Hey everybody, this is Mike Uhrlaub with another episode of Power Your Life. Many of us have had an episode of sciatica or know somebody who has, it’s a common term. It’s thrown around all the time, “my sciatica is acting up”. If you’ve ever experienced sciatica, you will never forget. It can be one of the most unrelenting back issues around and I’m speaking from experience. About four years ago I had a bout of sciatica and it was miserable.
Sciatica is Literally a Pain in Your Butt; a Deep-Seated Pain.
For me, it was in my left buttock cheek that went all the way down into my left ankle. It is hard to describe because it was like this really deep-seated pain with a tingling that shot down my leg. That tingling was constant and there was nothing I could do to get rid of that pain. There was no stretch or position that alleviated my pain.
A lot of times when your back hurts, you can stand up if you’re sitting down and that helps. If you’re standing up or walking you can sit down or kneel, squat or take one knee. For most of us there’s usually a position you can get into that at least alleviates and takes pressure off of the back subsiding some of that pain. But if you’ve never had sciatica, I’m here to tell you, there’s nothing that can get rid of that pain. There’s no position or medication that works.
What Happened with Me and My Sciatica…
My wife and I went on a trip to Tucson, Arizona to visit my brother. It was 12 hours of almost nonstop driving for two days (I am not used to this). Being the kind of a stubborn guy that I am, I refused to give up the driving. My wife wanted to take over and we should have taken shifts. That probably would have kept me from having this issue, but I insisted on driving all the time and I just kept pushing through. By the time we got down there, I had this pain that made me miserable and wouldn’t go away.
I tried laying down on my back and putting my legs up. Then I tried laying on my stomach, pulling my leg over and stretching the hip out. I even laid down and putting my ankle on top of my knee, the figure four, to stretch the hip out. Took anti-inflammatories, ibuprofen, Aleve, and Tylenol while applying ice and heat. I tried all of those things at my brothers to get the pain to go away. It just would not let up. Kept me up, I couldn’t sleep. It was just absolutely miserable.
Even though I was miserable and it was very painful, I could still get up and somewhat function, but it was this constant pain that never went away. If you’ve ever experienced it or know somebody who’s been around that, they get a little grouchy. You get a little irritable and you’re not a lot of fun to be around until you figure out how to alleviate that. For some people, it takes a very long time to get rid of that pain.
What Exactly is Going on When you Have Sciatica?
To understand what is happening, what the true issue is, you need to understand a little bit about what the sciatic nerve is. The sciatic nerve is the largest nerve in the body. It is a combination of several nerve roots coming off of the spine. These nerve roots come off the spinal cord, exit between the vertebrae, and come together to make the larger nerve called the sciatic nerve. This nerve travels down your backside, through the buttocks, around the hip, and down the back of the leg. It carries the signals from the spinal cord to the legs. That’s what gives you the sensations and tells the muscles to work. Because it is such a large nerve (the longest and largest nerve), it’s susceptible to getting pinched anywhere along its path.
Think of This Like a Garden Hose
When the garden hose is all the way open and you’ve got the faucet turned on, the water’s running through the hose. That’s like the spinal cord, the brain sending the signals through the spinal cord, the nerve, then down into the muscle and skin. It’s like that water flowing through the garden hose. You’re watering your yard or washing the car and everything’s going along great. Then all of a sudden, the water cuts off and you can’t figure it out. You look back and you see the garden hose is kinked. That’s what happens when the nerve gets kinked or pinched.
It can get pinched from a herniated disc, muscles around the nerve, or a change in position from pelvis or hips which put that nerve on a tension. That nerve has to have slack. Think of the nerve like a string too. The nerve is attached to your spine and it’s running down. If you’re going to lift your leg up you have to have movement of that nerve. It has to have slack in it. When it gets pinched, it gets really irritated then tightens up. The nerve itself will swell and tighten up. When you go to lift your leg, you can’t move it as far because it’s tugging and pulling; it’s lost the mobility. We call that the neural mobility.
Why Does This Happen?
The sciatic nerve gets pinched because of the imbalances within your body that have been created by too much sitting, too many repetitive movements, different job tasks, or even past injuries. One of the ways you can get sciatica is slip and fall landing right on your rear end earning a big bruise. That contusion causes swelling in the nerve making all the muscles around tighten up.
The most common way for sciatica to happen is from these imbalances we’ve been talking about over the past weeks.
Hip Flexors
The psoas muscle (key to the spine and lower back), comes right off of the spine, joins up with the iliacus, which lines inside the pelvis, and attaches to the femur. Remember, when that muscle contracts, it allows you to lift the leg up. When it gets tight, it creates other problems.
Weak Glutes
Weak buttock muscles, gluteal atrophy, disappearing butt syndrome; All of these things are indicative that there’s a problem with the back or someone who just maybe has back issues. But they definitely go hand in hand with sciatica.
