A detailed article from Dr. (Mrs) Anshul Verma, Chief Physiotherapist in PhysioEnturst
What is Sciatica?
The sciatic nerve is the longest nerve in your body. It runs from your lower back and down into both legs. It also connects your spinal cord with your feet and leg muscles. When in pain, the sciatic nerve condition is called sciatica.
Sciatic pain is typically caused by pressure on the sciatic nerve. It usually comes from a herniated disc, disc degeneration, spinal stenosis (narrowing) or a bone spur in the spine. This causes pain that starts in the lower (lumbar) spine.
It then radiates down the nerve, causing pain that travels down the back of your leg. This is sometimes accompanied by tingling in your feet. Sciatica typically only affects one side of the body.
This condition can happen suddenly after an injury It can also take months to slowly develop. It can be short-lived (acute) or long-term (chronic). Regardless, it is typically easy to identify and can sometimes be treated at home.
These factors put you at a higher risk for developing sciatica:
- Age: People age 30 to 50 are more likely to develop this condition as they develop spinal changes such as herniated discs.
- Weight: Being overweight or pregnant puts added pressure and stress on your spine, possibly triggering sciatica.
- Work: Jobs that require heavy lifting or twisting or prolonged sitting can add pressure to your spine.
- Diabetes: Because diabetes affects how your body processes and uses blood sugar, it can increase your risk of nerve damage and your chances of developing sciatica.
While you may suspect that you have sciatica, your doctor can give her professional medical advice and confirm the diagnosis with an exam. During the exam, your doctor may observe you during a number of activities, including:
- lying on your back
- lifting your legs one at a time
- walking on your toes or heels
Such activities generally worsen sciatica pain.
Risk factors
There are many factors that can leave you susceptible to sciatica, which affects both athletes and those who are less active. People who lead a sedentary lifestyle are more likely to develop sciatica than active people. However, endurance athletes are also prone to experiencing sciatica from overworked and stiff muscles. Obesity and diabetes are other common contributors.
The good news
According to Dr. Anshul, an expert physiotherapist can help you to determine whether sciatica can be relieved through conservative methods such as physiotherapy, static stretching, and cold therapy. Most people respond well to simple techniques and are pain-free within a matter of weeks. Chiropractic adjustments and massage therapy may help improve the alignment of your spine and address other underlying conditions while also improving blood circulation and muscle relaxation. Minor pain can also be treated with the application of heat and cold.
While some doctors may recommend surgery as a treatment for sciatica after noninvasive measures have failed, experts say it’s not always the right choice for everyone. In fact, according to the PhysioEntrust Clinic, nearly 50 percent of people with sciatica report their symptoms improving within 1.5 months of their diagnosis. Nonsurgical treatments may include a longer period of recovery. However, surgery comes with its own risks, which include infection and blood clots. It’s important to talk with your doctor about your sciatica to determine which treatment is best for you
The Idea is to improve core and back strength
The musculature around your spine and abdomen may be weak or overly tight, preventing it from supporting your body as needed. Poor posture and compromised muscles can impact the alignment of your spine, increasing your risk for lower back pain and sciatica. Gentle strengthening exercises that target your core and back will improve your posture and ability to respond to stress, reducing the likelihood and severity of back pain. While you’re recovering from sciatica, you may want to avoid high-impact exercises, such as running and plyometrics.
Increase hip and hamstring flexibility
Stiff hamstrings, glutes, and hips can alter your posture and increase the stress on your lower back, which may contribute to sciatica. Most types of sciatica will benefit significantly from a stretching routine that targets the hips and hamstrings and relieves an overused or inflamed piriformis muscle. The piriformis is a small muscle that attaches at the base of the spine and runs just above the sciatic nerve. Prolonged inactivity or sitting compresses the piriformis over the sciatic nerve, which can lead to aggravation and pain. Reverse the effects of tight hips and hamstrings by adopting a simple stretching routine or incorporating yoga into your overall fitness regimen.
Using cold and heat to alleviate sciatica pain
When you first start experiencing sciatica pain, applying a cold pack can provide a lot of relief. Wrap a cold pack or a bag of frozen peas in a clean towel, and apply it to the painful area a few times a day for up to 20 minutes each time.
If your sciatica is still bothering you after a few days, then it can be helpful to try heat instead. Apply a heat lamp on the lowest setting, a hot pack, or a heating pad to the painful area.
