I started running marathons 20 years ago. Soon, I started to have a deep, boring pain in my right buttock. Veterans shrugged and told me ‘it’s sciatica.’ My physician confirmed their diagnosis simply by listening to my symptoms.
Five years later I changed careers and entered medical school. Because I’m an endurance athlete, I opted to specialize in musculo-skeletal conditions. I distinctly recall the lecture on sciatica.
The physician started off with these statements: “I loathe the term sciatica. It is a garbage can term for pain along the distribution of the sciatic nerve. The term itself gives NO useful information on what is actually causing the problem.”
She was right. The Sciatic Nerve is the longest nerve (and the one with the largest diameter) in the human body. It innervates nearly all of the skin of the leg, as well as muscles in the posterior thigh, the calf and the foot.
The nerve roots which merge to form this nerve exit the spinal cord in the lumbo-sacral nerve plexus (specifically spinal nerve roots from L4 to S3).
The most common causes of so-called ‘sciatica’ are either a herniated (‘bulging’ or ‘slipped’) disk in the lower back or entrapment within a muscle. The most common of the entrapment issues is Piriformis Syndrome.
The Piriformis muscle is a small, powerful muscle with laterally rotates the thigh. It stabilizes the hip, and lifts and rotates the thigh away from the body. It’s involved in nearly every motion of the hips and legs.
In about 10% of the population, the Sciatic Nerve runs directly through the Piriformis muscle. Even if it doesn’t, because the nerve normally runs just deep to the muscle, a chronically tight Piriformis can trigger a fair amount of discomfort in the buttock region or along the back of the leg.
As I’d discovered, runners are prone to this condition. So are individuals who spend their days sitting. Stretching, ice or heat, and maintaining good mechanics and posture can help alleviate symptoms naturally. Some physicians prescribe anti-inflammatories and pain control medications.
The issue with treating sciatica-like symptoms is this: your physician has to determine what the actual problem is, and address the cause. Someone who has a herniated lumbar disk will have a very different treatment protocol than a patient with Piriformis syndrome.
As a runner and triathlete, my condition is caused by a tight or shortened Piriformis. I manage Piriformis Syndrome by using this stretch daily.
NOTE: prior to starting an exercise or stretching routine, consult with your primary care physician.