Sciatica: The 4 Best Exercises For People With Sciatica

By Dr Ken Nakamura+

Lower Back Pain and Sciatica

Are you frustrated with your sciatica?

 

Would you like to know the best ways to treat sciatica?

 

Keep reading to discover what your options are and how to do the exercises to help your chiropractor or physiotherapist through your treatment program.

What is Sciatica?

 

Simply put, pinching of a nerve which causes pain into your buttock, down your thigh into the leg and sometimes into the foot.

 

The nerve can be pinched in 6 different spots. So if your medical doctor or chiropractor is telling you that you have sciatica, ask them to be more specific.

 

Saying you have sciatica is the equivalent of saying you have pain in the neck that radiates down the arm. You already knew you had pain going down the leg.  It’s not a diagnosis. A non diagnosis or a wrong diagnosis will change the whole course of treatments and getting the wrong treatment will not get you better.

 

For example if your sciatica is from disc herniation your treatment will be very different from a person with degenerative disc disease.

See Also:  Best Toronto Chiropractor: How To Find The Best Chiropractor In Your City

 

Sciatica Spinal Nerve with Lumbar Vertebrae: Best Toronto Chiropractor

Sciatica: Spinal Nerve with Lumbar Vertebrae

L4 and L5

 

So how do I know where my pinched nerve is? There are two nerves that come out between the last two vertebrae in your body. Your nerve is very commonly pinched here.

 

Your lower back vertebrae are called lumbar vertebrae. There are 5 vertebrae in the lower back. Taking the “L” for lumbar spine, they are named L1, L2, L3, L4, L5. The last two vertebrae in your lower back are L4 and L5.

Sacrum and sacral nerves that form sciatic nerve

Sacrum bone pictured above with sacral nerves that form the sciatic nerve. The lumbar nerves  that help form the sciatic nerve is not in this picture.

ion medical designs http://www.ionmedicaldesigns.com/ion_site/two_dimensional_artwork.html

 

Just below L5 is one of your pelvic bones. It’s called the sacrum. The sacrum has holes with the yellow colored nerves coming out.

S1, S2, S3

The nerves are called S1, S2 and S3. “S” is for sacrum. These nerves are rarely pinched.

 

Your sciatic nerve is formed when the nerves from L4 L5 and L5 S1 join together with the S1,S2 and S3 nerves in your buttock.

 

So, most of you will have your nerve pinched in one of three spots.

 

  • In the buttock where the Sciatic Nerve starts, in other words where the S1,S2,S3 nerves join the two other nerves that come out between L4 ,L5 and L5 S1.
  • Between L4 and L5 vertebrae
  • Between L5 and S1 vertebrae
Sciatica- Piriformis Muscle and sciatic nerve

Sciatica- Piriformis Muscle and sciatic nerve –Picture from sciaticafastrelief.com

 

Now you know where the nerve can be pinched but it doesn’t answer why one of the nerves is pinched causing your sciatica

The Usual Suspects (Causes) of Sciatica

 

Most people’s sciatica is from:

 

  • Herniated Disc at L45 or Herniated Disc at L5S1 (some osteoarthritis = “wear and tear” is involved)
  • Degenerative Disc Disease (Osteoarthritis of the Disc=”Wear and Tear” of the Disc)
  • Stenosis (Basically advanced osteoarthritis)
  • Spondylisthesis (A fracture of the vertebra or Osteoarthritis with the vertebebra moving forward)
  • Piriformis Syndrome

 

These are the diagnosis that your doctor or chiropractor should be telling you about not sciatica. 

 

Remember sciatica only says that you have a pinched sciatic nerve causing pain into your buttock and leg, sciatica doesn’t tell you the cause of your pain. Without determining the cause you will get hit or miss treatments from your chiropractor or physiotherapist as they can’t give you specific treatment.

 

See Also: MRI CT scans X-rays, What’s Best For My Pain

 

The key exam that you need to determine what the heck is causing your pain is a neurological examination. You have probably seen it on TV before.

