Sciatica: What Causes It And How to Treat It Effectively
By Robert V. Duvall, DPT, MPT, ATC, MGFI
If youíre reading this article, itís a good bet that you have a
radiating pain running down the back of your leg that just wonít go
away. If what Iím about to tell you sounds familiar, donít worry,
help is on the way.
I guarantee you that what you are about to read will likely be
far different than what you have read or heard anywhere else!
First, let me tell you why todayís traditional treatment methods
for sciatic nerve pain just flat out miss the boat. The medical
community is often times so conditioned and focused on treating only
the symptoms that they fail to address the cause of the problem.
That is why I wrote this article, the more educated you are about
your body, the more likely you are to get the best results and the
To get rid of your sciatica once and for all, you must first know
what is causing your pain. There are four primary conditions that
can cause sciatica. But, just knowing your condition is not enough,
you need to dig down one more level of reasoning and that is to find
out why you now have one or more of the four conditions.
As you read on you will note a common theme. That common theme is
the key to your success for quick and lasting relief.
Condition #1 - Piriformis Syndrome
The most common cause of sciatic pain is created when pressure is
placed on the sciatic nerve by the piriformis muscle. Muscle
imbalances pull the hip joints and pelvis out of place and this
changes the positioning of the piriformis muscle, which then places
pressure on the sciatic nerve.
Simple right? So, if you believe that, than I ask you what good
does treating the symptoms do to get lasting pain relief? In my
opinion, none, and most likely that is all you have done. Just one
more quick question, did any of your health care providers check you
for muscle imbalances? If not, the help I promised is here.
Through defining Piriformis Syndrome we have identified the first
mention of muscle imbalances and what I believe to be the root cause
What The Heck Is a Muscle Imbalance Anyway?
When one muscle overpowers the opposing muscle or when there is a
difference in flexibility of opposing muscles or a combination
strength and flexibility.
When your muscles are out of balance they pull your bones and
joints out of their normal position and this places your muscles,
bones and joints under constant stress and uneven pressure.
For example, the proper position of your hips and curvature of
your spine are determined by numerous muscles and whether they are
balanced or not. There are over 640 muscles in the human body and
everything we do affects them. From sitting too much to playing the
sports we love, and if just one of these muscles are out of balance,
you're in trouble.
Let move on to the other three conditions and let me show you more
of the common theme.
Condition #2 - Herniated Discs
Pressure caused by a herniated or bulging disc can cause
Sciatica. A herniation is when a disc protrudes out from between the
vertebrae and this can either be caused by an event like a car
accident, or, by months or years of uneven pressure due to muscle
imbalances. This can sometimes cause sciatic pain, but it is also
important to note that many people with herniated discs donít even
experience pain or symptoms, and many donít know they have the
Strange but true, I believe that is has to do with the degree and
extent of their imbalances.
Condition #3 - Spinal Stenosis
Pressure caused by Spinal Stenosis, which is a narrowing of the
space within the spinal canal. If you have Sciatica from spinal
Stenosis and there is a good bet that your muscle imbalances are
pulling your hip and spine into an abnormal position causing the
contact which cause the pressure.
Condition #4 - Isthmic Spondylolisthesis
Pressure caused by Isthmic Spondylolisthesis, which is simply
when a vertebrae slips or moves. This can sometimes pinch the
sciatic nerve but often times people who have this condition donít
have any sciatic pain, symptoms, or even know they have it!
As you can see, there is a trend here...
In Nearly Every Case Of Sciatica, Muscle Imbalances Are The
Primary Cause Of The Pressure Being Placed On The Sciatic Nerve...
But how do muscle imbalances develop? Either through a traumatic
event, or through a long process of lifestyle choices, or a
combination of both.
The event scenario is most likely the catalyst for sudden onset
of sciatic pain. So what happens? When there is undue stress on the
Piriformis muscle that stress causes it to go into spasm and then
you have pain due to the Piriformis muscle putting pressure on the
In most cases, people go to physical therapy or minimize their
physical activity to break the painĖspasm cycle and in most cases
your symptoms subside. However, the event will also set you up for a
lifetime of sciatic pain if the Piriformis muscle does not recover
100 percent in both strength and flexibility.
When you have an injury to a muscle, both strength and
flexibility are compromised. If your recovery ends (meaning your
effort) before strength and flexibility return, you may never be 100
percent again and will likely struggle with the problem throughout
The other way sciatic pain creeps into your life is due to your
lifestyle and habits, and that is what we like to call the process.
The process can be described as a prolonged onset of symptoms based
on your everyday activities.
However, from a technical standpoint the process really describes
the development of the muscle imbalance in your hip. The Piriformis
muscle is responsible for external rotation (moving your leg so your
feet point outward). So over time that muscle gets tight from the
positions you put yourself in and it weakens from lack of use.
Let me give you some examples of what I mean:
1. If you sit on the edge of your chair with your legs separated
and your feet pointing outward you are keeping your Piriformis
muscle in a shortened position. Thatís how it gets tight, and with
extended sitting in that position, it gets weak form lack of use.
Hence the imbalance!
2. Another example are the runners and bikers who actually work
very hard, they tend to get sciatica because they fail to keep a
strength vs. stretch balance in their workouts. Hence the imbalance
creates a greater pull toward external rotation and the result is a
tight Piriformis and an irritated sciatic nerve, creating pain.
These are just two examples of how muscle imbalances can affect
the Piriformis muscle and cause sciatic pain. You may not be a
runner or cyclist but Iíll bet you have muscle imbalances that are
causing your sciatic pain!
So how do you get rid of your sciatic pain?
If you are not sure which one of the four is causing your
sciatica, I recommend you start with the basics. Most cases of
sciatic pain are caused by muscle imbalances so if you begin to work
on correcting any muscle imbalances you have, you should start to
see improvement right away, and likely eliminate your sciatic pain
in a few weeks or less!
Will learning one new stretch be enough? It very well may be.
However depending on the severity of your condition you may need to
change your activities of daily living to include new stretches, new
exercises that include the use of the hip rotators like inline
skating, basketball, tennis, etc, and even better, specific
corrective exercise specific to correct your imbalances that you
have and that are appropriate for your situation.
As always, learn as much as you can about your condition, so that
you can ask the tough questions to your healthcare providers and get
the best care possible.
About the author:
Dr. Robert V. Duvall, DPT, MPT, ATC, MGFI, graduated from
Shenandoah Universityís Program in Physical Therapy with a Master of
Physical Therapy degree in 1998. He recently received his Doctorate
of Physical Therapy degree from the Physical Therapy Program at
Shenandoah University in December 2004. Visit
www.losethebackpain.com to sign up for your free back pain
e-mail educational course.