Knee & Ankle Lower back Understand Pain By Sophie Xie / September 20, 2016 6 possible root causes of “sciatica” pain? Which one do you have? Quick Navigation Acute Herniated disc injuryLumbar spinal stenosisSpondylolisthesisPiriformis Syndrome Sacroiliac Joint DysfunctionGluteus medius and IT band pain What "sciatica" is might not be mysterious these days. It is not hard to understand the concept of a compressed, or pinched nerve, causing pain, weakness, and weird sensations going down your leg. However, the causes of sciatica pain are not that simple. First of all, "sciatica" is not all the same. Your "sciatica" pain could be drastically different than how your cousin experiences her "sciatica."It depends on the location of the nerve irritation. It also matters the types of irritation the sciatic nerve is undergoing. Even more, the chronicity of the root problem may also play a role in the treatment of this pain.Then, sometimes we see true "sciatica" pain and fake "sciatica" pain. Typical true "sciatica" pain is felt from the back of the hip to the outer thigh, then to the outer calf, finally possibly to the big toe. Fake "sciatica" pain may sound or feel like the real thing. However, they are commonly caused by referred pain from mechanical problems in the lower back/ hip region. What??!!!I know. That's why "sciatica" pain is difficult to rid of. However, if you can isolate the possible pain generating problems, you can proceed with much more effective treatments. True "Sciatica" pain causes Acute Herniated disc injuryHerniated disc or bulging disc are the common cause of the sudden onset of "sciatica." As the lumbar disc content protrudes out of its usual place, it may press into the narrow canal where the nerves exit your spine, thus nerve compression. If the injured lumbar disc has tears and the fluid inner content leaks to the surrounding area, it may cause chemical irritation to the surrounding nerve root as well. Pain Pattern:"Sciatica" pain occurred at the same time as the lower back pain from the herniated disc injury, no sciatica prior to the disc injurySciatica pain becomes more severe towards the end of the daySciatica symptoms are usually single sidedSciatica symptoms should improve significantly as the lower back pain healsEffective treatments:McKenzie positional treatment protocol - prone press up and side glideSeated sciatic nerve glideGentle core exercises such as clam shell, bridging and TA activation once the lower back pain starts to improveLumbar traction units under professional guidance and instructionsLumbar spinal stenosis Stenosis refers to the closing or narrowing of the space where the nerves pass through. The most common cause of stenosis in the lower back is aging and arthritis, and degeneration. Another common cause is a repetitive injury from overuse. People in the labor industry may suffer from numerous work-related lower back injuries, resulting in chronic "sciatica" pain.Another common and similar condition are called the degenerative disc disease. As the lumbar disc content tries out, the bony parts of the spinal collapse over each other, closing down spaces that used to be available for nerve tissues.Pain Pattern:Gradual increase in "sciatica" symptom over the yearsMore common is middle age to elderly individualsMay cause bilateral "sciatica", leg pain on both sideWorsening of symptom with prolong time on feet, relief when seatedTender buttocks or piriformis muscles secondary to chronic nerve irritationMay or may be have obvious chronic lower back painEffective treatments:Professional deep tissue muscle release targeting the hip flexors, lower back and gluteus muscles and fascia, reducing compression in lower backCore muscle strengthening (such as abdominal and gluteus muscle strengthening) to improve lower body posture over timeFrequent stretching and self release of piriformis muscles, hamstring musclesSevere conditions require invasive procesures and surgeriesSpondylolisthesis Spondylolisthesis, or "spondy", is a less common condition where one segment of your lumbar spine (usually L5) become loose and slip out of the spinal column. If this slippage is far and severe enough, it may cause nerve impingement. Spondylolisthesis is categorized as developmental (found at birth, develops during childhood) or acquired from spinal degeneration, trauma or physical stress (eg, gymnastics, lifting weights). If you are relatively young, experiencing unexplained vague lower back pain with sciatica over a period of time, you should speak to your doctor. Spondylolisthesis can be identified with an x-ray.Pain Pattern:This can happen to people at all agesMay cause