by Mary Ann Wilson, RN
Reprinted from the Sit and Be Fit™ newsletter, Focus on Fitness, Volume. 10, Number. 1 as accessed from the FEOAA News Volume 14, Issue 3.
Question: Can you identify which nerve has the distinction of being the largest and longest nerve in the body and when irritated, causes pain that elicits the familiar phrase, “Oh, my aching back!”?
Answer: The largest and longest nerve in the body that causes back pain when irritated is the sciatic nerve. The sciatic nerve is as wide as your thumb and runs from the lower back, down the buttocks, legs, and to the feet. It is responsible for the painful condition referred to as sciatica.
When this nerve is compressed or strained, the resulting irritation can play havoc with everyday life. For example:
- Next to the common cold, it is the second most common reason for lost days of work.
- Treating it can run into billions of healthcare dollars.
- It can interfere with being able to complete the simplest everyday duties without pain.
The symptoms help to diagnose this condition easily because the pain has several distinctive characteristics:
- It typically occurs on one side of the body.
- The pain is often described as tingling, burning, pins and needles sensations, feelings of electric shock, hot and cold sensations, numbness and weakness in the leg or foot.
- The classic symptom starts with lower back pain that runs through the buttocks, back of the thighs, and divides into two branches just above the knees. It continues to branch out into the calf muscle and all the way down to the feet.
The sciatic nerve is designed to transmit messages from the spinal cord to the legs, directing them to move. But when the sciatic nerve becomes compressed, irritated, or inflamed, the only message it transmits is pain. A herniated disc, arthritis, a tumor, an injury or spinal infection are a few of the various causes of sciatica.
Researchers in Finland have also discovered a genetic component that contributes to a predisposition for developing sciatica. So, don’t be surprised if you find that it runs in the family!
One of the most common causes of sciatic pain involves a small, deep muscle called the piriformis. It is located beneath the gluteus maximus and in a fraction of cases the sciatic nerve actually runs through the piriformis muscle. When the muscle contracts it compresses the nerve, causing irritation and pain.
There are other things that will cause the piriformis muscle to act up. For example, repetitive activity involving the hip, back, and buttocks can be intense enough to cause the piriformis muscle to swell up, creating pressure on the nerve. Last but not least, weak hip and gluteal muscles will cause the piriformis muscle to become tight, compressing the nerve.
Another common cause of sciatica is a herniated disc in the lower spine, which can pinch off or compress the nerve. Other circumstances that can create compression on the sciatic nerve include the bony, irregular projections due to osteoarthritis or swelling that develops as a result of an injured ligament. Even something as simple as a man sitting on a wallet in his back pocket can put enough pressure on the piriformis muscle to cause problems.
Good news! Dr. James Wheeler, III, an orthopedic surgeon in Marion, NC, reports, “Ninety percent or more of sciatica problems resolve themselves.” Surgery is considered only when a person becomes functionally disabled.
It is imperative to begin with professional help. A neurological exam is a must and a peripheral vascular exam is most likely needed to rule out any circulatory problems. Your doctor may prescribe an anti-inflammatory medication to relieve the pain temporarily and to reduce the inflammation. He may also recommend ten minutes of cold compresses or ice followed by stretching the hamstring group, piriformis muscle, and all the surrounding muscles.
Other treatment modalities might include physical therapy, biofeedback, extended bed rest, epidural steroid injections, or nerve blocks.
Engaging in a regular exercise program that focuses on strengthening the postural and abdominal muscles and stretching the hamstring group, piriformis muscle and the other external rotators is a great first step.
Here are a few suggestions that will help prevent sciatica if it is caused by prolonged sitting:
- Take a break from sitting by getting up and walking around once every hour.
- When sitting, keep your feel flat on the floor and don’t cross your legs.
- When sitting in a car, use a lumbar support, a rolled up towel, or a jacket for lower back support.
- Men, don’t carry your wallets in your back pockets to avoid putting pressure on the sciatic nerve when you sit down.
A Final Word
Along with using proper body mechanics, correcting your posture throughout the day, and avoiding prolonged sitting, there is one other important fact to keep in mind. It has been shown that individuals who are consistently improving their general fitness level are less prone to suffer back problems and most likely will never utter those dreadful words, “Oh, my aching back!”
Mary Ann Wilson, RN, Executive Director, Creator and Host of Sit and Be Fit began her career as a registered nurse, specializing in geriatrics and post-polio rehabilitation. While teaching aerobics to older adults, she noticed a high incidence of injury and attrition. In response, she designed a gentle program tailored to their special needs. Envisioning a broader audience, she created Sit and Be Fit. A medically safe, effective, functional exercise programming available to all via television. The series became an instant success and continues to be a favorite among older adult viewers because it effectively helps them feel better and age well.