 

  • Reflex tests with a reflex hammer on your knee and back of ankle
  • Muscle Strength Testing: Resisted muscle testing of your foot. You try and push up/down while the chiropractor holds your foot. An alternative is heel walking and walking on your toes.
  • Light Touch and Sharp Dull Testing:  A light touch directly on the unclothed legs and feet to determine if you are unequal in your sensitivity to light touch and sharp/dull testing.  Light touch is often enough as a screening.

 

Also remember that the diagnosis should pretty much be determined in the office and X-rays, MRI, CT scans done only if the their are signs of something else or the diagnosis is kind of fuzzy.

See Also: Herniated Disc Part 2: The Best Exercises For Your Herniated Disc

Herniated Disc

 

You herniate a disc from the everyday habits that you have. The everyday habits of slouching and bending with a rounded low back, build up to weaken and damage the disc to the point it is ready to break open and herniate.

 

The problem is there is no pain. You don’t feel sciatica, until the disc has herniated as there are no nerves inside the disc. So you continue your habits and think you don’t have a bad back until one day you lift your daughter off the floor.

 

The only problem is you had a bad back with no symptoms for a very long time. This is just like car with a little bit of rust showing but if you take the car apart you see a lot more rust.

Degenerative Disc Disease – Osteoarthritis of the Disc

 

Degenerative Disc Disease really is a continuation of the break down of the disc that was started by the bad lifting and slouching habits.

 

The disc becomes smaller, brittle like an old elastic band that is decaying, leading to the disc becoming smaller in height. The smaller disc makes the space between the vertebrae smaller. Thus, your nerve doesn’t have much room, so your nerve gets pinched between L4 and L5 or L5 and S1.

Stenosis- Most commonly from continuation of Osteoarthritis

 

Stenosis is a “narrowing”. There are two types of stenosis

  1. Lateral Stensosis
  2. Spinal Stenosis
    • Lateral Stenosis is the narrowing of the hole which the nerves from the spinal cord come from. Does this sound familiar. It’s really degenerative disc disease + the bone degenerating forming spurs that narrow the hole for the nerve. A smaller hole for your nerve eventually means a pinched nerve.
    • Spinal Stenosis is narrowing of the canal where the spinal cord sits. This is not as common so we shouldn’t get into it here.

Spondylolisthesis (Vertebebra moving forward)

 

Spondlylolisthesis is usually the moving forward of the vertebra (sometimes backwards). When the vertebra moves forward the spinal cord and nerves are pulled putting tension in your nerve. Nerves under tension get irritated and so turn into sciatica. This can happen from a fracture to the vetebrae or osteoarthritis.

Piriformis Syndrome

 

Most people’s sciatic nerve usually goes over or under the piriformis muscle. In some cases, possibly yours, the sciatic nerve goes right through the piriformis muscle. When the muscle tightens up it literally squeezes on the sciatic nerve causing sciatica.

 

Walking like a “man” is an another reason for sciatica. That’s right, when you walk bow-legged with your feet turned out might mean “you the man” but it also can give you trouble later.

 

Chances are, if you are reading this you already have a problem with sciatica. When you turn your feet out this makes the piriformis muscles work harder.

 

The harder your piriformis works the more likely the nerve will be pinched causing sciatica.

The 4 Best Exercises For Sciatica

 

While treatments are different for sciatica depending on the cause you can still help your chiropractor or physiotherapist by doing your home exercises.

Flossing: first introduced by Michael Shacklock

 

Flossing is good for your teeth but a different kind of flossing is good your spine and spinal hygiene.

 

First determine if you can floss safely:

 

  • Lie face-up on a bed or relatively hard surface. Please don’t lie on the couch, it is too soft and will aggravate your lower back.
  • Raise your painful leg to the point of pain and keep it there.
  • Bend your neck forward till your pain is aggravated from above
  • Lower the leg till the pain decreases.

 

If the pain decreased you are safe to do flossing.

