WHAT IS SCIATICA?
It is an intense or dull pain radiating from the lower back, through the buttocks, legs and sometimes to the feet. It can cause tingling, pins and needles and number, triggered by the sciatic nerve being pinched, aggravated, obstructed or restricted.
WHAT IS THE SCIATIC NERVE?
The Sciatic nerve is one of five nerves in the hip region, is the longest nerve in the body, running from deep inside the lower back, through the hip, buttock, thigh through to the foot.
WHAT IS IT'S FUNCTION?
The Sciatic nerve provides the majority of the motor and sensory activity for the lower extremities of the body - mainly the hips, knees, ankles and toes
WHO IS MOST AT RISK OF DEVELOPING SCIATICA?
People aged between 30 and 50 are most at risk because the vertebrae in the spine have not yet fused due to age so the discs between the vertebrae of the spine are vulnerable to injury. This can lead to sciatic pain.
Those people who sit for long periods at desks or driving cars are at risk of degeneration of the discs in the spine that might impact on the sciatic nerve.
Lifting heavy weights - such as weight lifting - can cause degeneration of the spinal vertebrae because of the pressure on the lower back.
Occupations that involves severe rotation and flexion of the lower back - building work - can cause damage to the lumbar (lower part) spine.
Health choices can also affect the back - being overweight or smoking can either put pressure on the lower back or prevent nutrients and blood supply getting to the discs in the spine to preserve the fluid around the discs that protect the vertebrae.
Vigorous exercise such as running can lead to tightness and over development of the Piriformis muscle that runs through hip, adjacent to the Sciatic nerve.
WHAT ARE MAIN CAUSES SCIATICA?
Imbalances in the muscles around the hip and lower back.
Repetitive movements - bending, twisting - such as weight lifting.
Poor posture - ie sitting at a desk for long periods.
Lifestyle factors - weight, smoking
Lower lumbar (back) herniated disc - where the spine has flexed forward and backward too much to cause the vertebrae cushions of liquid to rupture.
Spinal Stenosis - narrowing of the vertebrae in the spine
Degenerative Disc Disease - discs have simply work away and are rubbing against each other.
Spondylolisthesis - spinal disease
Piriformis Syndrome - can be caused by excessive exercise
Injuries - a fall.
HOW DO THESE CAUSES TRIGGER SCIATICA?
The spine runs from the top of the head down to base of the spine at the top of the buttocks. Wrapped around and connecting to the spine is the Central Nervous System of which the Sciatic nerve is part of.
The spine is a perfect 'S' shape is designed to support and protect the body from injury and assault and is really like a connecting row of beads, all perfectly aligned. Supporting the spine is a network of ligaments, muscles and tendons that act like struts on a bridge to keep the spine in position. The muscles in and around the spine work in tandem to mobilise or stabilise each other to re correct and balance the spine.
Here is a picture of the curvature of the spine:
Everything works well when the spine is in this position but once the muscles start working incorrectly the spine then becomes unstable, impacting on the nerves adjacent to the spine causing pain, throbbing sensations or shooting pains.
The Sciatic nerve's position near the lower back this makes it particularly vulnerable to being obstructed, restricted or irritated by an spine that is rotating or flexing too far out of it's normal range of motion. Most lower back injuries occur because the lower lumbar spine bears the most weight of the body.
WHAT ARE THE TREATMENTS FOR SCIATICA?
Most bouts of Sciatica tend to disappear after 4 to 6 weeks and the treatments are:
Anti inflammatory drugs
Healthier life style choices
WHAT IF THE SCIATICA KEEPS COMING BACK OR THE PAIN WILL NOT GO AWAY?
This usually means a visit to the GP, Chiropractor or Physiotherapist to establish if there is damage/injury to the lower spine, Piriformis or spinal disease, degeneration.
The Chiropractor/GP/Physiotherapist will offer treatment:
Stronger pain killers
Counselling to cope with the pain
Discetctomy - where the disc is removed.
Post Rehabilitation exercises - Pilates
HOW PILATES CAN HELP WITH SCIATICA
Pilates cannot cure Sciatica but it can help to:
Lessen stress and tension due to coping with the discomfort
Rebuild the muscles in the lower back and core
Focus on working the core to improve posture and support spine
Build strength from inside the body
PILATES EXERCISES TO AVOID IF YOU HAVE SCIATICA:
The Roll Down
The Roll Up
Open Leg Rocker
RECOMMENDED PILATES EXERCISES FOR SCIATICA:
The Cat Stretch - extension only
Half Swan - using the Pilates Magic Circle
Four Point Swimming
Stretching the hamstrings (muscles/tendons that run down the back of the legs).
