Updated: Feb 1, 2022
Sciatica can be extremely painful, limit your daily activities, and be difficult to relieve. It is a symptom that is characterized by pain, numbness, tingling, burning or weakness into the buttock or down into the back of the leg. Sciatic nerve pain comes from compression of the sciatic nerve where it exits the spinal cord in the lower back. This compression typically stems from a herniated or bulging disc, spinal stenosis or a slippage of one vertebrae over another (spondylolisthesis).
Unfortunately many people have to contend with pain from sciatica-up to 40% of adults, as a matter of fact. Adults in their 30’s to 50’s experience this pain most frequently and the chances of getting sciatica increases as we age. Other factors that increase the incidence of sciatica are obesity, height (greater than 6’1”) sedentary lifestyle, and previous history of low back pain.
What you can do to help relieve sciatic pain depends on the cause of the nerve compression. The lower back has 5 vertebrae and nerves exit from between each vertebrae. The nerves join together and dive down each side of our low back, into our pelvis, hips, and down each leg. It is the largest and longest nerve that it is our bodies, so when it becomes irritated-it causes a significant amount of pain.
With my patients, I most often see sciatica come seemingly out of nowhere. Most do not report having picked up something heavy, fell down, or some other significant “event” that brought on their pain. Many times, people wake up with it or it comes on slowly, worsening over time.
There are some things that you can do early on to help relieve your sciatic pain and before we touch on that, I want to discuss the situations when sciatic pain and associated symptoms require immediate evaluation/treatment by a medical professional. These are:
· Bowel or bladder incontinence or “leakage”
· Numbness in the groin area or genitals
· Radiating pain which occurs in BOTH legs
· Numbness or weakness that is a sudden onset or continues to worsen
If any of these symptoms occur along with your sciatic pain (or in general), see your doctor immediately.
So what can you do, should you begin to have pain in the buttock or down a leg? Provided you are not experiencing any of the above symptoms, then we want to look a bit more specifically into your type of pain. Not all sciatica is created equal and often we see the symptoms have biases or directional preferences.
What that means is that certain positions or movements consistently make sciatica symptoms better or worse. There are 3 biases or directional preferences that we see generally: 1) flexion bias, 2) extension bias, or 3) non-weight bearing bias.
A flexion bias means that your pain improves when you assume a flexed position of the spine. To test this: lying down bring your knees to your chest and hug them with your arms. Breathe and hold for approximately 30 to 45 seconds. If your pain improves or the pain does not go as far down the leg as it was previously-you have a flexion bias. You can also test this sitting in a chair and leaning forward with your hands to the ground.
An extension bias is present when your symptoms improve or resolve by putting your spine in an extended position. To test this: lie on your stomach for 30 to 45 seconds. If you pain slightly improves, but you still have it, push up onto your elbows and hold (please breathe) for 30 to 45 seconds. If you have further improvement of your symptoms while propped up on your elbows, then you have an extension bias.
Non-Weight Bearing Bias
If your symptoms improve or are best when you are lying down, regardless of position and worsen with sitting, standing, or walking-then you likely have a non-weight bearing bias.
Once you have determined what bias your sciatic pain has, then you can better choose what you can do to help it.
In all cases of sciatica, I recommend that my patients actually use ice over the painful areas for 15 minutes on, several times a day. Using an extra large ice pack such as this one, can be helpful in cooling down both the low back and the buttock/upper leg at the same time. You do not need to leave the ice on longer than this-you will just freeze your skin.
n addition, stretching a muscle in your hip called the piriformis muscle can relieve irritation over the sciatic nerve. This muscle has a close association with the sciatic nerve and often becomes tight, becoming a secondary source of pain.
1) FLEXION BIAS
· Positioning: lying on your back, bring one knee to your chest and hold for 30 seconds and breathe. Bring this down and switch to the other side. Repeat with both knees to your chest. Do this 3 to 4 times per day.
· Sleeping: sleep with pillows under your knees or on your side with a pillow between your knees
· Stretch: sitting on the edge of your chair, cross your right ankle over your left knee. Place your hand on your right knee and gently lean forward while applying downward pressure on your knee. You will feel a stretch in your right hip or buttock (piriformis) area. Lean forward only until you feel a comfortable stretch and hold for 30 seconds. Repeat twice on each leg, twice daily.
2) EXTENSION BIAS
· Positioning: lying on your stomach, push up onto your elbows and hold for 10 seconds, go back down flat. Push back up for 10 reps, gently and slowly. Do this 3 to 4 times per day.
· Sleeping: on your stomach or half prone by lying on your side with bottom leg straight, a bit more behind you.
· Stretch: lying on your back, bring your right knee up and use your left hand to pull it over to your left shoulder until you feel a comfortable stretch in your right hip or buttock (piriformis). Hold for 30 seconds and repeat twice on each leg, twice daily.
3) NON-WEIGHT BEARING BIAS
· Positioning: lying on your back with your knees bent or feet up on a chair. Put your hands on your thighs and push your thighs away from chest. Hold for 30 seconds and SLOWLY relax the push (don’t let go quickly). Repeat 3 to 5 times. Do this 3 to 5 times per day.
· Sleeping: whichever position you find to be comfortable.
· Stretch: stretch the piriformis as you would with extension bias, twice daily.
It can take days to weeks for sciatic pain to completely resolve. Once your pain reduces by approximately 50% you can begin some beginning core strengthening exercises to get your core kicked in a bit. With back pain or sciatica, the core muscles generally dial down and do not work as effectively as they should and this can contribute to further nerve irritation.
You can begin these beginning core exercises as you begin to feel better.
These are some strategies that you can begin right now to relieve your sciatica. If your sciatic pain does not improve or does not fully resolve, you should be evaluated by a physical therapist for a more detailed treatment program.
Stay Well & Feel Good,
Always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.
Hi! I am Dr. Kim MacDonald. I am a physical therapist who specializes in empowering my patients to optimize how they move their bodies and improve their ability to do the things they love regardless of age, experience, or capabilities.
My experience in the health care field allows me to teach the tools you need to ensure that you are working safely to improve your pain and maximize your physical potential.
If you would like to know more about how you can help yourself be healthier and live a more active lifestyle, join me here.
If you are having back pain or sciatica and cannot get relief, check out my quick Soothe Your Spine video course on what you should be doing to reduce your pain