Most cases of sciatica involve a bulging disc in the low back pressing on the S1 nerve root, left or right side; less commonly on both sides. The S1 nerve root is one of several that form the sciatic nerve, the largest/ thickest nerve in the body that controls muscle contraction and sensation in the legs.

The S1 nerve root may also be pinched by a thickened spinal ligament or an osteophyte (bone spur) in the foramen (hole) where the nerve comes out of the spine (notice the left vertebrae in the image below demonstrating this).


Sciatica can also arise from tight muscles in the buttock (hip rotator muscles) squeezing it. If you had a fall or injury that misaligned your sacrum, lumbar spine or hip joint it could throw those butt (gluteal) muscles out of balance, causing them to scissor the sciatic nerve where it passes between these muscles.


Lastly, the worse kind of sciatica is from spinal stenosis. This is when the central spinal canal in the lumbar spine narrows, pinching the nerves that lead to the legs. The canal narrows due to degenerative joint disease in the lumbar spine. Some people in this group walk in a crouched forward position, because it seems to provide relief.


Treating Sciatica Yourself

If you have some low back pain along with sciatica, or a history of it, chances are your sciatica is due to a bulging disc.  The strategy then is to reduce the bulging disc; i.e. decrease its size so that it doesn’t pinch the nerve.
Lumbar extension exercises at various angles can be helpful in reducing bulging lumbar discs.  The key is to find the right angle, as all disc bulges don’t behave the same in response to certain movements.  The correct movement causes the lumbar vertebrae to “pinch” the bulge back to center.   Watch this video where I demonstrate how to do this.

You can also use the PosturePump.  This is a device that extends the lumbar spine in the non-weight bearing position (while lying down).

If your sciatica is caused by pinching of the sciatic nerve in the buttock, try stretching your gluteal muscles (piriformis) muscle to lengthen it.  There are several ways to do it.  One is to cross your legs while sitting (bad leg on top), clasp your hand over the top knee and bend forward as far as you can go (may be difficult if you have a large belly).  Hold for about 15 seconds; relax.  Repeat 6 times twice a day.

You can use a power massager like the Max2 Percussion massager to “shake” the spasm out of the piriformis muscle.  Watch this video where I demonstrate this technique.

If you have canal stenosis, and your symptoms are unbearable, get a consultation from a spinal surgeon on your options.

Sciatica often affects those who sit frequently, for long hours.  Sitting places a lot of pressure on the discs and promotes bad posture.  It also places pressure on the sciatic nerve, especially if you don’t have much fat in the buttocks for cushioning and if you have a hard chair.  Wearing a thick wallet in your back pocket can cause more pressure to the nerve.

One of the best ways, in my opinion, to reduce the bad effects of sitting is to use a stand up desk.  Many employers will pay for this, since studies are coming out showing how prolonged sitting damages health over time.  The VariDesk  is an affordable option for a standing desk.


Other considerations

-Get good shoes with arch support.  This alone may ease your sciatica.
-Strengthen your low back, hip and butt muscles by doing kettlebell swings.
-Seek out an Active Release Technique (ART) practitioner.  This is a special massage designed to normalize muscle contraction and joint movement.

If you have a history of injury involving your low back and/or pelvis, get checked by a chiropractor.  Chiropractic adjustments can re- position the area, removing abnormal pressure to muscles and nerves.  If you live in or are visiting the San Francisco Bay Area, I am a San Ramon chiropractor and can help you with your sciatica using these treatment approaches.


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