Sciatica: What It Is, Why It Happens & Exercises To Reduce Sciatic Pain
Back pain is incredibly common, with up to 84% of American adults experiencing back pain at some point in their lives. Understanding what’s causing your pain key to determining the appropriate measures to ease your discomfort. Sciatica is just one potential cause of back pain. If you’re wondering if your pain is sciatica, this article is for you.
In this blog post, we’ll outline what sciatica is, how common it is and why it happens to help you get a clearer idea of whether the pain you’re experiencing is sciatica. Then we’ll provide you with 4 tips and 3 exercises that you can start using today to calm your pain.
What is sciatica?
Sciatica is defined as pain and symptoms along the sciatic nerve pathway caused by irritation along the nerve. This occurs as a result of irritation at either the lumbar or sacral nerve roots of L4-S3. In some cases, the irritation can result from impingement of the sciatic nerve further down the leg in the piriformis muscle.
Prevalence of sciatica
Estimates of sciatica prevalence vary widely, ranging anywhere from 10-40% experiencing sciatica at some point in their lives. The annual incidence of sciatica is much lower, between 1-5%. Compared to the 84% of adults that experience back pain, sciatica is a relatively minor driver of the overall prevalence of back pain in the American population.
Symptoms of sciatica
Symptoms of sciatica are caused by nerve irritation along the sciatic nerve. Depending on the cause of the irritation, symptoms can be progressive or can come and go. Symptoms of sciatica include:
Pain: This is the most common symptom of sciatica. This pain can feel like burning, pins and needles, muscle tightness or achiness. It can present in the low back, buttocks, back of the leg, calf, shin and/or foot. This pain is typically one sided.
Numbness: Prolonged impingement of the sciatic nerve can cause symptoms to progress from pain to numbness. This numbness occur in the same areas as the pain described above.
Weakness: Weakness as a result of sciatica can cause knee buckling and make it difficult to stand on your toes. Weakness is a sign of progressive impingement. If you begin to experience weakness in your leg, contact your medical provider.
Why does sciatica happen?
Sciatica occurs as a result of compression of the sciatic nerve, either at the spine or in the piriformis muscle. Nerves like space to slide and glide without restriction, and when that space is compressed for any reason, nerves can cause pain.
Common causes of sciatica include:
Disc herniations
Spinal stenosis
Postural changes that creates compression in the low back
Weakness in the abdominals, glutes or spinal stabilizers
Risk factors for developing sciatic pain include age, disc herniation, or professions that require prolonged sitting or heavy lifting.
Sacroiliac joint pain and other causes of low back pain are often confused for sciatica. If you’re not sure if your symptoms are coming from nerves or something else, start with an evaluation with our PTs to determine the root cause of your discomfort.
Sciatica and pregnancy
Estimates of sciatic prevalence during pregnancy range widely depending on the source, with articles suggesting anywhere from 1%-16% of of pregnant people experience sciatica. A number of factors contribute to the development of sciatic pain during pregnancy, including:
Postural changes: As the belly grows, most people develop a sway back posture. This places extra stress on your lumbar spine, compressing the space where the sciatic nerve exists the spine.
The baby: As the baby grows, they place additional stress on the lumbar spine and pelvis, potentially compressing the sciatic nerve.
Muscle weakness: As pregnancy progresses, without intentional and consistent strength training, the abdominals and glutes become inhibited and weaker. Weakness in the muscles around your spine and pelvis means reduced support for these structures, contributing to the development of symptoms like back pain and sciatica.
Muscle tension: Largely due to muscle fatigue, muscle weakness and postural changes, muscle around the pelvic can become tight. Muscle spasms in the glutes and paraspinals are common during pregnancy. These soft tissue restrictions can contribute to pain and nerve irritation like sciatica.
Pelvic floor physical therapy for sciatica management
If you’re struggling with symptoms associated with sciatica, working with a pelvic floor physical therapist can help. In order to effectively treat your symptoms, it’s important to understand their root cause. A pelvic floor physical therapist can evaluate you to help determine the specific contributors to your pain. Once we know where the pain is coming from, we can design a treatment plan to get you back to the pain free life you want to be living.