If your pain persists, try alternating between cold packs and hot packs.
Physiotherapy path to Relieve Sciatica
According to Dr. Anshul, Physiotherapy plays a vital role considering multidisciplinary sciatica treatment plan. Physical therapy (PT) typically involves passive and active therapies.
Passive PT refers to treatments (eg, heat/cold packs, TENS, Ultrasound and SWD) administered by the physical therapist and Active PT requires your “active” participation (eg, therapeutic exercise and Hydrotherapy).
Physiotherapy for Sciatica: What to Expect
Dr. Anshul says, during your first PT appointment, the therapist reviews your medical history, lifestyle habits, and asks you questions about your sciatica experience. He/she may ask when sciatica started, if an injury or specific event triggered sciatic symptoms, and inquire about your activity level before low back and leg pain developed.
Next, your physical therapist may ask you to perform a series of simple movements to evaluate your range of motion, posture, reflexes and movement ability. You may be asked to bend side-to-side, flex forward at the waist, extend backward, or twist at the waist. The therapist observes you walking too. This part of your exam provides your therapist with a baseline assessment of your current condition and how sciatica affects your physical functional ability to perform activities of daily life.
Then your physical therapist combines what he/she learned from your evaluation and crafts an organized PT program for you. Your passive and active therapy program is designed to include realistic goals you want to reach. As back and leg pain subsides and becomes more manageable, your therapy plan may be adjusted to include different types of stretches and exercises.
Like many treatment options, physical therapy is not a quick fix and may require several weeks to achieve the desired results. Your treatment plan will likely include a mix of clinic visits with your physiotherapist in addition to an at-home exercise regimen.
10 Stretches for Sciatica Pain Relief
Here are 10 exercises that do just that:
- reclining pigeon pose
- sitting pigeon pose
- forward pigeon pose
- knee to opposite shoulder
- sitting spinal stretch
- standing hamstring stretch
- basic seated stretch
- standing piriformis stretch
- groin and long abductor muscle stretch
- scissor hamstring stretch
1. Reclining pigeon pose
The reclining pigeon pose is a common yoga pose. It works to open the hips. There are multiple versions of this stretch. The first is a starting version known as the reclining pigeon pose. If you’re just starting your treatment, you should try the reclining pose first.
- While on your back, bring your right leg up to a right angle. Clasp both hands behind the thigh, locking your fingers.
- Lift your left leg and place your right ankle on top of the left knee.
- Hold the position for a moment. This helps stretch the piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve, causing pain. It also stretches all the deep hip rotator muscles.
- Do the same exercise with the other leg.
Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions of the pigeon pose
2. Sitting pigeon pose
- Sit on the floor with your legs stretched out straight in front of you.
- Bend your right leg, putting your right ankle on top of the left knee.
- Lean forward and allow your upper body to reach toward your thigh.
- Hold for 15 to 30 seconds. This stretches the glutes and lower back.
- Repeat on the other side.
3. Forward pigeon pose
- Kneel on the floor on all fours.
- Pick up your right leg and move it forward on the ground in front of your body. Your lower leg should be on the ground, horizontal to the body. Your right foot should be in front of your left knee while your right knee stays to the right.
- Stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.
- Shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
- Take a deep breath. While exhaling, lean your upper body forward over your front leg. Support your weight with your arms as much as possible.
- Repeat on the other side.
4. Knee to the opposite shoulder
This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve.
- Lie on your back with your legs extended and your feet flexed upward.
- Bend your right leg and clasp your hands around the knee.
- Gently pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds. Remember to pull your knee only as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.
- Push your knee so your leg returns to its starting position.
- Repeat for a total of 3 reps, then switch legs.
5. Sitting spinal stretch
Sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure on the sciatic nerve.
- Sit on the ground with your legs extended straight out with your feet flexed upward.
- Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
- Place your left elbow on the outside of your right knee to help you gently turn your body toward the right.
- Hold for 30 seconds and repeat three times, then switch sides.
6. Standing hamstring stretch
This stretch can help ease pain and tightness in the hamstring caused by sciatica.
- Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it.
- Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Don’t push so far that you feel pain.
- Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot.
- Hold for at least 30 seconds, then repeat on the other side.
