Sciatica is a common concern women report during pregnancy. It can make walking, sitting, sleeping and driving very painful. And if you have older kids, it feels impossible to keep up with them. Sciatica is often confused with a sacroiliac dysfunction so let's separate these two and then talk about treatment for each.
Sciatica
Sciatica is a condition that occurs when the sciatic nerve is irritated or injured. The sciatic nerve travels from the lumbar (low back) spine, down through the gluteal muscles that make up your buttock then down the back of the middle part of the thigh. Above the knee, the sciatic nerve branches into two parts and continues into the lower leg. One branch runs down the outside of the leg while the other travels down the back of the calf toward the heel. The nerve can be injured anywhere along this path. Common areas of injury are the spine and posterior hip.
Sciatica can occur with a lifting injury, with a new activity or exercise using glutes and hamstrings.
Sacroiliac Dysfunction
Sacroiliac (SI) dysfunction is irritation of the sacroiliac joint. This joint connects the sacrum (base of the spine) with the pelvic bones on both sides. Pain is typically localized to the area just around the joint. This location is easily recognizable by looking for dimples just above the buttock.
SI pain is common during pregnancy and postpartum but can also occur with weak abdominals and imbalanced hip and thigh musculature. Stepping off a curb and “jarring your back” is also a typical injury leading to SI dysfunction.
Symptom Comparison
Both of these conditions can cause pain with walking, standing, sitting or specific movements. So how do you know which one it is? Sciatica often occurs from the back into the back of the thigh. It will never be on the side or front. SI dysfunction does not usually occur in the back of the thigh but the person may also experience pain in the side of the hips. Another difference is when the pain occurs. Sciatica will (more often) occur standing and walking and will reduce with sitting or bending forward. SI dysfunction can hurt when you first stand up or after walking for a longer period of time. It will be painful to roll over in bed with SI dysfunction.
In the clinic I complete several tests for sacroiliac integrity and irritability as well as sciatic nerve tension, hip and spine mobility, and muscle strength and mobility. This, along with your pain pattern and history, helps me to determine the cause of the pain and how to resolve it.
Treatment
Sacroiliac dysfunction can be treated with sciatic nerve flossing, posterior hip muscle mobility and lumbar mobility exercises. Dry needling helps to reduce nerve irritation and reset the nervous system.
These pictures are sciatic nerve flossing. Start in a comfortable position, which may be on your side. Straighten your knee as far as comfortable then flex your ankle pulling your toes toward your head. If you feel pain in your back or leg increase, stop there. Then point your toes away from you while keeping your knee still. You can add another piece to this by lifting the head while you point your toes and resting your head when you flex your toes.
Sacroiliac dysfunction can be treated with strengthening of the core and hips, improving mobility of the adductors and glute med via foam rolling or a massage stick. Dry needling is used here to improve muscle mobility and reduce pull on the SI joint. If you are pregnant, modifying activities such as rolling by squeezing your knees together can greatly reduce pain immediately. In the picture below you can see how I’m rolling with the knees and feet together to reduce pain.
These exercises are designed to be one part of the treatment plan in combination with hands on treatment to improve joint, muscle and fascia mobility in order for you to get the best results quickly.
Have questions or need some help resolving your pain? Give me a call at 214-600-8168!
*Always consult your doctor or physical therapist if you are experiencing pain in order to get the safest and most effective treatment for your specific situation.