What is sciatica and what causes it? Are there sciatica exercises that will help relieve the pain?
Dr. Brent Anderson has dedicated a lot of researches to that question. He is a physical therapist, Orthopedic Certified Specialist, and the founder of Polestar Pilates method, one of the leaders in Pilates instructor training focusing on rehabilitation.
So in this article we will see what’s sciatica, and the role of Pilates exercise can play in relieving the pain.
The sciatic nerve is one of the largest nerves in the body. It provides the majority of the motor and sensory activity for the lower extremities. It is made up of a nerve plexus 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, 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.
2- Causes of the pain
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, 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. An overactive piriformis muscle pressuring sciatic nerve is also a common reason for sciatic irritation.
Another common cause of sciatic pain is neural tension (NT) (tension of the nerve).
NT is thought to be caused by restriction on the sheath (biological term for girdle) 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.
3- Protect the nerve
As we’ve seen sciatica is a nerve injury; First preventive is to : protect the nerve.
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 a gentle movement without over-stretching the nerve.
Adapt the movements
In my approach I Like to caution people about “over recruiting” the muscles; for example, if you follow classical Pilates, you have some moves where you tuck your bottom a little bit or squeeze hips extensors, it might not be appropriate for 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.
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.
- Work from a neutral spine, get things to move and relax, and get the core
- Work with a qualified instructor, one on one one if possible
- Find instructor that knows sciatica and can put you in touch with physiotherapist or chiropractors if needed adjustments
- Also work on your own
People with sciatica should do exercises at home too.
I have clients who say “I feel great here but terrible when I go back to work”, and I say, do Pilates at work!
4- Home exercises for sciatica
In general, pre-Pilates simple exercises are good to practice:
- Quadruped with knees / hands support; like Cat stretch
- Pelvic curl and bridging exercises to mobilize and articulate the spine
- Sides exercises: clams and glutes
- Leg circles
5-Exercises to avoid
Exercises that would probably bother a person with sciatica would be exercises:
- like rolling like a ball
- intense stretches like spine stretch, spine twist, and saw
But in my approach I’m much more inclined to do whole body movement and do modifications to perform the movement successfully.
As a teacher, I know how to modify the exercise and make corrections to provide a successful workout experience without pain.
I’ll tell the student it’s their responsibility to let me know when they have discomfort, and my responsibility to modify the exercise so that they have a successful movement experience and results. Pain free is my mojo.
In general, that formula of equal responsibility and knowledge has been the best for dealing with the ones with back pain, sciatica or any kind of injuries.
Conclusion and general tips for people with sciatica
You want to improve awareness of the core, increase mobility of the hips, and become efficient movers, minimizing over recruitment of the body’s musculature.