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Anatomy Angel: Sciatica

February 22, 2014 by Kathy Dooley

Dooley Noted: 2/22/14

I’m in the class of therapists that sees a fair share of sciatica.

Sciatica tends to be a blanketed term for leg pain. While I love people using anatomical and clinical terms, let’s learn what true sciatica represents.

The sciatic nerve is a massive nerve about the size of your thumb. Wedged between the ischial tuberosity (read: sit bone) and greater trochanter (read: large outer thigh bump), this nerve supplies electricity to the posterior thigh and nearly the entire leg and foot. It can transmit pain, temperature, stretch, and other sensory as well as motor supplies.

The sciatic nerve supplies the fascia around its respective muscles. Thus, this nerve carries pain from the top and bottom of the foot, as well as the vast majority of the leg and posterior thigh. It also supplies the bursa between the muscles and bones of its respected areas.

This nerve is huge for a reason. It’s busy.

A pear-shaped buttock and pelvic muscle called piriformis covers the nerve posteriorly. Therapists famously ostracize piriformis as the culprit in cases of true sciatica.

Buyer beware.

If you watch the anatomy, the nerve is pinned down also by the long head of biceps femoris, a hamstring muscle.

Since hamstring tightness is famously taking over for wobbly core stability, the likelihood increases of biceps femoris clamping down on the sciatic nerve. And the surface area connection between hamstring and sciatic nerve is longer, with more connective tissue adherence.

The short story: your hamstring tightness may be creating your sciatica.

You might even have gluteal amnesia and core instability, resulting in piriformis and hamstring tightness. This compresses the sciatic nerve in TWO places.

Long head of biceps femoris and piriformis both can bring your thigh away from your hip, clamping the nerve between the greater trochanter and ischial tuberosity. Now, these two muscles are causing TRIPLE crush of the sciatic nerve!

If you are experiencing sciatica (true or not), please get it assessed and corrected.

Feel free to share this link with your therapist, so you both can understand sciatica even better.

As always, it’s your call.

– Dr. Kathy Dooley