Where does sciatic pain come from? Excruciating pain in the back of the knee. Is there a pinched nerve? Is it the sciatic nerve? The sciatic nerve is the longest and thickest nerve. Its painful sphere of influence is correspondingly large.
First aid against acute pain. Can you do something about it yourself or do you need to see a doctor?
Table of contents
The Sciatica And Its Sphere Of Influence
Sciatic pain is quite common. This is no wonder, it is the thickest and longest nerve in humans. The sciatic nerve (nervus ischiadicus) has a diameter of just over one centimeter and runs through almost the entire lower half of the body.
The Course Of The Sciatic Nerve
The ischial nerve, or hip nerve as it is also called, emerges from the spinal cord through the vertebrae of the lower lumbar spine (LW 4) and the sacrum (KW 2). It arises there on both sides from a plexus of nerves called the lumbar-cruciate plexus.
From there, the sciatic nerve passes through the buttocks, along the back of the thigh, to the back of the knee. Here it divides into a tibial nerve and calf nerve. Both run, longitudinally at the front and back, into the foot.
The Tasks Of The Sciatic Nerve
The sciatic nerve is composed of motor and sensory nerve fibers. It relays commands from the central office to the muscles in its area of influence. It also signals to the brain when it gets cold or hurts somewhere. Its supply area extends from the buttocks through the upper and lower legs and into the feet.
Sciatic Pain, Symptoms And Possible Causes
Lower back or leg pain is not always sciatica pain. Below is a brief overview of how symptoms often manifest in irritated sciatica.
The sensation of pain, as well as the radiation of pain, can vary greatly from one individual to another. The various causes also influence how sciatic pain ultimately manifests itself.
This Is How Sciatic Pain Becomes Noticeable
The pain can come on suddenly. Somewhat less frequently, it develops over a few days. If the back is involved, a sharp sudden pain is usually felt there. The pain is described as sharp and pulling.
An important indication of sciatica is unilateral radiation of the pain into the back of the knee, leg, or buttocks.
Other common symptoms of sciatic pain:
- Abnormal sensations (numbness, formication).
- Pain in the lumbar spine that worsens with prolonged sitting.
- Drawing pain in the back of the thigh that worsens with prolonged lying down.
- Pinpoint pain in the buttocks (possibly with a palpable, nodular induration).
- Pain in the leg.
- Pinpoint pain in the back of the knee.
- Pain decreases somewhat with movement.
- Pain worsens with excessive and one-sided strain.
- Pressing, coughing, sneezing aggravate the pain.
- Acute onset of pain more frequent than gradual onset.
- Restricted movement, relieving posture.
- Tension pain in other places, due to relieving posture.
Sometimes sciatic pain is confused with lumbago (lumbalgia, lumbago). The difference lies in the involvement of sciatica, which is responsible for the radiation of the pain. If the irritation of the nerve originates from the spine, it is called lumboischialgia.
A short test can show you if indeed the sciatic nerve is causing your pain. This is the Lasègue test. However, the test is only positive if the sciatic nerve is irritated at the nerve root. It will tell you if the sciatic nerve is involved in your back pain in the lumbar spine.
Lie on your back stretched out straight. Now have another person lift one leg straight up. If there is a pain in the buttocks or leg at about 45 degrees, the nerve is pinched. This is a typical case of sciatic pain.
The Causes Cause Sciatic Pain
We speak of sciatic pain (sciatica or neuropathic pain of sciatica) as soon as the pain comes from irritation or damage of sciatica. The irritation or motor disturbance can be felt throughout the area of influence of this large nerve.
The most common cause is compression or damage in the spinal area. Then it is correctly called lumboischialgia. Possible causes are a bulging disc or a herniated disc.
Muscle tension in the entire area of sciatica can put pressure on the nerve and cause pain. For example, piriformis syndrome. The culprit is the piriformis muscle, a small, internal hip muscle.
Injury or hardening due to sports or incorrect strain causes compression of the sciatic nerve in the transition area from the pelvis to the leg. This happens especially often to runners or in weight training sports. Quite unsportingly, this muscle can be damaged, for example, by a thick wallet in the back pocket.
Other Causes Of Ischa Pain:
- Injuries to a vertebral body.
- Degenerative changes of the spine (osteochondrosis, spondylosis).
- Inflammatory, rheumatic diseases.
- Abscesses, tumors, hematomas.
- Muscle tension, muscle hardening.
Why Sciatic Pain During Pregnancy Of All Times?
The good news first, less than one percent of pregnant women suffer from true sciatica. Nevertheless, almost one in two women complain of deep-seated back pain during pregnancy, sometimes with radiation into the buttocks or leg.
Most often, sciatic irritation occurs in the last third of pregnancy. Where does it come from? In medicine, one may not yet determine why this is so.
A bundle of possible causes is suspected for sciatic pain during pregnancy.