 

Warning: This exercise can cause acute sciatica but chances are minimized by doing the screening exercise. Don’t floss until you have been out of  bed for at least 2 hours.  Now The Flossing:

Nerve Flossing for Sciatica

Nerve Flossing for Sciatica   photo by ahskc.com

 

  • Sit down in a chair with your legs swinging freely
  • Bend your neck forward for 5 seconds (if this doesn’t cause sciatica you can do the next step)
  • Bend your neck backwards as far as posssible and straighten the knee (5 seconds)
  • Repeat 3 sets of 10X on each leg. You can do this up to 5/day.

Piriformis Stretch   A) Sitting and    B) Lying Face-Up

Sitting:

Sciatica: Seated Piriformis Stretch

Sciatica: Seated Piriformis Stretch -photo by doubleyourgains

  • Sit in a chair and cross the bad leg over the good
  • Keep the arch in your back and move your chest forward
  • Repeat 3 sets 30 secs.  This can be done several times a day
Sciatica: Piriformis Stretch Best Toronto Chiropractor

Sciatica: Piriformis Stretch to help your sciatica -photo by dhbiokineticists.webs.com

 

Lying Face-up:  This exercise might be easier for some of you.

 

  • Lying Face-up both knees bent.  Put the bad leg over the good.
  • Bring the good leg up to support the bad leg.
  • Push the bad leg outward.

 

Ball Exercises:  Piriformis, Gluteus Maximus, Gluteus Medius

Piriformis

 

  • Cross your bad side leg over the other knee
  • Get a tennis ball, basketball or a medicine ball and sit on it with your buttock.
  • To treat the pififormis go lean at about a 45-degree angle.
  • Stop at each tender point and hold until each one is ironed out or feel less tender.

 

Gluteus Maximus

  • Same as the piriformis except that you don’t need to cross the bad over the good.

Gluteus Medius

  • Same  as Gluteus Maximus except that you now lean at almost a 90 degree angle -You are almost on your side with a focus on the side area just below the belt or hip bone

Cobra

Herniated DIsc Cobra Exercise to Put your Disc Back In & Prevent Herniated Discs

  • Lie down face down with your hands underneath your shoulders.
  • Push up from as high as you can until your lower back stops you or your elbows are straight.
  • The pelvis should still be on the floor and the lower back muscles relaxed.
  • Do these exercises holding each time for 1-2 seconds 6-8 times per set. This exercise can be repeated every two hours throughout the day.

 

If your pain is from a disc herniation you can combine the disc herniations part 2 exercises with these exercises. If your sciatica is from a different cause I will write about all the conditions that cause sciatica over time.

 

Write in the comments to tell us how you are doing with your sciatica. Connect with me on LinkedIn.

 

 


Author

Dr Ken Nakamura

Who is Dr. Ken? I’m a father, spouse, chiropractor, and I love what I do! I created Bodi Empowerment to bring you and everyone-else safe and effective methods for self-treatment by basing my articles on research to everything I can. Still many parts will be based on 18 years of experience, seminars, and collaboration with other health experts; which means you will get opinions as well. Sometimes my articles won’t agree with what is currently accepted, but I am not here to please everyone. I’m here to empower you through the knowledge that I give you. Dr. Ken works at Rebalance Sports Medicine in downtown, Toronto.

521 Responses to Sciatica: The 4 Best Exercises For People With Sciatica
  • Tushar Agarwal says:
    April 7, 2017 at 9:55 pm

    Hello sir , this is Tusshar agarwal from
    India my father is suffering from l4/l5,s1 Problem from past 2 months tried ozone treatment, massage , acupressure, but no results there is not much back pain but numness in left leg and can’t walk 100-200 mts
    2-3 doctors suggested for surgery but do you think should we take this decision so early or is there any alternative way to get cure

    • Dr Ken Nakamura says:
      April 9, 2017 at 8:51 pm

      Thanks for your question Tushar. This sounds like spinal stenosis to me and not simple sciatica. Not a lot that can be done but you can try these exercises. http://www.bodiempowerment.com/spinal-stenosis-comprehensive-guide-5-exercises-spinal-stenosis-lateral-stenosis/
      You can try those stretches. You should go to someone that knows how to do the exercises as you may not be doing them properly. This is an opinion and not a recommendation.

