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


557 Responses to Sciatica: The 4 Best Exercises For People With Sciatica
  • M R VENKATESH says:
    January 9, 2018 at 5:37 pm

    Hi Dr. Ken,

    after trying various physiotherapy at different hospitals, wearing Lumbar support belt, and later accupuncture, and now recently i am taking ayurvedic and sidha medicines combined with verma treatment. By Verma treatment i had some relief for the lower back pain cause due to disc bulge of L4/L5 and L5/S1.

    I am able to walk, dance, run, but when i sit continuously for more than 15 mins, my pelvic region slowly develops a heated effect and also i am having nerve paint travelling all through from my right buttock to my legs. But no numbness.

    Recently i am feeling such pain in my back leg. Tired of all this, i went to my school yoga master.

    Kindly suggest me, the best thing that can be done to maintain the pain level to less with some exercise and stretches.

    • Dr Ken Nakamura says:
      January 24, 2018 at 7:02 am

      Thanks for your question Venkatesh. Try these exercises first and see you how you do. This is an opinion and not a recommendation.

      Hope that helps your sciatica.

  • fouzi says:
    December 9, 2017 at 4:22 am

    hello doc i had a herniated disk l4-l5 i have wrote you before i think 1 year ago about sciatica pain it had went away but this summer i went to the pool and jumped so many time , dived thus it came back and the pain is so bad now it has been 5 or 6 monthes since it came back and da pain cant go away from my right leg i have lost mobility and flexibelity any advice doctor i want to go back to normale activities so bad i feel like its holding me back from doing any sport .plz help and thnx for being there for me .

  • Casi says:
    September 26, 2017 at 3:29 am

    Hello Dr,

    Thank you for your recommendations; they are very helpful.

    I did something seemingly innocent this past July then heard (and felt) 2 pops inside my body then the immediate constant sciatica started. Felt like the nerve was on fire and nothing would calm it down. Could not put the left foot on the ground or sit to drive but experienced no back pain. MRI showed a 7 mm caudally directed broad based herniation at L5 S1 and a small herniation at L4 L5. The 7 mm herniation is pressing on both left and right S1 nerve roots but only the left side had severe sciatic spasms. I should state that I had a laminectomy at L5 S1 20+ years ago which was successful.

    While I was waiting on revision surgery to address my sciatica, I took your advice and immediately did lots of extension exercises. I also refused to sit for approx 4 weeks but I walked every day. By the time of my surgery, my symptoms had improved so much that the surgery was postponed/cancelled. I returned to work with minimal pain and PT once a week. Everything was going great and recently…

    Recently, I noticed that one leg seemed longer than the other and that I experienced more nerve ‘throbs and tingles’ than normal during the night time. Then it happened… I woke up one morning and upon standing straight and moving my hips to remove my pj bottoms, felt a sharp, running jolt of sciatica in my left hip area. The only diffeence between this pain and the pain from July was that this pain was limited to the buttocks, hip, upper thigh whereas the previous jolt ran straight down to my toes. Also this new pain vanished after 10 seconds and the previous pain was a constant spasm. I also noticed that all of the exercises that had helped my herniated disk seemed not to help this time: back extensions hurt, walking hurt, etc. Oh, and I noticed that I could re-create the sharp nerve pain in my left hip by kneeling on my right knee while using my right knee to push up from a lunge.

    Is it possible that this latest pain is from something other than the herniated disks? The sciatic pain seems both the same (same nerve, same type of pain) and different (different location, different response to exercises).

    Btw, I used to get my SI joints adjusted by my chiropractor in the past but I am not allowed to get adjustments right now due to the herniated disks right above the area.

    Could this new ‘sciatica’ be from a source other than the herniated disk at L5 S1? What are your thoughts?

    Thank you for your help

    • Dr Ken Nakamura says:
      September 26, 2017 at 9:20 pm

      Thanks for your question Casi. It is very likely the same disc pushed out in a different direction. Discs move once they are weakened, that’s why they herniate in the first place. You will have to find a different physiotherapist or chiropractor that can determine how the disc is herniated or if it is another disc.

      Also, it’s nonsense that you cannot get lower back adjustments. The only thing is the chiropractor has to really know what they are doing. I treat people with disc herniations all the time with adjustments. However, you have to test the direction of the disc. Once tested and you are gentle I don’t have people getting worse. I have the odd person that gets sore for a day or two but they are better afterwards. I do this 10-15 times a day just for the lower back. So, I believe that your surgeon is speaking about patients’with reactions and discs that have been aggravated by chiropractors that are not doing the proper testing and simply adjusting people the same way as a formula or cookbook chiropractic. The surgeon has no way of knowing which chiropractor is being diligent and which is taking the time to determine the direction of the disc.

