As a physiotherapist, it’s a common occurrence to have someone walk into my office and tell me they have sciatica. Somehow ‘sciatica,’ the medical term for pain caused by the sciatic nerve, became an umbrella term for any pain that travels down the back of the leg. In actuality, several different body structures or tissues can cause pain to refer down the leg, not just the sciatic nerve. The problem is they all require different, often opposite, treatment. If you are experiencing leg pain and decide to Google ‘exercises for sciatica’ you can easily end up with exercises for the wrong diagnosis, and make your problem worse. Here are 5 distinctly different causes of sciatica pain patterns, and how to decide which exercises for sciatica are right for you.
1. Sciatic Nerve. Let’s start with something familiar, the sciatic nerve. This is a large nerve that starts in your buttocks and runs down the back of the leg.
Sciatic nerve pain is extremely intense, and can include: numbness, tingling, pins and needles, weakness, loss of sensation, or any combination of these symptoms.
Treatment for sciatica will depend on what’s causing the nerve irritation. Typically, nerves get irritated because they have or had to much compression. Treatment will depend on what caused the compression and this can be tricky to distinguish. If you have nerve irritation of any kind it is best to consult a knowledgeable physiotherapist to get the best combination of treatment and exercises to resolve the issue.
Here is one common exercise for nerve irritation called nerve flossing:
Lay on your back and bring the knee of your affected side towards your chest. Hold your foot flexed while you bend and straighten your knee as much as possible without causing pain or other symptoms. Do 15 reps slowly and smoothly with no holds. Repeat 2-5 times per day.
Note: This exercise is meant to be done pain free. If it causes the pain or numbness in your leg to be exaggerated, stop the exercise and discuss it with your physiotherapist.
2. Facet Joints. Facet joints are small spinal joints where two vertebrae meet. In your lower back these are called lumbar facet joints. These joints can get injured in a number of ways, often from forced compression or too much load which jams the joint surfaces together. When lumbar facet joints get irritated they can refer pain into the gluts, hips, and occasionally down the legs.
These injuries usually have a directional preference for exercises and reliving positions. In this case it is usually flexion-based or ‘joint-opening’ exercises. You can find relief by using flexion-based bending exercises to take the pressure of the irritated joint surfaces. Here is one example of a gentle flexion based exercise:
Lay on your back and bring both knees to your chest. Hold 30 to 60 seconds. Repeat 2 -5 times per day.
Note: This exercise should always relieve symptoms, never exacerbate them. If you find this exercise is making your pain or symptoms worse you may have a wrong or incomplete diagnosis. Stop the exercise and consult your physiotherapist.
3. Sacroiliac Joints (SIJ). The SIJ are a pair of joints that are part of your pelvis. The pain associated with these joints are most commonly found in the lower back and pelvis, but can refer all the way down your leg and into your foot.
Treatment for this joint commonly involves mobilizing the joint to create good movement, and core exercises to stabilize it. One exercise to mobilize the SIJ goes like this:
Place the foot of your affected side on a chair. Rock your hips forward and back into a lunge while keeping your body upright. Repeat this 15-20 times as a slow, rhythmical movement.
This exercise should be done every hour or two to keep the joint moving. Do not perform this exercise through pain. It should be relieving or neutral, but not irritate your symptoms.
If the SIJ is inflamed it can be very tricky to find the right combination of treatments to settle it down. Once again it is best to consult a physiotherapist.
4. Muscles. All muscles in the body can have painful tense spots called trigger points. Trigger points are hyper-irritable muscle fibres that have a problem with their neuromuscular system (the neuromuscular system is basically the connections between your brain, nerves, and muscles to create movement). Trigger points commonly have referral patterns associated with them. As you might have already guessed, the muscles of the low back and hips commonly refer pain into your bum, down the back or side of your leg, and commonly into the foot.
It often surprises people to learn their leg pain is caused by muscle irritation as they don’t realize a muscle injury can be so debilitating. If you have muscle trigger point pain, you will benefit from rolling. Here is how to roll your glut muscles.
Sit on the floor with your knees bent and your affected side on a small sports ball (tennis ball or lacrosse ball will do). Find the sore spot and stay stationary on it for 15-20 seconds. Move only slightly and repeat. Do not roll sporadically on the ball. Do this for 1-5 minutes every day or every second day.
Make sure not to ‘over-roll’ a trigger point. There is a difference between rolling a trigger point and rolling an inflamed muscle. The former feels more like an intense but reliving pain and you should feel better when finished. The latter feels more like you are pressing on a bruise and can actually increase your pain. If you feel you have over-rolled a muscle, take a few days off rolling and consult your physiotherapist to review rolling technique and revisit your diagnosis.
5. Discs. Intervertebral discs are the donut looking structures that are stacked between each vertebrae to make up your spinal column. Injuries to these structures involve tearing, bulging or ruptures to the outer fibers of the disc.
These injuries can result in pain down one or both legs. Disc injuries also tend to have an extension directional preference. You can use this preference to treat the injury and alleviate symptoms.
Lay on your stomach, keeping your back relaxed do a mini push-up using just your arms. Hold for 1-2 seconds, and repeat 10 times every few hours. Do not push through pain. This exercise should always be relieving. If you are experiencing pain while doing this exercise, stop and consult a physiotherapist before continuing.
It takes quite a bit of knowledge and clinical experience to differentiate between causes of leg pain and prescribe the correct treatment. The exercises given for one person with leg pain referral might be the exact opposite for another, despite there being a similar pain pattern. Choosing the wrong treatment for leg pain can not only worsen your pain, but prolong the agony. So don’t rely on Google to tell you how to resolve your sciatica pain. Consult a local physiotherapist to help you decide what treatment is right for you.