Tight Hips
Can’t lift the leg up as far, can’t rotate it many times. I see this; Where somebody can’t sit in a figure four. Sitting in the chair, they can’t put their foot on top of the knee because they’ve lost that ability to rotate it to the outside. We call the femur rotating out external rotation. Test this yourself. Can you put your foot on top of your knee? Can you sit in a figure four position? If you can’t do that, your hips are too tight and you’re losing the mobility.
Abdominal Muscles
The lower half the muscles below the belly button. Muscles that include the internal/external obliques, the transversus abdominis, these lower abdominals, that attach to your pelvis. When they’re strong enough, they help keep your pelvis in a good position.
Psoas Muscle
The psoas muscle is in a longer position when you’re standing. When you’re sitting for a period of time, whether it be in a vehicle, at work, or home watching too much TV, the psoas muscle gets shortened. When you stand up or move from sitting too long your psoas muscle goes into a spasm that creates compression or pull on the lumbar spine. This also causes the pelvis to tip forward called the anterior pelvic tilt.
The pelvis tipping forward, combined with the compression of the lumbar spine is setting you up in a position where things are not going to be good. When that pelvis gets tipped forward because of the alignment of the hip joint, it creates a position where the femur starts to get a little rotated to the inside. We call this internal rotation.
Internal Rotation
Inside your buttock muscles (gluteal muscles) is a little tiny muscle, the piriformis. This runs from the femur and comes across. That muscle is important because as the sciatic nerves coming down it goes either under that muscle, over that muscle, or right through that muscle. It varies from person to person. Due to this relationship of the piriformis to the sciatic nerve; when the femur gets rotated in because the pelvis is tipped forward, it puts that piriformis muscle on a bit of a stretch. Muscles don’t like that, they don’t like to be stretched out, especially this one in particular. The muscle then gets mad and starts to tighten up.
When the muscle starts to tighten up, guess what it pinches; the sciatic nerve. Now you’re going to start getting pain down the leg. It creates irritation and inflammation in that area. If this is left like this for too long, (a tipped pelvis, compressed spine, the hip gets rotated a little bit to the inside, piriformis gets spasms) then your gluteal muscles start to get weak. Those gluteal muscles occur and they get weak because of a process that we call reciprocal inhibition.
Reciprocal Inhibition
What that means is your hip flexor shuts off that gluteal muscle making it get even weaker. If your gluteal muscle gets weaker, your psoas muscle can overpower that and tip the pelvis more. If this is left unchecked and not fixed, the lower abdominals get stretched out from the tipping forward. You may have seen people like that. Looking at them from the side, their hips are kind of tipped forward and they have a bit of a protruding belly. Their lower abdominals aren’t strong enough to hold everything up in neutral and they start to get stretched out.
All of these combined contribute to sciatica. You’ve got to fix all of those things. A common mistake folks make when they come in to see me is try to stretch out that piriformis. So many people get a golf ball, racket ball, or foam roller and try to massage that out. They will just sit on it in that figure four position, pulling the knee up trying to stretch that out. It might kind of feel good for a little bit but they don’t fix those other areas and it just tightens going right back into a spasm.
You have to correct the issue with the hip flexors, the psoas and the lower abdominals. Stretching alone will NOT fix the issue.
You can’t just inject the hip or take pills and decrease the inflammation because the problem with that sciatic nerve is mechanical. It’s being pinched and compressed because the entire pelvis, lumbar, and lower spine is out of position. It all starts from that psoas muscle.
That’s why I say that muscle is the key to everything else. If you can’t get that muscle to unlock or the hypertonicity in it to shut down, then you just continue to have the same problems over and over again. It keeps that pelvis tipped forward. It keeps the hip rotated to the inside and makes that piriformis continue to spasm.
You can stretch the piriformis till you’re blue in the face for as long as you want, but if you don’t fix that psoas, you’re not going to be able to fix your sciatica.
The good news is these things can all be corrected. There is hope. When you’re in that kind of unrelenting pain, you just want out of it. It just hurts. You’ll do anything to get rid of that pain. I had to seek out somebody in Tucson to work on my hip flexor. To actually get in there and release my psoas muscle. That was the only way I was able to actually get relief so I could use my knowledge to strengthen and work on those other areas.
The next time I take a trip, I can guarantee you, I’m going to listen to my wife. I can guarantee you, I will not be stubborn, I will let her drive. Because I don’t want sciatica ever again.
My advice to you:
If you’re suffering from this, take the time, work on each of those areas.
- Psoas
- Hips
- Glutes
- Lower Abdominal Muscles
It’s extremely important.
If you would like to know more, I do have a new eBook out and it’s called The Five Best Kept Secrets to Fast Back Pain Relief. You can get your free copy by sending me a Facebook message. Just say “Hey, Mike, send me the FREE back report”, or just email me, mike@flex-pt.com. I guarantee you; it’s going to help. I would to leave you with this amazing quote I came across from Andy Stanley. He’s a pastor and author. His quote really got me thinking.
He said “it is when our hearts are stirred that we become most of most aware of what they contain”.
Until next time, Power Your Life and keep moving forward.
