What is sciatica? What causes sciatica? Are there sciatica exercises that will help relieve the pain?
If you've experienced sciatic pain or know someone who has, these questions have probably surged to the top of you must-get-answered list. To answer them, I decided to get in touch with Dr. Brent Anderson.
Dr. Anderson is a physical therapist, Orthopedic Certified Specialist, and the founder of Polestar Pilates, one of the leaders in Pilates instructor training focusing on rehabilitation. I knew that if anyone would have good information on sciatica, and the role of Pilates exercise in relieving sciatic pain, it would be him.
Dr. Anderson begins our conversation with this definition of sciatica: Sciatica is any obstruction, restriction, or irritation that is applied to the sciatic nerve. He goes on to suggest that if you can understand what the structure associated with sciatica is, you can understand where an irritation could come from. We start there, move on to exercises, and finish up with tips for teachers.
The Sciatic Nerve
Anderson: The sciatic nerve is one of the largest nerves in body. It provides the majority of the motor and sensory activity for the lower extremities. It is made up of a nerve pelxus originating from L1 to S1 and passes from inside the pelvis to outside the pelvis through the sciatic notch - a little hollowing in the pelvis. The sciatic nerve then typically goes under the piriformis muscle (see image 2), runs down the back of the leg behind the knee and splits, going inside and outside the calf and along the top and bottom of the foot.
Causes of Sciatica
Anderson: Anything that puts pressure on the sciatic nerve or its root can create the irritation we refer to as sciatica. This can happen from a vertebral disc putting pressure on the nerve root, and that root feeding into the sciatic nerve creating pain. Or you could have some problem in the sciatic notch - an accident or fall on your buttocks that caused a trauma to the nerve passing through the sciatic notch. The injury could cause swelling and that could cause sciatic pain. Pressure on the sciatic nerve from an overactive piriformis muscle is also a common reason for sciatic irritation.
Another common cause of sciatic pain is neural tension (NT). NT is thought to be caused by restriction on the sheath that surrounds the nerve. The nerve should glide smoothly through the sheath like a bicycle brake cable gliding through its casing. But sometimes the nerve does not glide through the sheath well and this can cause restriction.
An example of NT impeding movement can be seen in an exercise class when a student appears to have tight hamstrings. They might have, for example, a very short straight leg raise. Then, after their Pilates session they have a very nice straight leg raise. In this case the muscles were not physiologically short - they were actually trying to protect the nerves. Once the nerve was mobilized, tension decreased, and good range of motion was restored.
Having been reminded of the many causes of sciatic nerve pain, I quickly toss out the idea that we are going to get one or two miracle stretches or exercises that apply to sciatic nerve pain across the board. I ask anyway. But Dr. Anderson goes on to guide us through a more nuanced approach to exercise for sciatica that illustrates the adaptability of the Pilates method, and its roots as a rehabilitative program.
Protecting the Sciatic Nerve in Exercise
Anderson: Sciatica is a nerve injury. With a sciatic injury you want to be careful not to irritate the nerve more than it already is. Consider that the nervous system is continuous through your whole body from the crown of head to the toes and fingertips. Anywhere we move the body we are in essence moving the nervous system. So what you want is gentle movement without over-stretching the nerve.
I caution people about the idea of over-recruiting muscles. For example, if you are doing Pilates from a more classical perspective where you are tucking your bottom a little bit and squeezing the hip extensors (glutes), it could be inappropriate for somebody with sciatica. That would increase the pressure on the sciatic nerve and decrease the space around the nerve. You want to work in a more neutral spine. We often use the phrase: As much as necessary, as little as possible.
If the sciatica is coming from a herniated disc, then we have to take all the disc precautions. Disc precautions include not going into unnecessary flexion, and sometimes extension. Avoid overusing the buttocks and the piriformis muscles. Avoid putting the nerve on stretch. Avoid too much flexion [forward bending] in the lumbar spine which could irritate the nerve if there is a disc lesion. Again, work from a neutral spine, get things to move and relax, and get the core strong. You can do a lot of Pilates and still remove stressors on the sciatic nerve.