the restrictions in her fascia with hands-on treatments and low-level laser therapy. 

Treating the knee area eased her pain considerably, but she experienced even more pain relief as we treated the other areas. The release of fascia restrictions also improved function in her lower abdominal muscles. This made it possible for her to use the exercises that she had already learned in physical therapy to strengthen and stabilize her abdominal muscles. Helen reported that she was feeling 90 percent better, but then she had a setback. 

Preventing Recurrence

Helen had been feeling so much better that she resumed her former gardening activities, but this seemed to flare up the pain once again. I asked her to show me the method that she normally used to move her pots, and she imitated what I consider to be one of the most dangerous activities for back health. She had been lifting and twisting—planting her feet in one spot, lifting her pots, then twisting her back to set them down, all without ever shifting her feet.

We treated her for new muscle injuries and fascia restrictions, then explained the importance of turning her whole body when moving these heavy items, rather than lifting and twisting. By the time she returned to gardening a few weeks later, she was entirely pain free.  She also learned to be more careful about how she used her body.

Occasionally, I have seen more serious causes of sciatica, such as a severe disk herniation pressing on the sciatic nerve or an allergic reaction to a metal hip joint that irritated the sciatic nerve.  Cases like this might require more invasive treatments like a surgical operation, but fortunately, these are few and far between. 

Most cases of sciatica—whether true sciatica or sciatic-like pain—are caused by the three factors mentioned above. Most sciatica cases can be resolved by treating fascia restrictions, increasing core muscles strength and stability, and reducing movement issues to allow for healing and to prevent future injuries. 

Dr. Eric Winder has been practicing chiropractic for 27 years, with a focus on treatment of fascia and soft tissue for the past 24 years. Dr. Winder’s practice emphasizes relieving pain and restoring alignment and motion with gentle therapies. For more information, call 941-957-8390 or visit GentleBay.com.