bilateral "sciatica" symptoms (both sides)Usually accompanied by vague pain across the lower backEffective treatments:In mild cases, flexion based abdominal core exercises are beneficialAvoid extension based core exercises such as supermanProfessional deep tissue release of the hip flexor muscles in a non-extended positionSevere cases requires surgical proceduresPiriformis Syndrome The piriformis syndrome is the only non-spine related true "sciatica" pain cause. The piriformis muscles are two triangular muscles deep inside your buttocks. they help to stabilize and rotate our hip joints. What's special about these piriformis muscles are that they seat directly on top of the large sciatic nerve. In some people, the sciatic nerve travels through these muscles. When the piriformis muscles became overworked and tensed up, they apply direct pressure on the sciatic nerve, resulting in the "sciatica" symptoms.Piriformis syndrome is common among runners and sports players. It can also happen to new runners, or office workers with weakened core muscles. Please note that dehydration and extreme diet combined with intense workout routines is also a common cause of "sciatica" pain and other health issues.Pain Pattern:"Sciatic" symptoms with no lower back painTender to touch buttocksSymptom intensity with cardio works such as running, stair climbing or bikingMay also experience IT band or knee painEffective treatments:Professional deep tissue release to piriformis muscles, hamstring muscles, IT bands and gluteus medius musclesFrequent stretching of piriformis muscles and hamstring musclesStrengthening exercises such as clam shell, bridging, side walk with resistance, and proper squats.Proper balance between strengthening, resting, hydration and calorie intakeSeated sciatic nerve glide exercises and targeted icing to the piriformis musclesSevere cases require anti-inflammatory medication injectionOther rear causes of true "sciatica" pain include spinal tumor and direct trauma to nerve tissues. False "Sciatica" pain causes Sacroiliac Joint DysfunctionThe sacroiliac joint dysfunction, or SI dysfunction, is a condition where the "tail bone" joints become unstable and irritated. An irritated SI joint can cause a lot of pain, especially when we shift body weight, such as lying to sitting, sitting to standing, jumping and basic moving around. Sometimes the pain is tender and sore over the area between lower back and buttocks. Other times, the SI pain can shoot down the leg, mimic a nerve pain. In rear cases, the SI irritation results in spreading inflammation, affecting nearby L5 nerve roots causing real nerve pain.Pain Pattern:Sharp pain in SI joint region while performing transitional movements such as sit to stand, getting out of bed, stepping down, etc...Pain may shoot down back of leg, but does not get pass the kneeNo movements, no shooting painSI belt reduce the symptomsEffective treatments:See a physical therapist, get your sacroiliac joints assessed and alignedGet fitted for a SI beltStrengthening the gluteus muscle group for SI stabilizationSevere cases might need anti-inflammatory injectionsGluteus medius and IT band pain Common soft tissue pains that mimic the "sciatica" are caused by trigger points in the gluteus medius muscles and the IT band. These muscles are frequently overused during intense sports and activities. Trigger points in these muscles will spread the pain over the hip and thigh area.Pain Pattern:Aching pain over the hip, buttocks and outer thigh areaPain does not refer pass the kneeNo lower back pain, no tingling, numbness, weaknessPain improves once staying away from intense sports or activitiesTrigger points can be felt with massageEffective treatments:Deep tissue massage to release trigger points in gluts and IT bandUse Tennis ball or foam roller for trigger point releaseUse moist heating pad over the painful area for muscle relaxation and blood circulationFrequent stretchingProper balance between hydration, activities and resting Thank you for reading, and I hope you find this post helpful.Recommended readings:Sciatica nerve flossing? How does it help to relieve your sciatica painWhat's the cause of sudden stabbing pain in my lower backLooking for stretches for lower back pain? Hip flexor stretch is the place to startBest 4 gentle yet effective core exercises for lower back painWhy your chronic lower back pain has nothing to do with a herniating discLike what you just read? Share this post via our social media buttons! They are everywhere on this page!Want to know more about treating your own pain with techniques from a physical therapist? Please subscribe to our newsletter!