Persistent Sciatica

Hello,

I am writing this to get some help fixing the source problem of my sciatica that I've been dealing with for almost a year now. If I may start from the beginning; in the early 2020 (prior to pandemic) I was a freelance software engineer and I was getting a lot of jobs, so I spent A TON of time sitting on a chair and getting my work done (I'm talking about all through the night and mostly through the day). I would skip the gym so I could spend more time working on projects. A month or two (maybe three) of this and I started experiencing back pain, bending forward, lifting my leg (I have notoriously tight hip flexors so perhaps this was what caused the back pain), and even squatting (no weight) would hurt my back. I tried fixing this by normal exercise/stretching and slowly it went 90% away. I decided to meet up with some friends to play soccer and while we were playing there was a moment where the ball was a little bit higher than my head and when I kicked it (front kick, over extending the hamstring) I think I may have pushed my leg muscles a little too far because after I did that; the next morning I was feeling a small burning sensation in the back of my left leg (first instance of sciatica). Since then the pain has only gotten worse.

Here is a list of the things that flare up the pain:

• when I bend forward past 40 degrees
• a faint amount when I bend backwards (not during the bending but when I stop bending backwards the pain comes)
• no pain at all when I bend sideways
• getting up from sitting on a chair
• it hurts when I get out of the pigeon pose stretch (most of the time not during)
• when I sit on a chair or on the floor(my back can be on the floor or not on the floor) and straighten my leg and move my foot up and down
• while standing if I hard flex all the muscles in my core

Here is a list of the things I've tried to fix the pain:

• stretching hip flexors, lower back, and glutes (this alleviates the pain but it always returns)
• I've tried rolling on a lacrosse ball on the piriformis muscle (this literally kills me, but the pain returns)

The pain does go away for most of the day if I exercise in the morning (I isolate my glute muscles with some exercises then do I a stationary bike circuit), but it still comes back. When I bend forward to touch my toes there is a small crack in my lower back (no pain, it just feels weird when it happens). Also the pain starts from the glute and runs down the leg, sometimes (on good days) it will just be a little pain in the calf or back of the knee.

I hope my post wasn't too long, I just wanted to give as much detail as I possibly could. If there is any more details I can give please let me know. I really need help

Do you suffer from any underlying health conditions such as diabetes?

It is important to understand that sciatica can unfortunately be chronic and the best treatment is a carefully tailored approach.

I would recommend really focusing on the lower back muscles in improving strength while also flexibility. Movement is key so continue with the exercise in the mornings.
Exercise releases endorphins which reduce inflammation.

Focus on building up lower limb strength with resistance training and avoid static positions longer than 45 minutes.

Is this diagnosed by some expert already? Piriformis is just one of the reason that might cause the pain. I would not irritate nerve by pain by rolling on lacrosse ball. Especially if you dont know wether it is trapped in piriformis or not. In my opinion, best approach is to avoid all activity that clearly might cause irritation. You dont have to be afraid of exercise and movement, but everything should be pain free and done with caution. Remember to do stretching and mobility exercises especially really slowly and painless, dont rush for the results.

Sorry about troubles. Here are some ideas:

"When I bend forward to touch my toes there is a small crack in my lower back (no pain, it just feels weird when it happens)" - No way anyone with sciatica can do that. This is gluteal and perhaps piriformis with maybe some sacroiliac with it. Some techniques:
1) Stretch- Sit; Cross affected leg over knee. Lean forward while maybe pulling up crossed knee. - If it's piriformis you should feel the stretch.
2) Positional release: - Lie on stomach in bed and drop affected side over edge of bed holding in about 90 degrees and try to pull it in a bit (adduct). Nice to have a stool the right height to hold knee. If you get the knee in right place piriformis will relax and if you hold it for 90 seconds might be good a few hours (help you sleep).
3) Flexor-extensor reflex - If you pull up the medial muscles above the knee while touching your prirformis buttock area in about 30 seconds the piriformis will temporarily relax.
4) The best measure ( besides botulinum) for piriformis and gluteal muscles if a repeated robust brutal transverse stretch/massage:
Piriformis Syndrome: Diagnosis, Treatment, and Outcome—a 10-Year Study
Loren M. Fishman, MD, George W. Dombi, PhD, Christopher Michaelsen, MD, Stephen Ringel, MD, Jacob Rozbruch, MD, Bernard Rosner, PhD, Cheryl Weber, MD
Arch Phys Med Rehabil Vol 83, March 2002 Pages 295-301
https://www.archives-pmr.org/action/...2802%2909009-3

I start by having bad side up lying on side and engage muscles of buttock with fingers above tender muscles towards foot with finger - pushing down for 10 minutes and then pulling up with fingers from below for 5 minutes and then knuckling area. Do tender locations 2-3 times a week. Can really hurt to start but benefits are obvious. I do both gluteal and piriformis muscles that way. Can take weeks to get substantial results. Haven't been able to find a therapist mean enough to do it here so I (an MD) have to do it...
I discussed it here:
How Should One Investigate Chronic Back Pain and What about the Back Muscles? | Pain Medical Musing