Sciatica: 3 Exercises to Relieve Sciatic Nerve Pain

 Sciatica is a literal pain in the butt! 

I have suffered from sciatica on and off for years. I feel it in my left glute, and when it gets really bad, the pain extends down my hamstring on the back of my upper thigh. If you’ve had it, then you know that it can be quite debilitating, impacting many activities, such as driving, walking, sitting, running, and cycling. Because it has so many causes, sciatica is one of the most common conditions that I assist my posture therapy clients with. Read on to learn more about what causes sciatica.

Causes of Sciatica

If you look at the word cloud above, it’ll give you an idea about the complexity of sciatic nerve pain. Its many causes include the following:

• Injury, degeneration, herniation or bulging of vertebral discs
• Spondylosis--or, in other words, spinal osteoarthritis
• Postural misalignments--generally noted in the pelvis and/or spine
• Scoliosis--or, a lateral curvature of the spine
• Sacroiliac Dysfunction (SIJ)
• Spondylolisthesis--that is, a slippage of one vertebrae on another
• Stenosis--a narrowing of the spinal canal through which the nerves travel

After reading the above list, you might notice something interesting. That is, I started out this article saying that a person feels sciatica pain in the butt/glute. Yet, nearly all of the causes listed are related to the spine! This is typical of nerve pain. It travels, and, as a result, distant parts of the body experience the pain. Let’s take a closer look at the sciatic nerve to understand the connection.

Anatomy of the Sciatic Nerve

The sciatic nerve is part of the peripheral nervous system. As you might know, the spinal cord runs down the back side of the body through the vertebrae of the spine. The peripheral nerves (in the peripheral nervous system) branch off the spinal cord, which along with the brain, make up the central nervous system.

Now let’s move on to the sciatic nerve itself. The sciatic nerve emerges from the spinal cord in the lumbar area (low back) of the spine--specifically, L4-L5 and SI-S3 on the sacrum. (The sacrum is the fused vertebrae at the base of the spine that’s in the shape of a triangle). As shown in the picture below, the sciatic nerve starts small and then increases in size as it crosses the pelvis and goes down the leg. It is the longest and widest nerve in the body. 

Nerve Pain Pathways

Recall that I feel sciatic nerve pain in the glute, which is typical. However, sometimes, sciatica can also be felt along the front of the leg. The location of the pain is related to wherever the cause (i.e. disc bulge, stenosis, misalignment) is located on the spine.

Note the diagrams below. They show the relationship between spinal segments and pain sensations in the lower body. In the diagrams, the teal color represents the lumbar spine, and the yellow color represents the sacrum. As shown in the figures, pain that’s associated with the lumbar spine (L1-L5) goes down the outside of the leg and wraps around to the front. If you focus on the path of the teal color on the images, you’ll see the pain starting in the lumbar area of the spine and spreading outward to the sides of the legs and down the front to the top of the foot. In contrast, pain associated with the sacrum, specifically the lumbosacral joint L5-S1, which is the most common site of spinal dysfunction, is focused at the glutes and goes down the back of the legs. Note how the yellow color in the figures starts at the sacrum at the base of the spine and goes down the hamstrings and calves. It also includes the outside of the lower leg.

Sciatica and Piriformis Syndrome

The piriformis muscle is often blamed for sciatica, though it is not generally the cause. Rather, it is an asymmetrical position of the pelvis that creates excess tension in the piriformis that is the cause.

The piriformis muscle is positioned on the back of the body, connecting the sacrum at the base of the spine to the greater trochanter of the femur (thigh bone). As shown in the picture, in most people, the sciatic nerve runs underneath the piriformis muscle. In a small percentage of people, ~15%, the sciatica nerve runs through the piriformis, and in an even smaller percentage, the sciatic nerve runs on top of the piriformis muscle.

When sciatica is the result of the sciatic nerve being pinched by the piriformis muscle, it is called piriformis syndrome. With piriformis syndrome, the muscle can be short and tight or long and tight. Either way, it causes compression of the sciatic nerve.

To explain, think about it this way: imagine how the anatomy of the pelvis, spine and femurs would be altered if the piriformis were shorter or longer than pictured. If this were to happen, the sacrum could twist to the right or left, which would impact the position of the spine above and pelvic bones on either side. A twisted sacrum could create a lateral curve or rotation of the vertebrae. Then, the sacroiliac joint (SIJ)--the joint between the pelvic bones and the sacrum--would become misaligned as the sacrum twisted. Additionally, the tilt of the right and left pelvic bones along with the internal and external rotation of the femurs (thigh bones) could change.

