Correct posture critical to prevent sciatica
By Lee Sung-hun
The sciatic nerve is the thickest and the longest nerve in the human body. It is roughly as thick as one’s finger and starts from the hip bone down to the back of the lower leg. Sciatica is a type of neuralgia where the sciatic nerve is compressed or irritated.
Sciatica is possibly the most common type of neuralgia. The sciatic nerve controls and responds to sensory inputs from the outer thighs, outer and the back of the calves and almost all of the feet. When sciatica occurs, the pain can be in any of such areas. Commonly the pain radiates from the hip or thighs down to the outside and back of the calves in a band-like manner, and common symptoms include;
— Pain in the rear or leg that is worse when sitting
— Burning or tingling down the leg
— Weakness, numbness or difficulty moving the leg or foot
— A constant pain on one side of the rear
— A shooting pain that makes it difficult to stand up
Although sciatica is known to be more common with old age, it is observed that people in their 40s are most prone to it, contrary to the commonly believed notion that it is associated with older people.
Another common misconception is that sciatica is a diagnostic term. However, it is actually a term for a set of symptoms and the root cause has to be precisely diagnosed for it to be treated properly. The most common cause is known to be a lumbar herniated disc but spinal stenosis or piriformis syndrome can cause it as well.
The sciatic nerve is derived from the spinal and sacral nerves and if the spine is compressed it can cause sciatica. With a herniated disc, the jelly-like disc between the vertebrae presses on the nerves and causes pain. Most commonly, this happens between lumbar 4 (L4) and the L5 vertebrae or between L5 and sacral 1 (S1). Spinal stenosis is the abnormal narrowing of the spinal canal through which the spinal nerves pass. Generally, it is caused by degenerative changes in the bone or ligaments. Patients with spinal stenosis commonly feel numb or pain in their legs after walking.
While herniated discs or spinal stenosis are problems in the spinal region, piriformis syndrome is caused by issues in the pelvis. The piriformis is a muscle in the gluteal region and the sciatic nerve passes through, over or under it. If the piriformis is overly strained, it can press on the sciatic nerve to cause sciatica. There have been reports of some patients who were initially diagnosed with a herniated disc due to leg pain and went through surgery that failed to alleviate it, and the cause turned out to be issues in the piriformis. As piriformis syndrome and herniated discs can display similar symptoms, a different diagnosis may be required.
In Oriental clinics, sciatica is treated with a combination of Chuna-chiropractic treatment, herbs, acupuncture, and bee venom therapy. If the herniated disc is the underlying cause, a bent spine is adjusted, and the structural defect is corrected to offset the pressure that causes the disc to herniate. This in turn decreases the pressure on the nerves. If sciatica is caused by issues in the pelvis, a twisted pelvis is adjusted so that the large muscles in the gluteal region can relax to alleviate pressure on the sciatic nerves.
In cases where a herniated disc causes inflammation that irritates the sciatic nerve, herbal medicine can help with the inflammation while strengthening the ligaments in the lumbar and pelvic areas. Acupuncture helps circulation of the “qi” or energy flow in the affected region while loosening static blood. Bee venom therapy is effective in strengthening weakened muscles while acting as an anti-inflammatory agent.
To prevent sciatica, maintaining a correct posture is crucial. Sitting down with the back bent places unnecessary pressure on the lumbar vertebrae that can cause a herniated disc or spinal stenosis. Sitting with the buttocks sticking out puts a load on the back and also adds tension on the pelvic muscles. A good seated posture is very important for the back. Also to maintain a left/right balance, crossing the legs should be avoided. Crossing the legs twists the pelvis and puts tension on the pelvic muscles, which in turn can put pressure on the nerves.
Regular exercises such as walking and swimming can help strengthen the muscles in the back and pelvis. Although it is helpful, one should avoid overstraining just to strengthen the back. I occasionally treat patients who thought exercising could help with their initial symptoms. However, it is best to treat the symptoms first and then gradually increase the workout load. If in doubt, always seek professional advice and treatment.
The writer practices Korean Oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul. He can be reached at sung_hun@naver.com.