Muscle Minute TUESDAY – Sciatica and the Sciatic Nerve

Diagram of sciatic nerve anatomy and connections

Ever experience a literal pain in the butt? Sciatica affects up to 40% of people in their lifetime, causing pain in the gluteal region and potentially radiating into the posterior thigh. Let’s take a closer look at the potential sciatic nerve compression points:

Exits from L4-S3
Passes underneath the piriformis
Exits the pelvis through the greater sciatic foramen
Passes deep to the bicep femoris
Divides into common fibular n. and tibial n. just proximal to the popliteal fossa (above the popliteus)

The sciatic nerve must not only traverse through those structures but it must also be able to glide (like dental floss) as you walk and bend.

Laseague’s test (SLR test) is used to assess the ability of the sciatic nerve to stretch
Neurotension testing may be used as a treatment to restore gliding of the nerve

Below is a picture of a full stretch position of the sciatic nerve:

Man performing seated nerve glide stretch exercise.

This is an example of the sciatic nerve being glided (like dental floss):

Man demonstrating posture correction exercise on bench.

Notice in the gliding position, the nerve (represented by the yellow tubing) is shortened on one end and lengthened at the other end. (Note: the sciatic nerve does not start at the head, but was just attached there for illustrative purposes).

Successful treatment of sciatica must include evaluation of each of the potential compression sites. Here is a quick checklist to help you get started:

Compression site	Evaluation	Treatment
L4-S3	Manual lumbar traction	Lumbar traction Muscle energy technique
Piriformis	Palpate for trigger point midway between greater trochanter and PSIS	Counterstrain piriformis Strengthen gluteus maximus in sagittal plane with hip hinging Correct sacral torsion with MET
Greater sciatic foramen	Palpate for pain midway between greater trochanter and ischial tuberosity	(this is just a confirmation of sciatic nerve inflammation)
Behind bicep femoris	Palpate for trigger point in mid-muscle belly (mid thigh) or 1.5″ above fibular head	Correct posteriorly displaced fibular head with MET Stretch bicep femoris with revolving triangle
Popliteus	Palpate for trigger point proximal to the medial gastroc muscle belly	Counterstrain with passive tibial IR with the knee flexed

Why does this matter?

There is a reason why sciatica is sometimes so difficult to manage. There are so many potential causes of compression, making it so that one stretch doesn’t always fix the problem. Successful treatment depends on a thorough evaluation of all potential compression points. So roll up your sleeves and get to the bottom of the pain in the bottom.

Because nobody has time to be in pain.

Until next time…