      Hope that helps your father’s sciatica and quite possibly spinal stenosis. If you have any questions for this Toronto downtown chiropractor, I will do my best to give you a useful answer.

  • ChelRae says:
    March 14, 2017 at 12:43 am

    I’ve always have had a bad back. Last year, I learned that I have 4 bulging discs and a pinched nerve (L5). The pain would come and go, overall living my life in at the pain level #6 after medication. I’ve been told to tighten my core muscles, but like the majority of us I have done a poor job in doing what I should do. I recently hurt my sciatica from trauma. I misstepped and ended up sliding down 10 stairs on my buttocks. The pain wasn’t immediate. In fact, I had some other drama going on in my life that it was necessary for me to step it up and do things (like move boxes) pushing pass pain. That 7 day stretch pushing past my limitations came to a screaming holt when the sciatica nerve decide to introduce it’s self! I’ve been receiving massage therapy once a week, Chiropractic care (2 to 3 days a week traction)…and very limited activity for the last 4 weeks. The nerve has calmed down and I want to start some moderate stretches. My Chiropractor tells me to wait it out and start with walking on the treadmill. If I can tolerate 10 minutes of moderate walking without pain, then “maybe” I can proceed.

    I want to regain range of motion, especially. To do the simplest stretch such as the sitting one with my leg crossed over the other there is discomfort in my thigh muscle because the muscle is too tight and I look like I am attempting to put my knee to my chest. LOL (laugh out loud).

    Question I have for you. Is it better to ice/heat after stretching?

    • Dr Ken Nakamura says:
      March 14, 2017 at 11:23 am

      Thanks for your question Chelrae. I think it’s important to start exercises that will push the disc back in right away so, I obviously have a different opinion.

      Hope that helps your sciatica. Keep in mind I haven’t examined you so I am giving you an opinion without all the information.

  • LesSens says:
    March 10, 2017 at 12:05 am

    Hi Ken,
    I am a 35 year old very active women. I have been experience low back pain for 1 year now and finally got an MRI in November. The imaging result show a disc herniation oat L5-S1. I saw a Chiro right away and these are the steps he suggested for me to follow (I have only followed his recommendations and nothing more):

    Step 1: I was on bed rest for 3 weeks
    Step 2: I started doing a lot of extension exercises (cobra pose) for three weeks and incorporation 60min of walking (in total) every day (avoiding flexion and sitting)
    Step 3: I stated doing VERY VERY light yoga for two weeks and increasing working and sitting duration
    Step 4: I got a set back – the pain was very strong again and couldn’t walk for a few days
    Step 5: I stopped all exercises and all activity for two weeks. I barely sit – I try to lay down on hard surfaces as much as I can.

    I recently saw my MD and he said that I have gained a bit of motor strength but still have mild sciatica (L5-S1 disc herniation). He wants me to continue with light yoga and exercise and massage therapy… he said that the pain might stay with me for another year. Is that TRUE????

    I dont know what to do now. I still have pain in my buttocks as if some muscles were about to tear. Can you please inform me of next steps? how long will this pain last? I am finding it really hard to be immobile. I need to start my active lifestyle again – I have gained so much weight and feel horrible.

    Can you please guide my recovery a little bit? I will follow your lead.
    Thank you for your time.

    • Dr Ken Nakamura says:
      March 10, 2017 at 10:15 am

      Thanks for your question LesSens or Lessons in French. It shouldn’t take you a year to get better. Likely your MD is saying that as others this bad have taken that long. Light Yoga usually makes someone better and worse but usually overall worse unless the exercises are tailored to that person. If you are taking group classes that could be the problem.

      These are all safe exercises except the cobra, which can cause a problem. If it does then you need to have them modified. You can get the other chiropractor to modify it for you as I cannot see how you are reacting. http://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/

      This is an opinion a not a recommendation. If you have any more questions for this downtown Toronto chiropractor I will do my best to answer them for you.

      Hope that helps your sciatica

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