7. Basic seated stretch
You begin this stretch by sitting down on a chair and crossing your painful leg over the knee of your other leg. Then follow these steps:
- Bend forward with your chest and try to hold your spine straight. As long as it’s not painful, try to bend over a bit more. Stop if you feel any pain.
- Keep this position for 30 seconds and repeat the exercise with the other leg.
8. Standing piriformis stretch
This is another standing stretch that can help with sciatica pain. You can do this without support if you’re able, or you can stand against a wall and place your feet about 24 inches from the wall.
- Put your painful leg over the knee of your other leg while standing. Bend your standing leg and try to make the number 4 with your hips lowered to the ground at a 45-degree angle.
- Bend your waist down and swing your arms down while holding your back straight. Stay in position for 30 to 60 seconds.
- Switch legs and repeat.
9. Groin and long adductor muscle stretch
This stretch requires sitting down on the floor with your legs spread out as far apart as you can straight in front of you.
- Place your hands on the floor in front of you on the floor and angle your torso toward the floor.
- Lean forward, leaving your elbows on the floor. Hold the position for 10 to 20 seconds. Stop if you feel any pain.
10. Scissor hamstring stretch
The hamstring muscles attach to the ischial tuberosity via the sacrotuberous ligament (STL). When they are tight, hamstring muscles can mimic sciatica symptoms.
This stretch can help loosen those hamstring muscles, helping relieve their pressure on the sciatic nerve. It may help to do this exercise daily.
- Place your right foot about 3 feet behind your left foot.
- Pull your hips forward and push your shoulders back, but your right hip shouldn’t be farther forward than your left hip. A mirror may help make a judgment on this.
- Put your hands on your hips. You may use a chair for balance if you need it.
- Push your torso a bit over your front leg by bending your waist while keeping your back straight. Keep your weight on your front leg.
- Keep this position for 5 to 10 seconds, then repeat the stretch with the opposite leg. Do the stretch for each leg 3 to 5 times.
What to avoid if you have Sciatica pain?
Listen to your body and stay away from any activities that cause pain. Certain exercises can exacerbate sciatica symptoms, especially if they strain or put pressure on your back, core, and legs. While it’s important to increase strength and flexibility in these areas, you need to do it slowly and safely.
Avoid high-impact activities which can aggravate symptoms and cause injury. If you’re experiencing severe pain, take a break from activity. However, inactivity or sitting for long periods may worsen your symptoms, so aim to do light exercise or stretching when possible.
Here are exercises, stretches, and activities to avoid if you have sciatica. If you have general back pain without sciatica, it’s a good idea to stay away from these exercises as well.
Seated and standing forward bend
This exercise can cause tightness and stress to your lower back, pelvis, and hamstrings, which aggravates sciatica.
Hurdler stretch
This stretch strains your back, hips, and hamstrings. Twisting your pelvis puts more stress on your back as you fold forward.
Supine leg circles
This Pilates exercise stretches your hamstring as you rotate your leg in a circular motion. This can cause pain, irritate the sciatic nerve, and cause a hamstring injury.
Double leg lift
This supine exercise involves lifting and lowering both legs simultaneously, which activates your abdominals and leg muscles. It can aggravate sciatic pain, especially if you use improper form.
Revolved triangle pose
This pose may cause you to overstretch your spine, hips, and hamstrings, which can aggravate sciatica.
Burpees
This exercise involves high-impact movements that can aggravate back and hip pain. Repeatedly bending forward and jumping can aggravate sciatica symptoms.
Bent-over row
This weightlifting exercise can strain your low back and irritate your sciatic nerve, especially if you do it with a rounded spine. This can cause inflammation, a herniated disc, or an injury.
Weighted squats
Weighted squats increase compression to your lower back, nerves, and intervertebral discs. They can also put pressure on your legs, leading to pain and injury. Try them instead without weights, keeping your core engaged and your back in a neutral position. Stop if you feel any pain or tightness in your back.
Cycling
Cycling may increase pressure on your spine and sciatic nerve, especially on a hard bike seat. Riding in a hunched or forward-leaning position can irritate sciatica, especially if your seat and handlebars are positioned incorrectly.
High-impact sports
Avoid any type of high-impact activity or contact sport that causes you to make sudden movements or put stress on your body. This includes basketball, soccer, tennis, volleyball, running, and HIIT workouts.
