All About Sciatica

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Sciatica is the term a lot of people use to describe pain that travels anywhere from the low back to the glutes (butt) to the back of your thigh and sometimes into the lower leg or even into your foot and toes. The sciatic nerve is a large nerve that travels in this region. Irritation of the sciatic nerve anywhere along this path may be contributing to your discomfort. Some of the muscles in this area – glutes – also have trigger point referral patterns similar to sciatic nerve irritation meaning that if you have tight muscles in this area you might also get some pain in your butt or down the back of your leg. It’s difficult to discern for certain if it’s tension on the nerve, tight muscles, or more likely a combination.

Note: If you are experiencing worsening radiating pain all the way to your foot including numbness, and/or weakness it’s important to discuss this with your primary provider.  And if you are experiencing any numbness in your “saddle region” (picture the part of your body that would touch a saddle – so pubic bone to tailbone area), or sudden loss of bowel or bladder control reach out to your provider immediately.

If you’re not experiencing any of the above medical concerns or you’ve discussed things with your primary provider then let’s move onto what you can do about sciatica.

Stretching

Stretch the muscles along the pain area (this should feel neutral or positive, it’s great to feel a stretch but don’t push into pain, think “sore but safe”, or “motion is lotion”) – hold most stretches for 30-60 seconds, 1-2x each side depending on what feels good to your body and what you have time for

  • Glutes: lying on your back bring 1 or both knees to chest
  • Piriformis: lying on back (or sitting) bring 1 ankle onto opposite thigh – if more stretch is needed you can pull knee and ankle towards your opposite shoulder until you feel the stretch in your butt
  • Hamstrings: seated at the edge of your chair with 1 leg straight & back straight hinge forward at the hips slightly until you feel a stretch in the back of your thigh
  • Gastroc: standing at a wall place your toes/ball of your foot up on the wall while your heel is on the ground and lean towards the wall until you feel a stretch in the back of your lower leg
  • Other ideas: pelvic tilts and circles on your back or sitting on a chair or an exercise ball, lumbar rotation (lying on your back with your knees bent letting your legs fall side to side together)

Nerve glides

Lying on your back or seated in a chair straighten one knee until you feel a slight stretch in the back of your leg and then straighten and bend your ankle back and forth with only 1-2 second holds for 10 repetitions

Movement

Try to avoid sitting or standing for too long in one place – change up what surface you’re sitting on, take brief walks if possible, use sit to stand options, listen to your body when it’s time to move or start to notice patterns and set timers if needed to remind yourself to move

Posture

  • Pelvis: tilt your pelvis back and forth going between arching your back/untuck tailbone and flattening back/tucking tailbone and find a happy medium that feels ok to you (doing this back and forth can feel like a nice motion, go within the range that feels good to you)
  • Ribcage: arch your back and sit your ribs forward and then flatten/round your back and tuck your ribs back and then find the happy medium where your ribs stack nicely over your pelvis
  • Another quick check is that your ears are over your shoulders are over your hips in sitting and then the same in standing plus hips over ankles
  • If you get discomfort with standing consider adding a stool under one foot and alternating placement to mix up stance versus jutting out a hip to the side which can sometimes get uncomfortable

Massage/foam roller

Use a racquetball, tennis ball or or other massage balls to work into your glutes, or anywhere else along your pain area (back of thigh or lower leg too). You can also use a foam roller along this same area – butt, thigh, lower leg

Build up core strength

A great long term solution is to connect with your pelvic floor, lower abdominals, breathing techniques and build up core strength / strategy which might improve your posture, decrease some muscles from being overused and tighten up on you and allow you to move through transitions/movements during your day with more ease

Physical Therapy

You might benefit from working with a local pelvic PT who can assess your individual needs. A PT may also help you improve with manual therapy techniques including manual trigger point release, fascial releases, muscle energy techniques or trigger point release with dry needling (a technique that uses a very small monofilament needle into myofascial trigger points to get a release).

Other helpful tools

Depending on when/where you’re getting pain and how much you might benefit from options like a seat cushion for in the car or at a desk, kinesiotaping, or a TENS unit for pain relief. 

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Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer.

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