Back Pain & Sciatica

Irritation of the sciatic nerve can cause pain, tingling, or numbness along the course of the nerve and its branches, from the backside to the toes.  Many people who have history of lumbar disc injury, even following surgery, experience pain which travels into the buttock and/or legs.  This type of radiating pain is usually the result of chemical or mechanical irritation to the nerve roots that exit the spine and contribute to the sciatic nerve.  For many sufferers, it is possible to manage their pain with the help of stretches and exercises.

Stretching Basics

• Relax your neck and shoulders, you’re not doing sit-ups
• Maintain slow, even breathing while holding 30 second stretches
• Don’t bounce, hold steady and try to gently increase the stretch with time
• If any stretch or maneuver causes pain, stop the activity and discuss with your Doctor

Knee-to-Chest Stretch

Aside from ice and rest, this stretch is generally the first line of defense against lower back pain with radiculopathy (radiating nerve pain).  I recommend that patients with sciatic pain do the knee-to-chest stretch on a daily basis.  The stretch can be especially effective when performed after waking, but before getting out of bed and putting weight on the back for the first time in the morning.  To stretch, lie on your back and bring the knees towards your torso.  Pull with your arms around your knees or legs to increase the intensity.  Hold the position for 30 seconds while slowly breathing and gently trying to bring the legs closer to the body.  Repeat 2 to 3 times.  If stretching both legs at the same time is too intense, then start by bringing one leg towards the body, stretching then switching to the opposite side (lower illustration).  Alternatives to stretching on the back include deep squatting and pulling the knees to your body or bending to touch your toes while sitting in a chair.  These moves can be repeated multiple times a day.

Piriformis Muscle Stretch

The first stretch that I recommend is for the piriformis muscle.  The sciatic nerve usually runs under and sometimes through the piriformis muscle as the nerve travels between the sacrum and hip, then towards the leg.  Stretching of the piriformis muscle can be achieved in a seated position.  While sitting in a chair, cross the affected ankle over the opposite knee.  With one hand, stabilize your ankle on your knee and with the other hand or forearm apply gentle pressure downward on the involved knee.  If you have strong pain to push down on the knee, than simply stabilize the crossed leg and avoid the added pressure.  *If this movement significantly increase your pain, than stop immediately.  You should start to feel the stretch in your buttock.  From the crossed leg position, with the knee being held down, you can further increase the intensity of the stretch by slowly leaning forward, bringing your chest closer to your knees.  Always maintain the lumbar lordosis or curvature of the back – think “arching the back” while bending forward.  Be sure to maintain slow breathing while performing this and any other stretches.  Try to hold the stretch for 30 seconds, repeat 2 to 3 times and don’t hold your breath.

The next installment of this series, Home Care for Sciatica II, will include nerve glide and sciatic tensioning maneuvers to add gear to the self-treatment toolbox.