sciatica

Sciatica in gamers: an undeniable pain in the butt

Sciatica is the term used to describe nerve symptoms—most commonly pain—that travels down the thigh and/or leg. Sciatica, on its own, does not indicate lower back pain.

What is sciatica?

Sciatica is the name for pain patterns caused by irritation of the sciatic nerve—most notably in the back of the thigh and leg. The sciatic nerve is most often irritated by the piriformis muscle, a hip muscle that exits the pelvis through the same opening as the sciatic nerve.

For gamers, sciatica usually occurs due to prolonged sitting and is exacerbated by poor posture. Refer to our guide for gamer posture to reduce your risk for the piriformis muscle causing sciatica.

Symptoms of sciatica may also stem from irritation of some nerves at the spinal level; however, this page will focus primarily on true sciatica, or direct impingement of the sciatic nerve in the pelvis or thigh.

Pertinent anatomy

It’s important to know some basic anatomy of the lumbar spine and pelvis to understand sciatica.

To begin, the sciatic nerve is the largest nerve in the human body. It is a collection of lumbar & sacral nerve roots that provides motor control for the majority of the thigh, leg, and foot.

Through its terminal branches, the sciatic nerve also supplies touch sensation for the lower leg and foot.

For each bone in your spine, there is an associated nerve root that corresponds with an area of the body. In the lower back, nerve roots L4, L5, S1, S2, and S3* combine to form the sciatic nerve.

* The letters and numbers refer to the spinal region and segment (L = lumbar, S = sacrum); there are 5 lumbar bones & nerve roots and the sacrum bone has 4 nerve roots

underneath the piriformis muscle
The sciatic nerve travels underneath the piriformis muscle

Sciatic nerve

Nerve roots L4 through S3 combine to form the sciatic nerve within the pelvis. The sciatic nerve then exits into the gluteal region through an opening in the pelvis called the sciatic notch.

In the thigh, innervation of the sciatic nerve is motor only; it does not include cutaneous (skin sensation) innervation. The muscles of the sciatic nerve are the hip external rotator muscles and the muscles in the posterior compartment of the thigh:

  • Hip external rotator muscles: these muscles all turn the thighs outward
    • Gemellus superior
    • Obturator internus
    • Gemellus inferior
    • Obturator externus
  • Posterior thigh compartment muscles (hamstring): these muscles extend the hips and flex the knees
    • Semitendinosus
    • Semimembranosus
    • Biceps femoris

Just above the knee, the sciatic nerve splits into 2 branches: the common peroneal nerve and the tibial nerve. These nerve branches innervate the muscles in the lower leg, ankle, and foot.

These nerve branches also include cutaneous innervation to the lower leg and foot with the exception of the medial (inner) portion.

Sciatica in gamers
The sciatic nerve is often compressed by the piriformis muscle

Pathophysiology

Sciatica occurs when there is compression or irritation of the sciatic nerve. The compression or irritation may be caused by:

  • Piriformis syndrome
    • This is the most common cause. Tightness or spasm in the piriformis muscle impinges the sciatic nerve directly where both structures exit through the pelvis through the greater sciatic notch
  • Direct compression of the sciatic nerve
    • Prolonged or awkward seated posture: sitting awkwardly or for long periods of time can compress the sciatic nerve, directly
    • Tightness in the hamstrings may also contribute to sciatica
  • Lumbar nerve root impingement
    • Impingement or irritation of any individual lumbar nerve root, L4 through S3, may also cause sciatic-type symptoms
    • Lumbar nerve root impingement may occur from lumbar disc herniation or other stenosis (narrowing) of the neural canal

Signs & symptoms

Since the sciatic nerve contains nerve roots L4 through S3, the possible affected area is quite large:

  • The back or outer portion of your thigh
  • The back, front, or outer portion of your lower leg
  • The majority of the skin of your foot excluding a small area on the inner portion
area of sciatica in legs

In these regions, sciatica will present as one or more of the following symptoms:

  • Numbness & tingling
    • Many times, the first sign is a change in sensation which may include pins & needles, numbness, and/or tingling
  • Pain
    • Sciatic-type pain is often described as sharp-shooting or burning
  • Weakness
    • You may experience difficulty in flexing your knee or any action of your ankle joint

Sciatica will not present as pain, numbness, tingling, or weakness in the inner portion of the thigh, lower leg, or foot. These symptoms are instead associated with femoral nerve impingement or nerve root irritation T12 through L3.

Note: if you experience the above-listed symptoms along with swelling of the leg, ankle, or foot, paleness or blue color, and/or cool or cold sensation, these are signs of a more serious condition. You should consult your doctor or visit the emergency room if you experience these symptoms.

Common mechanism(s) of injury

Prolonged sitting pain
Prolonged sitting may increase the likelihood of sciatic-type pain

Sciatica is more likely to occur in people who sit for prolonged periods of time, especially if the seated posture is awkward or off balance. Prolonged sitting or awkward position may cause irritation in two ways:

  • Direct compression
    • Constant pressure on the gluteal region and back of the thighs may compress the sciatic nerve
    • A well-cushioned chair will make it less likely for sciatic nerve compression
  • Chronic muscle tightness in the piriformis or hamstrings
    • Sitting for extended periods of time may lead to hypertonicity (tightness) which can cause crowding or compression of the sciatic nerve
    • Sitting awkwardly (i.e. legs crossed or feet not flat on the floor) may put unnecessary tension on muscles leading to strain and tightness

Prevention

The most common mechanisms of injury for sciatica are direct compression of the sciatic nerve and poor and/or prolonged static position.

Body position: check out our posture education page to check your seated posture and reduce the risk of developing sciatica.

  • Sit with your hips all the way back in the chair so your back is pressed against the backrest
  • Keep both thighs flat on the chair
  • The chair height should allow your feet to rest flat on the floor with no additional strain on your legs
  • Your knees should be bent approximately 90 degrees
  • Rest both feet flat on the floor below your knees

Take breaks: for every half hour you’re sitting, you should stand up and walk around for 5 minutes!

Self-performed hamstring stretch
Self-performed hamstring stretch

Rehabilitation

To effectively resolve sciatica, it is important to first identify and correct the initial cause. For example, if you’re sitting too frequently without taking breaks or sitting awkwardly, protocols may be ineffective because of the constant exacerbation.

In practice, the following treatments are effective for the treatment of piriformis syndrome:

  • Manual therapy techniques (i.e. pressure release) of the piriformis muscle
  • Post-isometric relaxation stretch of the piriformis muscle
  • Post-facilitation stretch of the hamstrings
  • Contrast therapy in the gluteal region: heat therapy followed by cold therapy
  • Therapeutic exercises
    • Functional Range Conditioning (FRC®): 90/90 hip PAILs/RAILs
    • Hip mobility exercises (FRC®: hip CARs)
    • Sciatic nerve glide
  • Education in proper ergonomics

It is also important to eat an anti-inflammatory diet and/or include anti-inflammatory supplements in your diet to prevent chronic, systemic inflammation that may worsen nerve compression in the gluteal region.

Following resolution, continuation of these protocols allows for prevention of this condition from reoccurring.

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Disclaimer

This information is for educational purposes only and is not intended to replace the advice of your doctor. Esports Healthcare disclaims any liability for the decisions you make based on this information.

The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

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