The Causes Of Sciatica And Treatment Exercises

Exercises You Can Do At Home To Treat Sciatica

Sciatica is a term often used to represent a diagnosis when it is in fact a symptom of a larger underlying condition. Sciatica refers to pain radiating from the buttocks down the back and/or outside of the leg. It is important to understand how this pain is caused so you can effectively manage it. I’ll give you some insight on how sciatica is caused, how to perform some exercises to help manage the symptoms and how the TherRex™ balance board trainer can help.

To fully understand how sciatica is caused, you have to know a little anatomy about how the Sciatic nerve is formed and where it runs. The Sciatic nerve is the largest nerve in the human body. It is formed by spinal nerve roots L4-S3. After it passes by the piriformis muscle, the nerve continues down the back of the thigh where it divides into the tibial and common peroneal (aka common fibular) nerves. The course of the nerve is long, compression anywhere along the nerve can cause pain.

Sciatica is most often experienced in a herniated lumbar disc and in piriformis syndrome. A herniated disc compressing on the nerve root is the most common cause of sciatic pain. A herniated disc is what people are commonly referring to when they say, “I threw my back out.” In bending and twisting activities the disc between the vertebrae of the spine is pushed posterolaterally (back and to the side) and compresses on the nerves that leave the spinal cord through an opening called the intervertebral foramen.

Beyond the nerve roots at the vertebral level, the sciatic nerve passes beneath the piriformis muscle, in 80 percent of the population. This muscle has a high prevalence of type-I fibers which have a tendency to become short and stiff when abnormally stressed. When the piriformis is shortened, its diameter increases, which in turn increases pressure on the sciatic nerve. Due to this close proximity of the sciatic nerve to the piriformis muscle, it is at high risk for nerve entrapment. Coupled with the natural tendency of the piriformis muscle fibers to stiffen up, nerve entrapment is also caused by inflammation, hypertrophy of the piriformis muscle, irritation, and the aberrant anatomy of the sciatic nerve as it courses between muscles. Due to the varying causes of the condition it can be difficult to diagnose.

Making the diagnosis of piriformis syndrome is largely based on symptoms that include buttocks pain, radiating pain down the thigh, pain aggravated by sitting, tenderness over the piriformis. This small muscle can cause a lot of problems, but when it’s not a literal pain in the butt it is actually doing some good.

The piriformis muscle works as an external rotator, weak abductor, and weak flexor of the hip. In standing and walking, it also provides postural stability. The piriformis will remain active at a low grade contraction throughout seated positions as well. Interestingly enough the action of this muscle can also change depending on the position of the hip. It remains an external rotator of the hip at less than 60 degrees of hip flexion, but when the hip is flexed at greater than 60 degrees it acts as an internal rotator due to its positioning at this angle. Because this muscle is so close to the lower back it’s not hard to see why these symptoms are seen in up to 36 percent of people with lower back pain. Thankfully, there are modifiable risk factors that can be changed now to decrease your chance of dealing with sciatica.

Being overweight increases the risk of experiencing sciatica by 12 percent and obesity increases that risk by 31 percent. Also, smoking increases the risk of experiencing sciatica by 35 percent. The risk of hospitalization due to sciatica also increases with all of these factors. The good news is that these are risk factors for a complete gamut of diseases/conditions, so by modifying them now you would also be decreasing your risk of heart disease, stroke, and COPD, to name a few. A healthy lifestyle is a necessity for longevity and quality of life.

A large part of any healthy lifestyle is moderate exercise. Balance exercise equipment can be added to any stretch or exercise to put a demand on your core at the same time. It is persistent activation of the abdominals that will get you the tone you’re looking for. Time to put the abs back at ‘the core’ of everything you do. Pictured below is one way to implement this while stretching the piriformis.

 

 

 

 

Piriformis Stretch

Lie supine (on your back) on the TherRex™ balance board trainer and put the foot of the painful side on the opposite knee. Increase the intensity of the stretch by pulling harder from behind the knee. Hold for 30 seconds.

 

 

 

 

 

 

 

 

Hamstring Stretch

Lie supine with your leg straight, pull from behind the knee with both hands until a stretch is felt in your hamstring. Hold for 30 seconds.

 

 

 

 

 

 

 

 

Bridges

Lie supine with your shoulders on your TherRex™ board, bend your knees and place your feet flat on the ground, shoulder-width apart. Draw-in your navel and contract your glutes. Slowly push through your heels and lift your hips off the floor until your knees, hips and shoulders are in line. Hold this position for two seconds and then slowly lower your pelvis back down to the floor.

*Using the TherRex™ board will ensure your back stays straight, and not flexed, when you lift your hips.

 

 

 

 

 

 

Squat

While standing and maintaining your balance on the TherRex™ balance board trainer, squat and return to a standing position. Try to maintain a level position of the balance exercise board throughout the movement. Knees should not pass the toes.

 

 

 

 

 

 

 

 

 

 

 

 

The prevalence of piriformis tightness is high in the sedentary population, as high as 79.5 percent, in one study. In addition to exercise, movement throughout the day is the best way to prevent this tightness from developing into piriformis syndrome and later on, low back pain. As with any exercise program, consult with your doctor prior to participation.

 

 

Click here for the complete sciatica recovery program and get back to pain free activity.

 

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References:

Mondal M, Sarkar B, et al. Prevalence of Piriformis Tightness in Healthy Sedentary Individuals: A Cross-Sectional Study. IJHSR. 2017; 7(7): 134-142.

Stoyanov J, Georgieva A, Dimitrov N, Surchev L, Sivrev D. Non-formation of the Main Trunk of the Sciatic Nerve and Unusual Relationships to the Piriformis Muscle. Trakia Journal of Sciences. 2017; 3: 252-254.

Shiri R, Euro U, et al. Lifestyle Risk Factors Increase the Risk of Hospitalization for Sciatica: Findings of Four Prospective Cohort Studies. The American Journal of Medicine. 2017; 7: 1-7.

Hanan AR, Gehan SH. The effectiveness of the proposed range-of-motion program on reducing sciatic pain. Menoufia Medical Journal. 2015, 28:608–615.

Han S, Kim Y, Kim T, Kang S. Surgical Treatment of Piriformis Syndrome. Clinics in Orthopedic Surgery. 2017; 9: 136-144.

Khuman P, Surbula L, Dusad G, Jadeja S, Chandrabharu V. Effect of Reciprocal Inhibition Muscle Energy Technique in Acute Piriformis Syndrome: A Single Case Study. 2014; 5(10): 1794-1798.