Sciatica: A Real Pain
Like other common medical terms, sciatica is not the name of a disease. Rather, it is a set of symptoms
(a syndrome) that includes pain, numbness, weakness or tingling in the
lower back, buttocks and parts of the legs, knees or feet. Usually, this
happens on one side of the body only. We
give this syndrome the name “sciatica” because of its relation to the
Sciatica Can Have Many Causes?
The sciatic nerve is the longest and widest
nerve in your body. It starts in
your lower back, runs through your buttocks, divides into two branches
in your thighs and runs down each leg to your feet.
Very simply, when the fibers of
this nerve are compressed or irritated, it hurts big time.
What's Happening in Your Body?
There are many ways that the sciatic nerve can
get in trouble, and depending on the location, we give it a different
name. For example: There is a
muscle called the piriformis that goes from your sacroiliac joint
(bottom of the spine) to your hip bone. And
alas, the sciatic nerve runs right under the piriformis.
That means that if the piriformis
spasms or is just too tight, then you have instant sciatica, but we call
it the piriformis syndrome.
Sciatica can result from a herniated (ruptured)
disc, a bone spur on the spine or stenosis (abnormal narrowing) of the
spinal canal. The weight of the
fetus during pregnancy, and rarely, vigorous coughing or even
sneezing, and even more rarely, one vertebra sliding over another can
result in sciatica. Arthritis,
osteoporosis, a tumor, blood clot or abscess can be sources of pressure
on the nerve, as well.
Between each pair of vertebrae in your spine is
a cushioning pad that we call a “disc.” The
disc consists of a tough fibrous outer ring that contains a soft,
central portion. In this most
common cause of sciatica—some say 90 percent—that fibrous ring gets
torn, allowing the jellylike inside of the disc to bulge out.
This may not only put pressure on
nerve fibers, but also release an inflammatory chemical called tumor
necrosis factor alpha (TNF) that causes pain even without compression;
TNF may also be present if there is stenosis, a narrowing of the spinal
And isn’t it really annoying when your doctor
says something like, “You know, Mr. Keller, age is a factor!”
Alas, however, aging, as well as
wear and tear, leads to some unfortunate changes in the spinal discs.
Specifically, that soft,
cushioning interior becomes a bit stiff, and so more of the load it
bears is transferred to the outer ring. This
additional pressure can lead to cracks in the ring, sometimes big enough
to allow the inner material to bulge through.
The bad news is that severe herniations may
require surgery. In fact, please
seek medical advice if:
There is sudden, severe pain in your low back or leg and numbness or
weakness in your leg
The pain follows a violent injury.
You have trouble controlling your bowels or bladder.
Minor Herniation and Other Causes.
The good news is that most minor herniations
heal within some weeks. And in
the meantime, to help control the pain, you might try
anti-inflammatories like aspirin, ibuprofen or naproxen, perhaps
combined with a muscle relaxant (ask your doctor).
As with many conditions, simple therapies
designed to balance your body and nervous system can go a long way
toward relieving sciatic pain. Among
the more effective seem to be acupuncture, yoga and the MYK system that
I practice. In addition, I often recommend using an ice pack for 20
minutes two or three times a day.
But the best therapy for sciatica is preventing
it in the first place, and there are some very simple precautions you
Keep your weight under control, get regular physical activity and don’t
sit for extended periods of time. Also—especially
to men—don’t carry your wallet or anything else in your hip pockets, and
wear an elastic belt instead of the unforgiving leather that most men
Daily stretching exercises—15 minutes anyway—will keep your piriformis
and other gluteal muscles flexible.
To help head off disc herniations, avoid especially heavy lifting and
exaggerated twisting of the torso.
The Metaphorical Side.
In her 1977 book “Illness as Metaphor,” Susan
Sontag points out that for centuries diseases that were not
well-understood became the subject of often wild metaphorical fantasies
about their origin, cause and effect, e.g., cancer as a curse or
punishment. And she goes on to
show that once the disease is understood, those fantasies tend to melt
away, thus discrediting the metaphorical side of disease.
“Illness is not metaphor,” she
But could there yet be some aspects of illness that might beneficially
be viewed metaphorically? Sciatica,
for example, produces pain in the buttocks, and so I have found it
interesting to receive a positive answer to the question: “Has something
in your life become a pain in the butt?”
Or with neck issues: “Is there something going on that’s a pain
in the neck?”
It’s not that recognizing the pain in the butt or neck connection is
going to cure your problem instantly, but we know that stress and other
emotions tend to get locked in the muscles.
And recognizing a possible
relationship between pain and other parts of a life can help release
those emotions, and open one to new possibilities for healing.
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