      Also possible is stenosis depending on age but not likely as extension helped you a short time ago.

      The above is an opinion and not a recommendation. Hope that helps your cervical disc herniation. If you have any more questions for this chiropractor from downtown Toronto I will do my best absolute best to give you a helpful answer.

      • Casi says:
        September 29, 2017 at 8:06 am

        Thanks for your recommendation. Its hard to find a chiropractor here who is willing to adjust my lower back due to the herniation. I’ve got one who is willing to use the Activator only (no hands on) but thats about it…

        Unfortunately, I dont know in what direction the disk is moving. The herniation as shown on mri is pretty much straight back and broad.

        Regarding the latest flare up, it appears that I had sacroilitis; prednisone knocked the inflammation down enough so that I could start McKenzie extensions again. It makes sense that the disk might have moved. Is it possible that inflammation of the joints spread to the L5-S1 nerve (which was already compressed)? They are in close proximity, correct? I guess I could have also caused the disk to move by trying to compensate my movements due to the locked SI joint. I know that I was walking ‘funny’ days prior to this episode due to hip lock up.

        • Dr Ken Nakamura says:
          September 30, 2017 at 9:10 pm

          That’s great that the inflammation has gone down enough that you can do the McKenzie exercises again. The disc and nerve roots from L5S1 are close but the SI is some distance away. Either way, the point is that you are better and now you know you get inflamed so you might look at foods that are more anti-inflammatory but more importantly avoid the inflammatory foods. Like more fish, less meat, more vegetables, fruit, seeds etc…

          Hope that helps your sciatica.

  • robert says:
    August 26, 2017 at 1:50 am

    spinal stenosis………….why not go into more detail……….my canal is narrowing….why………how do I get it to open………….if its rare ……what did I do to get it…………..mri ,,L5……..accupuncure has helped

    • Dr Ken Nakamura says:
      September 5, 2017 at 7:38 am

      Thanks for your question Robert. I am assuming you are saying you have spinal stenosis and asking how you open your canals with exercises. I have to assume as there is lack of details.
      Here are some exercises in the link below that helps spinal stenosis.
      https://www.bodiempowerment.com/spinal-stenosis-exercises-help-walk-longer/

      How did you get this? Well, it’s usually due to extensive degeneration of the spine. You probably didn’t do anything although some people have been in severe motor vehicle accidents.

      Hope that helps your sciatica and spinal stenosis. If you have any more questions for this downtown Toronto chiropractor I will do my best to help. Keep in my the above is an opinion and not a recommendation.

  • Karishma says:
    August 9, 2017 at 3:10 am

    Hi,
    I have been experiencing bad sciatica pain from the past 6 weeks. The pain subsided for two weeks in between but then i travelled in car and the pain started again. I have a pain in my buttocks that feels like a bruise and the pain seems to radiate from my buttock only. I do not have lower back pain. Is the herniated disk causing problem or it could be periformis syndrome?? Please suggest.

    • Dr Ken Nakamura says:
      August 10, 2017 at 6:54 pm

      Thanks for your question Karishma. You need to give much more details of your symptoms for me to give you an opinion.

  • Linda pizzolla says:
    July 25, 2017 at 3:46 am

    Hello doctor,
    I have had sciatic leg pain for years on and off.

    Now it has become chronic and unbearable when I walk.
    An MRI showed, among other things, nerve impingement on the L2 nerve. Gabapentin does not work. I have had epidural s and tried acupuncture. I just started physical therapy. Nothing seems to work and my thigh hurts terribly when I walk. What else can I do? Is surgery a safe and effective alternative?
    Thank you,
    Linda

    • Dr Ken Nakamura says:
      July 25, 2017 at 9:19 pm

      Thanks for your question Linda. Surgery is effective some of the time but over a 10 year period, research has shown that people that have had surgery and those that have not are pretty much in the same situation 10 years later. Better with occasional recurrences. Give physical therapy a chance. At least 8 visits over a month. If you go twice and say it doesn’t work that really doesn’t say anything about the effectiveness of the therapy. Next, try chiropractic treatment.

      Hope that helps your sciatica. This is an opinion and not a recommendation. If you have any more questions for this downtown Toronto chiropractor I will do my best to give you a good answer.

  • Anup Pradhan says:
    July 17, 2017 at 4:55 pm

    hello sir, I am having pain in back, buttock and leg probably since 08 week in my right side i did my mri and dr. said disc herniation in l4-l5 compressing nerve root and bulging disc l5-s1 with no neural compromise. I did my physiotherapy almost 08 round and doing light exercise as per physio therapist suggestion. But my pain is getting worse especially in the morning. Please do suggest me some exercise for l4l-l5 disc herniation. And tell me what would i do for pain relief and recover

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