Sciatica. Have you ever had it? If so, you know it’s a pestering pain that seems to come and go at its own will. But what's it really all about, and how can you get rid of it?
A common misconception is that sciatica refers to any pain running down any part of the leg. Sometimes people say to me, “oh, I have sciatica again” and they are pointing to the outside part of their thigh. That’s not sciatica. (Although that outer thigh pain is still disruptive, it is caused by something else. --Let’s talk about that on another blog post!) True sciatica refers to pain generated by irritation of the sciatic nerve, which is a broad nerve compiled of many nerve roots that exit the low back and travel to the pelvis, buttock, and down the legs. The pain itself typically starts near the buttocks and runs down the back of the leg, often to mid-thigh level but sometimes lower. Because it is a result of nerve impairments it can also sometimes cause weakness, numbness, or even burning sensations in the leg as well. (If you really want to geek out and read all about the sciatic nerve, click here, although fair warning: it’s awfully anatomy-dense.)
According to Physiopedia, an online evidence-based database for physical therapists, the most common cause of sciatica is a herniated disc in the lower lumbar or sacral regions of the spine. However, sciatica can also rear its head for many other reasons, such as nerve compression from tight muscles or spinal stenosis (narrowing of the openings between spinal segments where the nerve roots exit) just to name a few. There may also be tension in the nervous system (tightness anywhere from where the nerve originates from the spinal cord down to the toes). Regardless of what is causing it, if you’ve experienced it before you know that it is NOT FUN!
Often when I am treating somebody in the clinic for something unrelated (say, a shoulder) and they are experiencing sciatica they will ask me, “hey, I know I’m not here for this, but can you give me some ideas to help with this pain down my leg?” Due to the nature of the varying causes of sciatica, my response to these people who ask me what to do is, “to be completely accurate and understand why this particular pain is occurring, I need to do a full evaluation. But why don’t you try these few stretches and come back and let me know how they work.” Often they get better!
I’ve personally experienced sciatica just twice in my life, but I distinctly recall both times because it was so uncomfortable in a nagging, aching, can’t-get-comfortable sort of way. Both times I recovered 100% after being diligent with my rehab for a couple of days. It takes time and some patience, but it will get better. So what I want to share with you today is two of the most common stretches I show people and what helped me in my own successful recovery from bouts of sciatica.
How to help your sciatica pain
1. Knee to opposite shoulder stretch (piriformis stretch): Lie on your back on a comfortable
surface (either in bed or on the floor if you prefer). Bring your knee of the involved side up to your chest. Then, gently draw your knee toward the opposite shoulder and hold this stretch for 45 seconds. Ideally, you feel this stretch in the buttocks near where your pain originates. After 45 seconds, release the stretch to relax the muscles for a moment. Begin again, performing 3 times total. Stretch 2-3 times a day in this manner.
How often: Hold 45 seconds, 3 times. Do this 2-3 times a day.
2. Seated sciatic stretch: To begin, sit at the edge of your chair and extend the involved leg
out in front of you. Sit tall so that you maintain a long spine, as if you want to reach up for something with the crown of your head. Bring the ankle and toes up toward the ceiling. Once you are in this position of sitting tall and toes up, maintain that flat-backed position and lean forward slowly, hinging at the hips. Stop leaning forward and hold the position once you reach the point of a stretch you can maintain. (Some people feel a stretch in the starting position without leaning forward. If that describes you, no problem! That is the position for your stretch. No need to lean forward in that case.)
Gently look down like you are nodding “yes” and you should notice this increases your stretch each time you look down. [Note: Do not round your back! Most people want to bend over and try to touch their toes with this stretch. Toe-touching is NOT the goal, and people are often surprised as how much of a stretch they feel in the back of the legs once they do this the correct way.] Perform 5 nods, then release the stretch. Begin again, performing 3 times total. Do this stretch 3 times daily.
How often: Perform 5 nods "yes" once in your stretch position, then release. Do this 3 times. Perform that routine 3 times a day.
Know that utilizing these stretches assumes that your muscles are tight and/or the nerve is being compressed in the pelvis or buttock. If that IS the case, these stretches should help. If you try these consistently for a handful of days and your symptoms are unchanging or worsen, be sure to get in touch with your physical therapist so that you get a full, personalized evaluation of what is causing your symptoms.
So just like I tell my patients, try these for a few days and then let me know how they work for you. Best of luck, and happy stretching!