Also avoid potential pain
Certain situations can make your pain worse and should be avoided, as they can exacerbate your pain:
- wearing high heels
- sleeping on a mattress that’s too hard
- not having a consistent exercise program
Though you may be tempted to sit or rest, staying active can help to reduce both inflammation and pain. Low-impact exercise activities such as walking, swimming or yoga are ideal during your recovery.
Why is my sciatica not going away?
Here are some of the reasons why your sciatica may be getting worse.
Injury and reinjury
If an injury was responsible for your sciatica, and if your symptoms get better and then worse, you may have reaggravated the injury that originally caused your sciatica.
Sudden injuries and repetitive overuse injuries can lead to sciatic symptoms. Herniated discs are the most common cause of sciatica.
Age and underlying health conditions
In general, younger people heal more quickly than older people. But there are many underlying health conditions that can also slow your body’s ability to heal. Some conditions include:
- high blood pressure
- diabetes
- obesity
- heart disease
- alcoholism
- malnutrition
- smoking
Wear and tear
Wear and tear on your spine can lead to a condition called spinal stenosis, which is narrowing of the spaces within the spine. This narrowing can compress your nerve and lead to sciatica.
Infections
An epidural abscess is a collection of pus that develops between the bones of your spine and membrane of the spinal cord. It may lead to swelling that puts pressure on your nerves and leads to sciatica.
Lifestyle issues
Sciatica often responds to gentle exercise. It’s thought that mobilizing the sciatic nerve may help improve symptoms by decreasing nerve sensitivity. Gentle stretching and exercising may be recommended as a part of treatment.
Alternatively, a sedentary lifestyle and spending a lot of time sitting can potentially aggravate symptoms of sciatica.
Spinal mass or tumor
In very rare cases, a cancerous mass can put pressure on your sciatic nerve. One very rare type of tumor that can develop is called a malignant peripheral nerve sheath tumor.
Recurrent sciatica?? Know to prevent..
Making lifestyle changes like the following may help you prevent recurring sciatica symptoms:
- Eat a balanced diet and exercise regularly.
- Minimize sitting, and sit with good posture.
- Avoid bending your back when lifting heavy objects.
- Choose exercises that are unlikely to cause lower back injuries.
- Avoid smoking.
- Minimize your chances of falling by wearing sturdy shoes and keeping the floors of your house free from clutter.
- Evaluate your workplace with a focus on ergonomics to prevent your sciatica from returning.
- If you work in an office, then make sure that your seat offers you good lower back support. Also make sure your knees and hips are level when you’re seated.
- If you lift heavy loads, then focus on proper body mechanics. This includes bending at your knees, holding the load close to your body and never twisting as you lift.
The bottom line
Most of the time, sciatic pain goes away within a couple months. It’s best to see a medical professional at the first sign of symptoms to develop a treatment plan.
Some people have pain that may last longer than average. To prevent recurrent sciatica, try not to bend your back while lifting. It’s also a good idea to consider exercising regularly and eating a balanced diet.
If you have severe pain, your pain is getting progressively worse, or if you notice anything else concerning, it’s a good idea to speak with a health professional or good Physiotherapist.
FAQs about Sleeping with Sciatica
Why is sciatica pain worse at night?
When you lay down, muscle tension is creating a tug-of-war on your hip joints: your hip flexors in front and your piriformis in back. Your sciatic nerve runs alongside and underneath these muscles, and can become impinged by muscle tension and pelvis misalignment.
What is the best position to sleep in with sciatica?
There are ways to get comfortable in a variety of sleeping positions with sciatica, with the right angle and pillows! If you’re a side sleeper with sciatica, adding a pillow lengthwise between your knees and ankles in this position will help to put your hips in a more neutral position. If you’re a back sleeper with sciatica, adding a pillow or two under your knees can help by relaxing the position of your hip flexors.
How does the piriformis affect sciatica?
The sciatic nerve runs through or under the piriformis muscle. When this muscle is tight, it can impinge upon the sciatic nerve. Tension in the piriformis can be caused or worsened by tension in the iliopsoas muscle, your primary hip flexors.
What helps you manage your sciatica pain?
Tell us about your pain journey in the comments! What topics related to sciatica would you like to see us research?
Email us at contact@physioentrust.com with your ideas.
Like us below on Instagram and Facebook for more posts and health blogs like this.
