St Albans Osteopathy Blog

Sciatica

Sciatica is classified as pain in the sciatic nerve. This pain may be sharp, dull or burning. It may be focused in one area or it may radiate the entire length of the nerve. It is often felt in the lower back and buttocks region, and often spreads down the back of the leg. The pain is usually only felt on one side. Coughing, sneezing, squatting or extended periods of sitting can cause an increase in pain. The muscles that are innervated by the sciatic nerve may also spasm or cramp, causing additional pain. The pain in the lower back and hamstrings can also lead to inflexibility in the back and hips. Pain and stiffness in the opposite side may also result over time.

Four common causes of sciatica:

  1. Piriformis syndrome is one common cause and is the result of the piriformis muscle putting pressure on the nerve. This may be caused by misalignment of the pelvis and/or hip joint, which changes the position of the piriformis, placing pressure on the sciatic nerve. This misalignment is often caused by muscle imbalances.
  2. Herniated discs in the spinal column can also put pressure on the nerve. A herniation, or protrusion, of the disc can result from a traumatic event or from years of pressure from muscle imbalances.
  3. A third possibility is spinal stenosis, or a decrease in the space between the vertebrae. This reduced space compacts the nerve where it leaves the spinal column. The narrowing is often caused by compression on the spine due to muscle imbalances.
  4. The fourth cause is spondylolisthesis, which is a condition where one vertebrae moves forward in relation to the one below, putting pressure on or more roots of the sciatic nerve. This may be traumatic, degenerative or congenital.

Symptoms:

  • Pain - This pain can vary from dull, aching pain, to sharp, burning pain anywhere along the nerve pathway.
  • Numbness - This can also occur anywhere along the nerve pathway. Pain may be experienced in one area with numbness below it.
  • Weakness - The muscles innervated by the sciatic nerve may become weak due to a decreased ability to send signals along the pathway.
  • Tingling or “Pins and Needles” - This may be felt in the lower legs and feet.
  • Cramping or Spasm - The muscles of the hamstrings or calves may spasm or
  • cramp as a result of incomplete signals being sent through the nerve pathway.

Exercises

While Lying on the Back

Examples of the dynamic lumbar stabilizing exercises done while on the back include:

  • Hook-lying march.
    While lying on the back on the floor, with knees bent and arms at sides, tighten the stomach muscles and slowly raise alternate legs 3 to 4 inches from the floor. Aim to ‘march’ for 30 seconds, for two to three repetitions, with 30-second breaks in between repetitions.
  • Hook-lying march combination.
    Same exercise as described above, but includes raising and lowering the opposite arm over the head.
  • Bridging.
    Start by lying on the back with the knees bent, then slowly raise the buttocks from the floor. Hold bridge for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten bridges.

These exercises should all be performed with a rigid trunk. The pelvic tilt, tightening the lower stomach muscles and buttocks to flatten the back, can be used to find the most comfortable position for the
low back.

While Lying on the Stomach

This same pelvic position (tightening the lower stomach muscles to flatten the lower back) is maintained while performing stabilizing exercises from the prone position (lying flat on the stomach):

  • Raise one leg behind with the knee slightly bent and no arch in the back or neck
  • Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.
  • Lying face down, with elbows straight and arms stretched above the head, raise one arm and the opposite leg 2 to 3 inches off the floor. Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of opposite side raises.

Stabilizing exercises

These can be done in the 4-point position (kneeling on hands and knees), raising the arms and legs only as high as can be controlled, maintaining a stable trunk and avoiding any twisting or sagging:

  • Raise one leg behind with the knee slightly bent and no arch in the back or neck
  • Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.
  • For a slightly more advanced exercise, raise one leg with the knee slightly bent and no arch in the back or neck and also raise the opposite arm
  • Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg
May 25th 2019
 

Philip Bayliss, St Albans Osteopathy, 43 Thames Street, Christchurch 8013 ☎️ 03 356 1353