Facts on sciatica exercises and stretches
- Sciatica describes the symptoms associated with inflammation of the sciatic nerve. These include pain in the low back radiating to the buttock or hip and then down the leg to the foot and toes. There may also be associated numbness and tingling and muscle weakness.
- Activity may be more helpful than bedrest in recovering from symptoms.
- Exercises are useful in helping prevent and control sciatica by increasing low back muscle strength, flexibility, endurance, and correcting and maintaining good posture.
- Other treatment options that may be helpful include massage, acupuncture, spinal manipulation, and physical therapy.
- If possible, surgery and other invasive procedures should be reserved for those who have emergent conditions like cauda equina syndrome or for those who cannot control their symptoms in other ways.
What is sciatica?
Sciatica describes pain that radiates along the path of nerves that leave the lower back and into the leg.
The sciatic nerve is the largest and widest nerve in the body. It forms from nerve roots that leave the spinal cord from many levels in the low back, from L4 (lumbar) to S3 (sacral) and runs from the low back to the buttock/hip and then down the back of the leg to the foot and toes. These nerve roots leave the spinal canal through the intervertebral space, the space between the vertebrae (bones) that makes up the spine.
Inflammation or irritation of the sciatic nerve causes the typical symptoms of sciatica, including
- pain radiating down the leg,
- numbness and/or tingling of the leg and foot, and
- weakness of the muscles that the nerve controls.
Sciatica may have one or many of these symptoms and their location depends upon the involved nerve root.
What causes sciatic nerve pain?
Sciatic nerve pain occurs when the nerve or one of the nerve roots is irritated, usually due to compression of some of the nerve fibers by surrounding structures. It is a consequence of another disease or injury.
Common causes include situations where the intervertebral space is narrowed. This includes degenerative joint disease (DJD) or arthritis of the back, degenerative disc disease, spondylolisthesis, compression fractures of the lumbar spine, and lumbar stenosis.
Muscle of the low back may become inflamed and/or spasm that can affect the sciatic nerve if it is nearby. Piriformis syndrome is an example. Pregnancy and a growing uterus can cause inflammation of the nearby sciatic nerve. Diagnosing any underlying cause may help determine what exercises and stretches will be most helpful for the patient.
What exercises and stretches help to relieve sciatic nerve pain?
Physical therapy with the use of traction, stretching, ultrasound, and electrical stimulation may be of some help. Heat and ice therapy are also useful. While there is little research that confirms the benefit of using a back brace, patients often find some pain and function improvement.
Acupuncture, spinal manipulation, and massage may be helpful treatment options.
Exercise programs may be of benefit:
- Lumbar extensor muscle strengthening
- Dynamic lumbar stabilizing exercises
- Usually requires education and supervised training at the beginning
- Isometric low back exercises are done while the back is kept in neutral, pain-free position.
- Functional restoration exercises
- Aimed at restoring muscle strength, flexibility, and endurance in the low back
- Assess and correct posture issues
- Core muscle strengthening
- Stretches directed at the muscles surrounding the hip
When should I seek medical care for sciatica nerve pain?
Sciatica with just pain can often be controlled with the help of a primary care provider, chiropractor, or physical therapist. Other providers, including athletic trainers and acupuncturists, may also be resources for help. Patients should seek help with pain relief when they cannot control the pain.
Seek immediate medical evaluation of any sciatic nerve pain associated with injury or trauma.
Patients should seek urgent care when the sciatic nerve is so inflamed and damaged that it causes parts of the body to stop working.
Loss of bowel control, inability to urinate, and numbness around the perineum are symptoms of cauda equina syndrome (inflammation to the nerves at the end of the spinal cord), and the patient should seek emergent care to prevent permanent loss of function.
Weakness of muscles of the leg and foot, including foot drop, the inability to dorsiflex the foot (lift the toes upward), should have immediate evaluation.
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Shiri, R., D. Coggon, and K. Falah-Hassani. "Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials." Am J Epidemiol 187.5 (2018): 1093-1101.
Steele, J., S. Bruce-Low, and D. Smith. "A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning." Curr Med Res Opin 30.5 (2014): 865-911.