Weight gain during pregnancy shifts the body’s center of gravity. This puts more strain than usual on the lower part of the spine. The gluteus maximus is also particularly stressed by the unaccustomed shift.
Muscles in these areas therefore often tense up. This leads to tension pain. Sometimes permanently shortened muscle fibers press on parts of the sciatic nerve. This then leads to sciatic pain.
The hormonal changes during pregnancy cause the ligament structures in the lower trunk area to soften. This gives the unborn child enough room to grow.
Stretchy, loose structures of the ligaments and tissues are also necessary for birth. This area automatically becomes more unstable. There may be slight shifts in the bones and joints. The muscles compensate for this. In the process, reflex muscle tension occurs from time to time.
Well-known in this context is the vena cava compression syndrome. This is the name given to a sudden drop in blood pressure due to the pressure of the growing child on the inferior vena cava.
This can occur in the supine position, especially in the last weeks of pregnancy. The vena cava is squeezed. The blood backs up, putting pressure on the sciatic nerve in the lesser pelvis.
Also in advanced pregnancy, the uterus presses on the surrounding tissues. This can irritate the sciatic nerve in some places.
Especially towards the end of pregnancy and during childbirth, the sciatic nerve can be irritated from time to time. In the starting position for birth, the baby’s head then presses on the sciatic nerve.
In all these cases, constant irritation can lead to inflammation of the sciatic nerve. This then leads to prolonged periods of pain. As opposed to short-term pressure from weight or tension.
Means, Measures And Methods To Soothe The Sciatic Pain
In most cases, sciatic pain during pregnancy is temporary. Nevertheless, when they occur, the pain is often great and associated with significant limitations.
First, you need to clarify, with a doctor’s visit if necessary, that it is indeed just temporary sciatic pain due to pregnancy. Serious damage to the spine should be ruled out.
If the tension in a muscle or pressure from the growing child on the sciatica is the cause of the sciatic pain, relocation or stretching exercises will help.
For persistent pain, exercise and heat are the most effective measures. The first relief can bring a stepped bed position. In the supine position, the legs are elevated with a 90-degree angle at the knees.
- If there is pressure on the inferior vena cava: shift the weight. For example, from the supine to the lateral position.
- In case of pressure on the hip muscle (piriformis, below the large gluteal muscle): stretching exercises.
- In no case bed rest and take it easy, keep moving if possible.
Stretching Exercises For Hip And Gluteal Muscles
Place the legs in the supine position. Lean the leg of the affected side with the ankle behind the knee. To stretch further, pull the foot toward the hip.
In the lateral position, bend the upper leg at a 90-degree angle. The knee rests on the floor or points toward the floor. Both arms are stretched forward (90 degrees to the body) on top of each other. Now carefully rotate one arm and the head to the other side. The knee remains where it is.
When Is It Better To See A Doctor For Sciatic Pain?
If the pain cannot be soothed at all and it massively prevents you from moving further, you should see your doctor. Painkillers can help you to move again for a few days.
In pregnancy, it is always better to seek medical advice before taking any medication. Here, tests and further examinations can exclude serious causes of your sciatic pain.
In any case, you should visit your doctor’s office if the following symptoms occur in addition to sciatic pain and restricted movement.
- Numbness, tingling in the leg.
- On the inner side of the thigh.
- In the pubic area.
- Paralysis of the leg muscles.
- Sudden incontinence.
- In case of fever, fatigue, loss of appetite.
- When the pain becomes more severe.
If your sciatic pain is caused by pregnancy, then the above-mentioned immediate relief measures, as well as any prescribed painkillers, will help you. In case of a serious cause, appropriate orthopedic, neurological therapy will follow.
In case of sciatic pain due to pinched sciatica, the “three-pillar therapy” is usually applied: combating the pain, physiotherapy (physical therapy), and relaxation exercises.
Accompanying this, you can use both heat and cold to support the therapy. Here it has been shown that cold compresses help better with acute pain. The cold prevents the nerves from passing on the information.
Heat applications relax the muscles and help better with persistent pain. Here, heat baths and sauna sessions are also found to be beneficial.
What Can You Do?
First stretching exercises, movements, neither heat nor cold can relieve your sciatic pain? Then you can also resort to painkillers, such as paracetamol or ibuprofen for one or two days during pregnancy.
According to Embryotox, they are, with restrictions, considered safe for short-term use. Because you must keep moving. Only in this way can the muscles relax. Above all, this prevents you from adopting relieving postures, which can trigger new muscle tensions.
How To Prevent Sciatica Pain During Pregnancy
As already mentioned in the self-help measures, exercise is the method of choice for preventing sciatic pain. Well-developed back muscles are the best foundation for experiencing pregnancy without back or sciatic pain.
Pregnancy gymnastics, as well as yoga, breathing, and relaxation classes for pregnant women, you should take. These regular exercises are not only perfect prevention but also a great support during birth.