Sciatic nerve: first aid for sciatic pain

What is the sciatic nerve and why does it cause pain?

The sciatic nerve is a large and strong nerve consisting of several nerve roots in the lumbar, buttock and thigh area. Sciatic pain is usually caused by the nerve being pinched or irritated, and anyone can be affected.

What is sciatic pain?

Sciatic pain refers to pain that occurs along the sciatic nerve. It usually radiates unilaterally from the lower back through the buttocks and the back of the thigh to the back of the knee and foot. This pain syndrome is also known as sciatic nerve dysfunction, sciatic nerve pain, or simply 'sciatica'.

Where is the sciatic nerve located in the body?

The sciatic nerve is the thickest and longest nerve in the human body. It runs from the lower spine, through the buttocks, along the back of the thigh and down to the foot.

Why does the sciatic nerve cause pain?

An irritated or pinched sciatic nerve can cause tingling and pulling sensations – but also strong pain – from the back down the leg. This pain is sometimes accompanied by sensory disturbances or even signs of paralysis.

What type of pain and symptoms point towards sciatica?

Sciatica can take the form of lower back pain, but may also cause tingling in the back of the knee.

Possible causes of sciatic nerve pain

Sciatica is caused by irritation or compression of the sciatic nerve. The most common causes include:

• Muscular tension in the back and pelvis
  
• A slipped (or 'herniated') disc pressing on the sciatic nerve
  
• A particularly tense piriformis muscle in the buttocks
  
• Narrowing of the bony canals through which the spinal cord passes
• Damage to the nerve root
  
• Inflamed nerves or inflammation elsewhere in the body
  
• In rare cases, tumours in the spine

The most common symptoms of sciatic nerve pain

Sciatica is expressed in a variety of pain patterns that vary from person to person and can range from occasional pulling to prolonged, intense pain:

What to do in the case of severe sciatic pain?

If severe sciatica symptoms persist, it’s advisable to see a healthcare professional for an examination. This often includes a Lasègue test which involves gently raising the patient's outstretched leg in order to recognise any impairment to the sciatic nerve. Imaging procedures can also form part of the diagnosis to identify the exact causes of the pain.

When to see a doctor?

Should leg pain be accompanied by signs of paralysis or loss of bladder or bowel control it's important to seek medical advice in order to avoid irreparable damage to the nerve and to assess if surgery is required.

Immediate help for intense pain

There are a number of effective measures that can help provide initial relief for sciatic pain. One of these is to apply something cold to the pain, especially when it’s acute, to inhibit the transmission of pain impulses. By contrast, heat applications can help ease tense muscles and are particularly helpful in cases of prolonged pain. When administering these applications, care should always be taken to ensure that the skin is protected, for example by placing a cloth between the source of cold or heat and the skin.

Physiotherapy for sciatica

Physiotherapy exercises also form an important part of the treatment. These exercises keep the patient moving, preventing them from adopting protective postures which could increase the pressure on the sciatic nerve and worsen the symptoms. Examples of such exercises include gently pulling the knees towards the upper body or lying with the lower legs raised to relieve pressure on the lower back.

Painkillers

Lastly, in cases of severe pain, it may be best to take painkillers. If you’re already taking other medication, you should ideally speak to a doctor beforehand to ensure compatibility and correct dosage.

What exercises help for sciatica?

Sciatic pain can sometimes go away on its own, especially if it’s only caused by mild nerve irritation. In many cases, the pain can subside after a few days, provided no serious injury is the cause. Once the painful period has passed, active prevention is important in order to minimise the risk of recurrence. After the pain’s acute phase, patients are advised to avoid prolonged physical rest and get plenty of exercise instead in order to prevent the pain from becoming chronic.

Train your core muscles

It's particularly important to focus on building up the body's core muscles and to strengthen the muscle groups that tend to get neglected in day-to-day life. It's also worth consulting a physiotherapist or sports therapist on how to reverse any muscular imbalances in your back, pelvis or leg muscles.

Stretching the gluteal muscles

This exercise stretches the muscle group that often tenses up with sciatic pain: the gluteal muscles.

1. In a lying position, bend the right leg.Bend the left leg and place it on the right knee. The left ankle joint lies on the right knee.
2. If you feel a stretch in this position, maintain the pose as it is.
3. To increase the stretch intensity, press lightly against your right knee with your right hand, or you can even reach under your right thigh and pull both legs up towards your shoulders.
4. Hold the position for 20 breaths and ideally repeat 2-3 times per side.

Self-massage with a ball

Regular self-massage can help prevent muscle tension and improve flexibility. This is an exercise you can use to massage tense muscles yourself:

1. Correct position: Lie on a flat, stable surface and place the ball under the affected area, typically under the buttocks or along the sciatic nerve at the back of the thigh.
2. Regulate the pressure: Start with light pressure and press slowly until the feeling of pressure is clear but bearable. Excessive pressure can aggravate the pain or lead to new injuries.
3. Exercise: Move your body slowly to roll the ball over the tense areas. Stay a little longer in particularly painful areas (trigger points) and hold the pressure without pressing too hard.
4. Caution: Avoid applying pressure directly to bones, nerve pathways or the lower back as this can cause injury.
5. Duration: Limit the massage to a few minutes per area to avoid overstimulation.
6. Relaxation: Try to relax and breathe deeply during the massage to get the best effect.
7. Aftercare: After the massage, it’s helpful to stretch and drink plenty of water to promote circulation and flush out metabolic waste.
   

Did you know? Piriformis syndrome is the name given to the pain that occurs when the piriformis muscle spasms and presses on the sciatic nerve.

Sleeping positions for sciatica

When trying to sleep with sciatic pain, adopting the correct sleeping position can play a major role. A recommended method is to elevate the legs by resting them on a thick pillow so that the hips and knees form a right angle. This position can help relieve pressure on the spine and the sciatic nerve and ultimately improve sleep quality. It’s important that patients find a comfortable position that relieves pressure on the back while not putting additional strain on the muscles.

Sciatic pain during pregnancy

During pregnancy, sciatica or sciatica-like complaints can arise due to hormonal changes, weight gain and pressure from the growing uterus. The pain can start in the lower back and radiate down to the legs. During pregnancy, it’s important to integrate exercise into your daily routine, as too much rest and lying down for long periods can aggravate the symptoms.

Can sciatica be prevented?

Various measures can be taken to prevent sciatica. Regular physical activity plays a key role. Endurance sports such as swimming, walking or cycling are particularly recommended. Targeted back exercises can also help strengthen the muscles around the spine and prevent tension. It’s also important to maintain good posture, especially while sitting for long periods or when working at a computer. Furthermore, heavy loads should always be lifted using the knees and carried with a straight back. Since these measures are designed to promote overall spinal health and help provide relief for back pain in general, they can also reduce the risk of sciatic pain.

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