Sciatica

Sciatica

The largest nerve in your body has a very devious twist--and when you have a pain in that nerve, it can really get around.

Sciatica, pain in the sciatic nerve, can radiate from the buttocks down the back of the leg to the knee, even as far as the big toe. "People with sciatica often say their back pain is bad but their leg pain is worse," says Loren M. Fishman, M.D., a physiatrist and rehabilitation medicine specialist at Flushing Hospital Medical Center in New York City. Often the hip pain is far more severe on one side than the other.

When you've got pain like that, you'll need a hands-on diagnosis before anything else, Dr. Fishman says. Once the doctor has ruled out a disk problem or fracture, he may be able to find out whether tight buttocks muscles are causing your pain by compressing the sciatic nerve.

If you do have sciatica, the doctor will probably recommend a program of supervised exercises, usually with the aid of a physical therapist. Here are some of the self-care methods that could ease the pressure temporarily and bring you some pain relief.

Pick your own pocket. A bulging billfold in your hip pocket can crimp your sciatic nerve, especially if you sit on the wallet for long periods of time, says Scott Haldeman, M.D., D.C., Ph.D., associate clinical professor in the Department of Neurology at the University of California, Irvine, and adjunct professor at the Los Angeles Chiropractic College. He suggests that you put the wallet in a coat pocket or purse to make sure you don't put lopsided pressure on one buttock.

Stretch your piriformis. One of these spindle-shaped muscles lies deep inside each buttock. The piriformis is the muscle you use when you turn out your hip and raise your leg to the side--and it's often implicated in sciatic nerve pain.

To stretch the piriformis and help relieve the pain temporarily, here's what Dr. Fishman suggests.

Lie on your back on the floor and gently pull your right knee up toward your left shoulder. Grasping the instep of the right foot with your left hand, slowly draw the knee and foot across the body toward the left shoulder. Stretch for 30 seconds or more to elongate the piriformis deep in the back of the hip. Then lower your right leg, switch to the left, and repeat.

Partner up for stretches. Even better, if someone can help you with your stretches, is this routine: First lie on the floor or on a firm bed on the side that doesn't hurt. Lift the uppermost leg (on the side that hurts) and raise your knee to waist level as if you were taking a step. Then slowly drop the knee down toward the floor or bed. Have your partner hold this knee down with one hand while he raises the ankle of the same leg with his other hand. A cautionary note: He should raise the ankle only as far as it will go comfortably and hold for 15 to 30 seconds.

Do a butt press. You can ease sciatic pain by pressing on appropriate acupressure points, says acupressurist Michael Reed Gach, founder of the Acupressure Institute in Berkeley, California, and author of The Bum Back Book. First find the center of the depression at the sides of the buttocks. Then press both sides simultaneously and hard, because the acupressure points lie deep below the skin, Gach says. Keep the pressure on for a count of 15, then release.

Give your calves a seat. Assuming a position with hip joints and knees bent is the best way to depress the sciatic nerve and avoid pain, says Dr. Haldeman. Here's a posture that should help: Lie on your back on the floor and place your lower legs on the seat of a chair for 10 or 15 minutes.