How do you treat sciatica? What causes it? Best exercises to help.
What is sciatica?
Sciatica is a frustrating, crippling pain that can sometimes be as severe as causing you to be bed bound for a period of time. The term "sciatica" refers to the irritation of the sciatic nerve, which typically causes pain in the lower back and down your leg.
I spoke to the LadBible back in November 2020 about how to quickly and easily test if you have sciatica at home using the simple Slump Test. Although you'll probably already know you've got it if I'm honest!
What causes sciatica?
There can be a number of causes, some more severe and long lasting than others. The sciatic nerve branches out of the lower back, through the piriformis muscle in the hip and down the leg, ending in the foot.
An inflamed or aggravated piriformis muscle can therefore sometime cause friction or pressure to be placed on the nerve as it passes through, giving the feeling of pain. This is often one of the less serious causes and also luckily the most simple to resolve.
Seeing a physiotherapist, sports therapist or massage therapist might be your best option for any sciatic pain, but when the pain stems from an issue with the piriformis muscle, a therapist can help loosen the muscle, reduce tension and provide you with exercises to relieve the issue. This will then hopefully remove any compression or impingement of the piriformis muscle and help you with your symptoms. After this treatment, some people find immediate relief for sciatica pain.
Another, more serious but common cause of sciatica can be damage to the intervertebral discs in your back; specifically in the lumbar region. As nerves branch out of your spine to help (muscle) functions in other parts of our body, they can sometimes become compressed along the way. The compression of nerves can cause pain further down the nerve's root and one common cause of compression can be the discs that sit between the vertebrae that prevent the bones rubbing together. They are filled with fluid and surrounded by delicate nerve receptors. These discs can sometime protrude, causing the fluid to bulge out and press on the nerves running down the spine.
The video below shows the disc bulging out and pressing on the yellow structure - a nerve.
@aginjuryrehab What happens when you "slip a disc" #backpain #sciatica #discherniation #herniateddisc #backpain #lowbackpain #slippeddisc #lowerbackpain #backinjury ♬ Gay Bar - Electric Six
When should I see the doctor about my sciatica?
Before trying any exercises or alternative treatment, you should always get assessed by a doctor, physiotherapist or sports therapist to rule out any serious conditions that require urgent medical attention. Tumours etc are rare but can be a cause of back pain or sciatica and require urgent treatment. If you have severe night pain, have suffered unexplained weight loss, have a temperature or any of the other symptoms outlined here, you should seem urgent medical attention.
What is the best sciatica treatment?
It's important to work out which of the causes above is the most likely to be the root of your issues, pardon the pun.
You may need to rest for a few days if the pain has suddenly come on, for example if you have lifted heavy or awkwardly and have pain as a result. If you are able to take anti-inflammatories, you may find some relief as the inflammation is reduced, taking some of the pressure off the nerve.
Gentle movement can also help. Often people with lower back pain rest or lie down to avoid any painful movements, however when they return to move again or have to get up to go to the toilet, they often find their pain has increased. Light, regular movements can avoid this and prevent your muscles tightening up or losing any strength. You must be careful not to aggravate the issue though.
The treatment for this kind of injury varies and can therefore take a varied amount of time to "heal". Luckily, with age the discs themselves dehydrate which might naturally provide you with some relief. The most effective treatment tends to be managing the acute symptoms (lack of movement, pain and inflammation), followed by a structured rehabilitation exercise plan, aiming to strengthen up the structures around your injured disc to relieve some of the pressure.
The exact exercises vary from person to person, but Doctor Stu McGill, a pack pain expert from the USA suggests the "Big Three" should be done daily by those who may be susceptible to back pain. These exercises are a modified curl up, a side plank/bridge and the bird dog exercise. I posted a TikTok video to demonstrate the three exercises here.
What are the best exercises for sciatica?
The following 5 exercises are my favourite exercises to treat sciatica. They must be done in a pain free range and I would advise doing them under the supervision of a medical professional before trying them alone.
The sets and reps vary from person to person but start easy and gradually increase over time as your symptoms improve. You should never pass a 5-6/10 in pain during any of the exercises and if pain lasts longer than 48 hours after you've performed them, you've probably pushed it a little too far so take some extra time to rest.
The cat/camel exercise is a simple but effective exercise for back pain and sciatica. Start on your hands and knees and arch your back, lifting your head up to look forwards; you should feel a stretch in your stomach muscles. When you get to the end of the movement, reverse it and go the other way. This time bending your back and tucking your chin to your chest. Pause at the end and keep repeating the movements.
2. Bird Dog
Another simple but effective exercise for anyone with back and sciatic nerve issues. Start on your hands and knee and raise one hand to reach out in front of you, while simultaneously doing the same with the opposite leg out behind you. Swap arms and legs and repeat.
3. Nerve Flossing
This exercise addresses the sciatic nerve itself and can relief friction or pressure on it. You're essentially moving the nerve to remove any friction along it's route - picture yourself doing that funny towel movement when you're trying your back after getting out the shower! That's kind of what you're doing here.
Similar to the Slump Test to assess wether or not you've got sciatica, sit down with your hands underneath you and hunch your back over as shown above, with your chin to your chest. Slowly straighten one leg and bring your toes towards you if you can. Next, keep your body and leg in the same position but point your toes away and look to the ceiling with your head - nothing else should be moving just your foot and your head. Imagine they're attached by a piece of string throughout your body (this is your sciatic nerve). Keep moving your head away as your toes come towards you, and vice versa. You should feel a relief afterwards, especially if you're struggling with pain in the leg.
4. Farmer's Carry
This exercise is good for trunk stability. It's an anti-flexion exercise which basically means it helps strengthen the muscles that keep your torso upright. Walking with some kind of resistance in one hand to cause you to be off-balance is a great way to strengthen your core muscles. Walk a few steps and then swap hands - making sure you do an even number of steps with each hand.
5. Piriformis Stretch
The last one is a stretch for the piriformis - which as I mentioned earlier can cause your sciatic nerve a bit of grief. Sit down with one leg slightly bent. Cross your other leg over just above the knee and then bring then bottom leg towards you (bending the knee slightly more). The more you bend your bottom knee, the more intense you'll find the stretch. Repeat for the other side.
Hopefully that has helped you both understand the cause of your sciatica and back pain and has provided you with a few ways to gain some sciatic pain relief. Give the exercises a try and see if they help relieve your pain over the next couple of weeks.
Have you found an effective way of how to ease sciatica? Let us know in the comments below or tweet me @aginjuryrehab. I'm always keen to learn ways in which people manage their symptoms as it is one of the most common conditions I see in clinic. You can also join my free private Facebook back pain support group, full of hundreds of other people sharing tips and advice on how to manage back pain and sciatica.
If you're looking for some more detailed information, a structured exercise plan and some products that could help you recover from sciatica more quickly, have a look at my rehabilitation guide below. It's the most popular guide I have written and has helped hundreds of people just like you to overcome their sciatica pain.