Physical therapy treatment for sciatica typically includes:
Education: Once we identify what you’re doing throughout the day that’s contributing to your pain, your PT will work with you to modify those activities. They’ll educate you on why those specific habits are contributing to your pain and provide you with options so you can make a sustainable change.
Manual therapy: Hands-on manual therapy is an important part of calming pain. We use education and modification your daily activities as a way to stop throwing salt on the wound, but manual therapy helps calm your body and nervous system. Manual therapy for sciatica can include soft tissue work along the nerve pathway, nerve glides, joint mobilization and can involve tools like dry needling and cupping. The goal of manual therapy is to kickstart your recovery and get you feeling better, faster.
Exercise: Exercise is the ticket to long term pain relief, but which exercises you do depends on… you! Everyone is different, with different needs and goals. Depending on your specific areas of weakness, your pelvic floor PT will design an exercise program that targets your individual needs. Instead of having you set an hour aside every day and still not get the results you want, your PT can create a 10-15 minute daily program for you that helps bring your pain down and strength up.
4 Tips to manage sciatic pain:
While personalized advice is key when you’re in pain, there are a number of tips that benefit most people experiencing sciatic pain. If any of these make your symptoms worse, stop and contact your provider. If you’re looking for a place to start to get sciatic pain under control, try these 4 tips:
If you’re a back sleeper, sleep with a pillow under your knees. Laying on your back with extended legs brings your low back into an extended position, placing additional stress on the lumbar spine, further compressing the sciatic nerve. Placing a pillow under your knees bring your low back into a more neutral position, taking stress off the low back and creating more space around the sciatic nerve.
Practice standing with equal weight distribution between both legs. If you’re someone who likes to stand with one hip cocked to the side, the creates rotation and asymmetrical stress through the lumbar spine, compressing the space around the sciatic nerve on one side. Keeping your weight even between your feet will help remove that stress.
Avoid sitting with legs crossed: Keep your legs parallel when seated or laying down. This helps reduce rotational force on the spine and tensile force on the nerve, in the case that these are contributors to your pain.
Get in the pool: This is particularly useful for our pregnant folks. Getting in the water helps lift the weight of the baby off of your pelvis and reduce stress on your back, allowing you to walk and move around with less pressure on your body. This can feel like an amazing in the short term.
Daily exercises to reduce sciatic pain:
Below are three exercises that can be done daily help reduce sciatic nerve pain. Just like with the tips, if any of these movements aggravate your pain, stop and contact your provider. These exercises target 3 factors that typically contribute to sciatic pain: nerve mobilization, lumbar mobility and glute tension. Try them out and see how you feel!
Sciatic nerve glides: This should be entirely pain free. Lay on your back with both knees bent and feet flat on the floor. Grab one leg behind the thigh with both hands, bringing your hip to a supported 90 degree bed. Slowly straighten your leg, stabilizing your thigh with your hands, and point your toe towards the ceiling. If you start feeling pulling in the back of your leg you’ve gone too far. Then slowly bend your knee back to 90 degrees, pulling your toes towards your nose. Repeat 20-30 times, a few times a day.
Perform pelvic tilts: Start on your back with both knees bent and feet flat on the floor. Use your core to tuck your tailbone under your body, bringing your low back flat to the floor. Pause and then slowly release, allowing your pelvis and hips to rock forward, lifting your low back off the floor. Repeat 20-30 times, a few times a day.
Figure 4 Stretch: Lay on your back with your knees bent and feet flat on the floor. Cross one ankle over opposite knee and reach behind the opposite knee with both hands. Gently support your knee towards your chest until you feel a stretch in the opposite hip. Hold 45 seconds, repeat 2-3 times.
Ready to get started working with a pelvic floor PT?
If you’re wondering if pelvic floor PT postpartum is right for you, reach out to our team with your questions. We’re passionate about helping you find your way back to feeling strong, healthy and confident after birth. Call us at 512-766-2649, email us at contact@ladybirdpt.com or send us a message here to get started.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.