Leg on knee exercises for the Piriformis
I HAVE SCIATICA WITH LOWER BACK PAIN AND I'VE BEEN TOLD TO DO PILATES:
It would be worthwhile for you to have several one-to-one private Pilates sessions where:
Details of your health problems can be discussed
Your posture assessed
A programme of tailored Pilates exercises can be put together that will help you with your sciatica
You will learn how to stand correctly to protect your back and hips.
You will learn how to do the exercises correctly and safely in the privacy of the Pilates studio.
You can then practice the exercises at home.
Once you have been given a programme of exercises you will know what to expect in a group Pilates class and will know which Pilates exercises to avoid doing. Of course, there is no reason why you cannot progress with Pilates onto the more challenging Pilates and there always variations.
You must always tell your Instructor that you suffer from Sciatica and that you may avoid some exercises. I am sure that he/she will understand and will be very happy to find some variations or alternatives for you to try.
WILL PILATES SOLVE MY SCIATICA AND LOWER BACK PROBLEM?
Pilates cannot completely take away your Sciatica or back problem, particularly if it is due aging of the spine, disease of injury but Pilates can rebuild the muscles in the back and core so that you will stand taller, have more flexibility, improved posture and balance.
MOVEMENTS TO AVOID IF YOU HAVE SCIATICA
Extreme flexion or rotation of the lower spine for example:
Getting in and out of a car or chair
Getting a baby out of a car seat in the car
Extreme twisting or turning - ie shovelling.
Here is a great Pilates exercise to try that may help with tight hips that affect the Piriformis in runners or for lower back painj:
This works the three main muscles in the buttocks:
First of all start by lying on your side on a mat with your legs and bottom in line with the mat/floor. It is really important that you get your bottom, shoulders, head and feet in line with the mat. What I do is run a hand down my bottom, find the edge of the mat and move my bottom to my hand, then line up my feet and head. A main Pilates Principle is Alignment because your muscles must work perfectly against each other to stabilise the hips and spine.
Draw up your knees until they are level with your hips so look for your knees being level with your hip bones,then bring your feet up in line with your hips but if this starts to nag your lower back, drop your feet down lower until you feel comfortable. The above picture shows the easier version of the Clam with lower feet and knees.
Then take your hand that is furthest away from the mat and run it under your waist. If there is no gap lift up your waist by pulling in your core so that there is a small gap and hold for as long as you can during the exercise. Take your hand away and rest on the mat.
Next, inhale and lift the top knee as far as you can, you may not be able to go too far in the beginning but do try to feel the muscles in your buttock starting to react. It helps to lay a hand on one buttock so you can identify the movement. Exhale as you drop the knee back to meet the other one. Try to do this exercise five to six times, taking your time learning how the muscles work together.
Then come up into the sitting position, bring your feet together and open out your thighs and knees creating a small diamond, lean forward and feel a stretch in your hips and groin.
Repeat on the other side.
This next exercise is the Pilates 4 point swimming:
With this exercise make sure that your knees are hip distance apart with your hands under your shoulders. Take your time by sliding your hands and legs along the mat from a four point kneeling position and inhaling as you gently lift opposite arm and leg together. Hold for two seconds and then drop back to the mat and slide arm and leg into together as you exhale.
PILATES FOR SPINAL STENOSIS (NARROWING OF THE SPINE) OR HERNIATED DISC:
For those people suffering from these two injuries - these are recommended Pilates exercises:
PILATES EXERCISES TO AVOID:
PILATES EXERCISES RECOMMENDED:
Child's Pose Stetch
One Leg and Double Leg Stretch
All of these exercises are designed to strengthen the core, hip and back muscles to create a corset around the middle of the body to protect and balance the spine.
FOR PIRIFORMIS TIGHTNESS OR SYNDROME
For runners who have overexercised and have built up tightness and instability in the hips:
Lying Gluteal Stretch
Leg Across Knee Stretch
Open Leg Child's Pose
The Open Leg Rocker
PILATES CAN HELP EASE THE DISCOMFORT OF SCIATICA.
Pilates exercises help by rebuilding the back muscles and core to create a strong corset around the spine to provide stability and strength to protect the spine. Once the muscles in the back, hips and core have been built up over a series of twenty or thirty Pilates lessons you will have more inner strength, balance and flexibility and you will be able to move with ease and confidence.
Eventually, the pain and discomfort from Sciatica and back pain should start to lesson and even disappear but it does take time and commitment to go to classes and practice the exercises at home.
The Pilates Swan Diver - great exercise for strengthening the lower back, hips and core.