The Nerve of Some People! A Guide to Sciatica

By Omar Shamout

What is sciatica? It's a pain in the behind—and more. The sciatic nerve is the longest nerve in the human body, originating in the lower back and running down through each buttock and the back of each leg. Sciatic pain is "radicular" in nature, meaning it can radiate from the nerve root at the base of the spine down to the toes. It occurs when the nerve is pinched or irritated by a disc herniation in the lower back, or by some other underlying cause. The pain can manifest anywhere along the nerve, and can change locations as the injury progresses. Fortunately, educating yourself, as well as using a little patience and common sense, can help make it a little easier to deal with the pain and inconvenience of sciatica.

How can I tell the difference between nerve pain and muscle pain?

Because the sciatic nerve covers such a large area, many people confuse other types of pain with sciatica, when what they're really experiencing is "referred pain" from another source in the body, like a pulled muscle or an arthritic joint. Here are some characteristics of nerve pain and muscle pain to help you begin to tell the difference.

Nerve Pain

• Doesn't seem to be caused by an event or trauma.
• Constant and/or recurring pain that doesn't seem to go away.
• Burning, stabbing, pins and needles; even wearing clothing is painful.
• Feel depressed, helpless; normal pain medicine like aspirin does not stop the pain.

Muscle Pain

• Caused by a physical injury, such as a fall.
• Pain that stops once an injury heals.
• Sore and achy feeling.
• Feel distressed but hopeful because more pain medicine relieves the pain.

Why should I be worried about sciatica?

Sciatica is not a disorder in and of itself, but rather a set of symptoms that potentially indicate the presence of an underlying condition. A herniated disc is the most common reason for sciatic pain, and depending on the severity, the pain will often get better after a few weeks of rest, but because back pain can signal the need for more extensive treatment, it's important not to ignore it. (Even minor back pain that's persisted for more than a couple of weeks should be checked out by your doctor.)

As we get older, the cartilage all over our bodies, including the lower back, wears down, leading to conditions like arthritis. This weakened cartilage leaves us susceptible to sciatic pain because the nerve is not receiving the same kind of protection it once was. When the nerve becomes pinched, the sharp pain that results can make it difficult to stand or walk. Sitting can also make the pain worse, so it's important to consult with a physician to find out if a) the pain is indeed being caused by the nerve and b) the underlying condition is severe enough to warrant further treatment.

Is there anything I can do to help prevent sciatica from either occurring or recurring?

There are several "prehab" techniques you should practice regularly to aid in preventing sciatic pain. Not only can these help with back pain, but they'll help with pretty much every activity you do in your daily life.

1. Strengthen your core muscles. Strengthening the muscles in your abdomen and lower back is crucial to maintaining good posture, which will help to prevent the cartilage and muscles surrounding your sciatic nerve from weakening. Ideally, this should be done as part of a full exercise regimen like P90X^®, which features a Core Synergistics workout that helps you build the muscle groups that support your core.
2. Stretching. Keeping your muscles loose and limber is one of the best ways to prevent the occurrence or recurrence of sciatic pain.
3. Maintain proper posture when sitting. Your feet should be flat on the floor, and your lower back and hips should be properly supported by your chair. Your knees should be even with or slightly lower than your hips to avoid putting pressure on your lower back. Avoid sitting for extended periods of time. If your job requires that you sit for more than 30 minutes at a stretch, try to take short breaks to walk around and help keep those muscles from tightening up. You should also avoid strenuous activity, like lifting heavy objects, immediately after sitting for a long time—try to move around and stretch a little first to warm up your muscles.
4. Maintain healthy sleep posture, too. It may not be the most obvious connection, but the way we sleep is crucial to the long-term health of our backs. Avoid using giant pillows, or piling pillows on top of one another—this can force your neck into an unnatural angle. Not only can this leave you with neck pain, but the improper alignment can put stress on your entire back. Putting a pillow under your knees when sleeping on your back can help alleviate strain on your lower back. When sleeping on your side, putting a pillow between your knees and bending your knees slightly will help you keep your body aligned in a less stressful way for your lower back. (Sleeping on your stomach is generally not recommended, as this position doesn't support the natural lumbar curve of your back.)
5. Consider taking glucosamine and magnesium. While the medical benefits of glucosamine and magnesium haven't been proven, many people take both in an effort to strengthen deteriorating cartilage, which can be a factor in back pain.

How do I deal with sciatic pain when it happens?

1. See your doctor. Especially if pain is chronic or persistent. Almost everything you do radiates from your back, and it's not something to try to work through or take lightly. However, many of us have some amount of chronic back pain, and it's not always practical to call your doctor every time you wake up with a stiff back. Anyone with a preexisting back condition should be fastidious about their prehab routine. If you're unsure about what to do, have your doctor recommend a physical therapist, who'll give you exercises to do. Once you're armed with this information, it'll be much easier for you to assess when you should call your doctor and when you should take care of things yourself.
2. Apply ice. Most pain is caused by inflammation, and nothing reduces inflammation as well as ice. Start by applying an ice pack to your lower back for about 15 to 20 minutes to relieve inflammation and discomfort. This should be done several times a day. If the pain continues longer than 2 or 3 days, call your doctor.
3. Rest. We recover best when we're asleep, so getting adequate rest is vital to promote healing. When pain is acute, all you can really do is ice and rest. If this doesn't make the pain better, you need to see your doctor.
4. Apply heat. You don't want to use heat when you're inflamed, but for minor discomfort, warming up the area will help blood circulate in your muscles and make synovial fluids become less viscous. Applying heat can work in a way that's similar to an exercise warm-up if you're too stiff to begin doing any exercise.
5. Move. Exercise is a very important component of recovery from any injury, but it's only advised when you know you're on the mend. Be careful, follow your doctor's and/or physical therapist's orders, and limit what you do. If you exercise to the point where your injury hurts again, you've done too much. Most of your prehab exercises can serve as your rehab exercises too. It's certain, however, that many things, especially many stretches, can make sciatic pain worse, so this is another area where you'll want professional consultation rather than just winging it.

At some point in our lives, virtually everyone experiences pain, sciatica included. However, if we're proactive about keeping our bodies strong, we can often help prevent or postpone the onset of chronic discomfort, while also preventing further injury to ourselves by taking precautions once we do begin to feel pain. That's why it's important to be smart about the way we react to pain, and listen to our bodies when they're trying to tell us something.