In other words, these postural misalignments could narrow the space around the sciatic nerve, causing compression, and consequently, pain. Thus, alignment of the pelvis, spine and femurs needs to be equally positioned from right to left and front to back in order to relieve sciatica pain.

Body Symmetry: Balance the Piriformis and Psoas

As discussed above, the piriformis is an important postural muscle. In opposition to the piriformis is the psoas. The psoas lies on the front of the body. It originates on the last thoracic vertebrae (T12) and all lumbar (L1-L5) vertebrae and inserts on the lesser trochanter of the femur.

Observe that the psoas and piriformis both attach to the femur bone and perform opposite actions. The piriformis rotates the hip and leg outward, while the psoas rotates the hip and leg inward. So, in order to keep the hip and leg in a neutral position, these muscles must be balanced.

The piriformis and psoas also have opposing effects on the position of the pelvis. A shortening contraction of the psoas rotates the pelvis forward (anterior pelvic tilt), while engagement of the piriformis rotates the pelvis backward (posterior pelvic tilt).

One thing to know about both of these muscles is that they are deep within the body. The pictures show them isolated, but actually there are many muscle layers above the piriformis and psoas. Muscles that lie deep in the body and close to the bones are more important to postural position. The following exercises focus on these particular muscles.  Try these exercises in order to gain balance and relieve sciatic nerve pain. 

Related Blog: Tame Your Hip Flexors with the Egoscue Tower
This exercise is HIGHLY recommended for sciatica!

3 Sciatica Exercises

These Egoscue Method^©  exercises will help realign your spine, pelvis and femurs. Please do them in the order presented. You can add repetitions and/or sets as your body becomes stronger.

Static Back Knee Pillow Squeezes 

• First, lie on your back with your legs up on a chair, couch, block, or bench. Be sure your hips and knees are bent at a 90 degree angle. Your arms are out to your sides at a 45 degree angle with the palms up.
• Next, relax in this position. Notice how the back of your pelvis and lower back are contacting the floor.
• Then, place a firm ~6" pillow, block, ball, or roll of paper towels between your knees.
• Now, squeeze your knees into the pillow using your inner thigh muscles. Your knees should be roughly in line with your hips when you squeeze. Hold the contraction for two seconds, and then release.
• Coordinate this movement with your breath by exhaling out your mouth as you squeeze and inhaling through your nose as you release.
• Complete two sets of twenty repetitions.
• While you complete this exercise, recheck the contact of the back of your pelvis and lower back. You want to feel even contact right to left and your lower back flat on the ground. This indicates that your pelvis is more balanced.
• Complete additional sets as needed to obtain a symmetrical pelvic position.

Cobra Glute Squeezes 

• Start lying on your stomach with your hands under your forehead. If this position is uncomfortable on your lower back, place a pillow or two under your pelvis to reduce the curve in your lower back.
• Next, separate your feet wide, bend your knees and bring the bottoms of your feet together.
• Now, press your feet together to activate your glutes (butt) muscles. Hold the contraction for two seconds, and then release.
• Coordinate this movement with your breath by exhaling out your mouth as you squeeze and inhaling through your nose as you release.
• Complete 2-3 sets of 20 repetitions.

Airbench

First, stand with your back to the wall. Now slide down into a sitting position. The lower you go, the harder this will be. The goal is to have your upper legs parallel to the floor.

• Then position your feet hip width apart, facing straight ahead. Your heels should be approximately in line with your knees above. If you have sensitive knees, move your feet farther out so that your knees are behind your heels.
• Next, rotate your pelvis back (posterior tilt) to flatten your back against the wall. You are using the wall as a template for a balanced pelvic position. Each side should have equal contact.
• Now, pull your shoulders back flat into the wall. Only do this, though, if you can do so while keeping your lower back flat.
• Push your heels into the floor. Keep the weight in your heels throughout the exercise. This will direct the work back into your upper thighs and pelvis.
• Hold the position as long as you can with a goal of reaching 2-3 minutes.

Summary

Sciatica is a common cause of pain in the glutes and down the back of the legs. It is caused by compression of the sciatic nerve, which originates in the lower part of the spine. Postural misalignments that are in the pelvis, spine and femurs often cause compression of the sciatic nerve. If you reposition your body, you can alleviate the pressure on the nerve and the accompanying symptoms.

References

Biel, Andrew. (2005). Trail Guide to the Body Third Edition. Boulder, CO: Books of Discovery.

Kendall, Florence. (2005). Muscles Testing and Function with Posture and Pain Fifth Edition. Baltimore, MD: Lippincott Williams & Wilkins.

Sciatica Study Group Recording. Egoscue Institute.

Myers, Thomas. (1998). Poise: Psoas-Piriformis Balance. Massage Magazine, Issue 72.