Good morning! Good morning! Recently, have you noticed that you are having back pain all the time Health deteriorates when I am still young! Actually you are getting old! I have heard people said that having pain in this area is called sciatica. So, do you have an idea what sciatic nerve is all about It is related to sitting! Both of us are not experts, so we have invited Dr. Ronnie Chan today to explain to us what sciatic nerve and sciatica are. Good morning, Dr. Ronnie Chan! Good morning!.
So, what is a sciatic nerve Let’s talk about sciatica first. Sciatica is a type of back pain. However, many patients and even doctors will mix up sciatica with common lower back pain. The cause or source of pain is very different. The areas of sciatica are located at the buttock, back of the thigh and refer down to the calf area. According to what you have just said, the painful areas are located lower in the body below the lower back That is correct. Unfortunately, many people will say lower back pain is sciatica. It is a misunderstanding.
When people are having back pain, they will say they are having sciatica but actually not sure at all. At the back. But it is actually below the lower back, and that will consider as sciatica. Let’s take a look at the diagram. The red areas Yes, it is at the buttock, the back of the thigh and refers down to the calf area in red colour. To the ankle area Yes. All the way travel that far Yes, that is why common lower back pain will stay at the lower back, but sciatic will refer down to the lower body.
Sciatica what are the causes and how to treat 20100915
So, is the sciatic nerve this long Not really, but pain is referred down there. Pain is referred down there. That means the pain can refer farthest down to the ankle area That is correct. It is a lot clear now. So, what is sciatic nerve Sciatic nerve is the combination of a number of nerve roots. Let’s take a look at another diagram. Then we can understand sciatic nerve better. It looks complex but we just need to look at the area where I circled. In fact, sciatic nerve is composed of L4, L5, S1, S2 and S3 nerve roots.
That means, on the right hand side, L4, L5, and then S1 to 3, right That is correct. You can see where I circled, it is the sciatic nerve. Can you guess how big the sciatic nerve is How big This is another IQ question! Is it similar to a finger It is the size of your thumb! The size of my thumb! Not bad, your IQ is good! Well, I am looking at the diagram Haha! Since the sciatic nerve is so big, you can imagine how painful it is when you injure this nerve.
So, I have heard my friends said it is very painful and sometime I cannot picture how painful it is. It is because of its size in fact, it is the biggest nerve apart from the nerve roots. Is it because of the compression of this nerve that induces pain Usually it is not due to compression, but inflammation. Could you then explain to us what will cause sciatica One of the causes, which we had mentioned, is the problem at the muscle. Therefore, if the functioning of the muscles of the lower back and buttocks are not good,.
They will develop trigger points. Then the pain referral pain patterns of these trigger points are very similar to sciatica. Therefore, there are close relationship between trigger points and sciatica. Secondly, it is the misalignment. If there is any misalignment at the spine, it could cause irritations of the spinal nerve root. Then the functioning of the nerve root will be affected, and possibly causes sciatica. So, why is there misalignment in the spine Then, we need to look at the bodily conditions individually, like sitting posture, physical demands from work, any previous trauma, etc. These are possible causes.
There are many different factors which can cause misalignments of the spine. Thirdly, it is something directly affecting or injuring the nerve root. For example, disc herniation. In which I had talked about it. Also, bone spurs and canal stenosis can cause the compression of nerve roots. These will give rise to inflammation, and then pain will result. I can feel the severe pain just from listening to you. Haha! So, what are the treatment methods in case we have an injury Taking medication can decrease symptoms but may not treat the cause.
In general, if the cause is extrinsic, for example, muscles taking medication will just decrease the pain. But you are not taking care of the root cause. We will use more than one approach for treatments. We can do some physiotherapies, use heatice, ultrasound and acupuncture. All of these can help to reduce pain. Ok. Secondly, we need to exercise we can do stretching and strengthening exercise. Meaning strengthening muscles Correct, strengthening muscles. On the other side, we need to stretch the muscles which wraps around the nerve. I should put a bit more emphasis in here. About 80 of the sciatica is due to muscular factors.
The muscle which wraps around the sciatic nerve is called piriformis. We can take a look at the diagram. So, 80 of sciatica are caused by piriformis That is right. You can see the yellow coloured nerve is the sciatic nerve. You can also see there is a triangular muscle located above the nerve. That piece of muscle is called piriformis. Piriformis. Piriformis. This piece of muscle is responsible for 80 of sciatica. This is a small piece of muscle. Right, but this muscle is also strong. When this muscle tightens up or becomes fibrotic, it will compress the sciatic nerve.
Majority of sciatica is caused by this muscle. Oh! What do you mean by fibrotic That means it becomes hardened. For instance, I had talked about frozen shoulder. The muscles cause frozen shoulder are also fibrotic. Therefore, both conditions are very similar. But this one has a worse prognosis it is the nerve is bigger in this case that you may feel more painful than the other condition. I can feel the severe pain just from listening. I have a question as I know how to treat and what is the cause.
Many occasions, I have seen men would like to put their wallets in the pockets behind. Their buttocks are already imbalanced Put 2 wallets! Haha! Will that affect their sciatic nerve Of course! It is the exact location where they put their wallets So, if you do not have sciatica, you may develop sciatica! And, if you do have sciatica, pain will become more severe! You better take the wallet out, Rodney! What I will recommend, regardless you are man or woman, instead of putting wallet behind, you can put the wallet in the front pocket.
For 2 reasons, first of all, it is safer. Secondly, you are not compressing the sciatic nerve area. Yes, of course, especially for those who need to drive long distance. It hurts a lot when the area is being compressed all the time. Understood. We don’t have a lot of time, but can you teach us some exercisestretching Sure. Let me show you one simple stretching! We need to sit further away from the table. We only need to sit down to do this stretching. Put the ankle of the painful side on top of the opposite knee.
For example, the left ankle. Then, lean forward. You should feel some stretching at the left buttock area. That is the area of the piriformis. Oh! Oh! That is the triangular muscle you have just talked about. You only need to do this to stretch that muscle. Somebody may like to do this lying down. The difference is you are going to put both hands behind your thigh and pull it towards your chest. Oh, I see. But I will prefer this method for the reason Sitting down You can do this everywhere!.