Sciatica is one of the most common forms of chronic pain in the world. An estimated 40 percent of people will experience an episode of sciatica pain at some point in their lives, and these episodes become more frequent with time.
Yet despite being one of the most common pain complaints, sciatica is also often misunderstood.
Sciatic nerve pain is usually felt throughout the buttocks and legs, particularly along the posterior chain. For most cases, sciatica is also unilateral – meaning it only affects one side. While the pain can often radiate as far down as the food, sciatica as a syndrome almost always occurs due to a nerve impingement further up along the lower back.
While the pain is associated with numbness, loss of strength and coordination, and a radiating nerve pain along your leg, sciatica pain can be relieved with exercise, and particularly stretching. The right physical therapy regime can help complement other pain management options to make your pain go away quickly.
Understanding Sciatica Pain
Sciatica pain is usually caused by a condition known as radiculopathy. This is a medical condition that describes an impingement of a spinal nerve root. Radiculopathy can occur at any point along the spine, affecting nearly any nerve root – with a variety of consequences. Because the entire peripheral nervous system can be traced back to the spine, radiculopathy can result in pain and numbness far away from the actual impingement. In the case of sciatic pain, the sciatic nerve is pinched along the lumbar spine, or the lower back, causing pain that may focus on the buttocks or legs.
Most cases of radiculopathy occur due to inflamed or swollen tissue in the area, such as a herniated disc. Rarer causes include benign or malignant growths along the spine; bone spurs; and the tightening of the neural passageways along the spine, resulting in spinal stenosis.
An impingement caused by swelling or a recent injury often goes away on its own. But that process can still take days or weeks, resulting in undue pain and limited mobility. Pain relief, in the form of medication (such as painkillers and anti-inflammatory drugs) can help.
In many cases, certain exercises and stretches can result in both short-term and long-term pain relief as well. However, it’s important to note that your mileage may vary. Below are a few useful stretches and exercises that often target the areas most affected by sciatica pain – but the reasons for a person’s pain are different and complex. No single exercise plan will uniformly benefit everyone with sciatica pain, and it is important to consult a physical therapist or pain specialist to find out what kind of treatment plan is best for you.
Knee-to-Chest Stretch
One of the classics, and one of the easiest stretches to perform. There are multiple variations for this stretch, based on whichever feels most comfortable to you, or whichever you might be able to perform in your current environment.
- Bringing one knee to your chest will induce spinal flexion and stretch the muscles of the buttocks and quadriceps (your knee extensors, the front-facing muscles of the thigh).
- You can start in a seated position, on a chair or on the floor.
- For a deeper stretch, lie on your back and focus on bringing your ankles closer to your buttock, while keeping your knee as close to your chest as possible.
Piriformis Stretch
The piriformis muscle is one of the deeper muscles of the hips and buttocks, dedicated to hip abduction (spreading your legs apart). It is also a common root cause of sciatica pain, because the sciatic nerve passes under the piriformis muscle, meaning an inflamed or swollen piriformis may lead to pain throughout the rest of the affected leg. Because the piriformis focuses on opening the hips, one of the best ways to stretch it is to do the opposite:
- Start in a lying position, on your back.
- Bring both knees up, like in the starting position of a sit-up.
- Take the ankle of the affected leg, and gently place it atop the opposite knee, like you are crossing just one leg.
- Now, grab the crease between the knee and the thigh on the unaffected leg, and gently pull it to your chest. Try to keep your back straight to intensify the stretch in the buttock and side of the affected leg.
Hamstring Stretches
The hamstring is a series of muscles that aids in knee flexion, along the back of your thigh. You can feel these muscles working when you try to bring one foot up to your buttocks while standing. Conversely, keeping your knee straight can help stretch this muscle, and provide immediate relief for acute sciatica pain. A common variation of this stretch is known as the “toe-touch”.
- Start with your feet at hip-width, with your toes pointed forward.
- Keep your legs straight, and avoid bending them at the hip.
- Slowly try to reach your toes with your fingers. You will feel a stretch throughout the back of your legs, including your thighs and calves.
- You can alternate the stretch by bending one leg at a time, and keeping the other stiff.
The Hip Hinge: The Ultimate Exercise for a Strong, Pain-Free Back
Stretching the thighs and buttocks can help provide immediate relief for piriformis pain. But strengthening these muscles can help prevent recurring pain, and act as a therapeutic tool for speeding up the recovery process after an injury or a disc problem.
The hip hinge is a great way to strengthen your legs, back, and core, and target the muscles that are usually affected the most by sciatica pain. Furthermore, it is an exercise with hundreds of potential variations, and plenty of ways to easily increase or decrease difficulty.
- For the most part, the hip hinge involves hinging at the hip while keeping your back and torso in a neutral position. Think about bending over to lift something off the floor properly.
- Start with your feet in comfortable stance, usually about shoulder-width apart.
- To initiate the hinge, think about bringing your hips back while gently bending your knees.
- Keep your back straight as you descend. For a reference point, let your arms hang freely in front of you.
- Once your hands touch the floor, or once your torso is resting on your thighs, come back up by pushing through the hips, to come back into an upright position.
On its own, this exercise can help improve your body awareness and ingrain better movement patterns for picking things up off the floor. As an exercise, you can increase the difficulty by picking up a small weight, utilizing bands to increase resistance, or working up to a single-leg hip hinge.
When to See a Doctor About Your Sciatica Pain
Not all sciatica pain goes away on its own. Some causes of sciatica pain are more serious than others and may not simply be resolved through recovery and exercise. You should visit a doctor or seek emergency help if:
- Your pain suddenly becomes much worse.
- You are struggling to move or experience a sudden and massive loss of strength in one limb.
- You experience a total or near-total loss of feeling in one limb.
- You are experiencing back pain in coordination with sudden and severe nausea.
- You are experiencing back or leg pain with a high fever.
- You have trouble controlling your bladder or your bowels.
Even the right exercise plan can be detrimental if it is executed poorly. If you don’t have much experience with the exercises your physician or PT recommends, consider training only under supervision for the first few weeks.
Furthermore, while exercise plans – especially therapeutic exercise – are often individualized, they should also account for day-to-day fluctuations in strength and mobility. It’s okay if you’re feeling a little worse for wear one day, versus the last. You don’t need to progress every single session.
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