Sciatica exercises

Sciatica is a commonly used term for pain originating from the back that is felt along one of
several nerve distributions in the buttock, hip, thigh, leg, ankle or foot. Sciatica involves
compression or irritation of one or more nerves exiting the lower spine that make up the
sciatic nerve. The sciatic nerve branches off as it travels down the lower extremity, and thus
pain can be experienced along this route.
A physical therapist, certified athletic trainer (ATC, or other spine specialist who treats the
back pain and leg pain associated with sciatica may recommend exercise as part of a
treatment program. The specific exercises recommended will depend on the cause of the
sciatica.
The ma!or causes of sciatica include"
Sciatica from a herniated disc
Sciatica from spinal stenosis
#t is not !ust something to add to the routine at the end of the day. #t is recommended that
everyone consults with a physician or physical therapist prior to beginning any exercise
program.
Fig 1: Rise up on elbows, keeping hips on floor.
Fig 2: Press up on hands slowly, keeping hips in contact with floor. Relax low back and
buttocks.
Fig 3: Standing backward bend.
$ith hands on hips and knees slightly bent, arch back slowly and slightly.
Fig 4: Clasp hands behind back and lift hands and chest slightly off floor, keeping chin
tucked.
Fig 5: With knee straight, raise one leg and opposite arm 2- inches off floor.
Fig 6: !old arms across chest, flatten back by tightening lower abs, and raise head and
shoulders from floor.
Fig 7: "ighten lower abs to flatten back, slowly raise straight leg #-$2 inches off floor.
Sciatica from a herniated disc
%erniated discs commonly involve disk material protruding backwards and irritating or
compressing a nerve root.
See &verview of lumbar disc herniation
See #nteractive spine animation ' lumbar disc herniation
(xercises to treat this condition are prescribed according to which positions will cause the
symptoms to move up the lower extremity and into the low back.
)or many patients, this is accomplished by getting into a backwards bending position.
The low back is gently placed into extension by lying on the stomach (prone position
and propping the upper body up on the elbows, keeping hips on the floor ()igure *.
This should be started slowly, since some patients can not tolerate this position
initially.
This position is typically held from five to +, seconds per repetition, for *, repetitions.
After practicing this exercise, the spine specialist may recommend a more advanced form of
the extension"
)rom the prone position, press up on the hands while the pelvis remains in contact
with the floor ()igure -.
This position is typically held for * second, repeated *, times.
A similar exercise can be done standing by arching backward slowly with hands on hips if the
patient is unable to lie flat ()igure +. %owever, the prone position is usually preferred.
These .extension/ exercises are done regularly, about every two hours. 0ore importantly, the
spine specialist may recommend that the person with this condition should avoid getting into a
forward flexed (bent over position. This tends to counteract the effects of the extension
exercises. The specialists may ask the patient to correct forward flexed positions immediately
with an extension exercise.
As the pain works out of the lower extremity, the exercises typically are advanced to
strengthen the low back and abdominal muscles to prevent recurrences of the condition. To
strengthen the low back muscles"
#n the prone position and hands clasped behind the lower back, raise the head and
chest slightly against gravity ()igure 1 while looking at the floor (stay low.
#n the prone position with the head and chest
lowere1111111111x111111x111111/11111111111111/1111112%11111 111111
111111111111311 11x111111/111111x111
1 1 1 1 1 1 1 111111111111111111111114444444441111111111111113
11111145111111 11111 111111116 11-711,
11x111111x11111111111111111111111111111111111111111111111111111111111
11185111111/111111911
::: ;<o=> ::::::::
?@::::::A::.
:::b(:: : g% : : : : ::B(::C::D9::::::E:::::D9::%:::85::::::::::::::F::::
::F::::::x::::::x::::::x::::::x::::::::::::::::::::::D9:::::::::::::
:x::::::85:: :::/::G:::H:::::
::
::
::I::J:::K::J:::::::::::::::::::::::::::::::::::/::::::/::::::/::::::
%LLLLLL
%&&&&&&'&&&&&&'&&(&&p&& & & ' & & & &&&p)&&&&&&&
&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&MMM&7777777&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&
Fig 9: !rom all fours, sit back on heels keeping hands in place.
Fig 10: "ighten lower stomach muscles and buttocks to flatten back.
Fig 11: "ighten lower stomach muscles and raise one leg slowly -* inches from floor.
Fig 6: !old arms across chest, flatten back by tightening lower abs, and raise head and
shoulders from floor.
Sciatica from spinal stenosis
Spinal stenosis can also cause nerve root irritation or impingement through a narrowing of the
nerveNs passageway.
See &verview of lumbar spinal stenosis
See #nteractive spine animation ' spinal stenosis
$hen treating stenosis, the spine specialist may encourage flexion exercises. )lexing the lower
spine increases the siOe of these passageways and allows the irritation or impingement to
resolve.
This is accomplished by stretching the muscles of the back that hold the spine in extension
(backwards bending and strengthen the muscles that bring the spine into flexion (forward
bending.
Stretches for the low back extensors are typically held lightly for +, seconds.
9ay on the back and gently pull the knees to the chest until a comfortable stretch is
felt ()igure P.
)rom all fours, sit back on the heels with the chest down and arms outstretched
()igure Q.
Strengthening exercises for the lower abdominal muscles"
9ay on the back and press the low back into the floor by tightening the lower stomach
muscles ()igure *,, hold for *, seconds.
)or a more advanced exercise, hold this position while marching in place in the hookR
lying position, slowly raising alternate legs + to 1 inches from the floor ()igure **.
CurlRups ()igure L may be recommended by the specialists here as well.
These exercises alone will not necessarily make the patient better, but they will allow the
patient to more easily hold a posterior pelvic tilt during activities, especially standing and
walking. This posture will allow the patient to perform more activities with less pain. The pelvic
tilt is often very difficult for patients to learn and can take a good deal of practice with the
guidance of a physical therapist before it is used effectively.

Fig 11: "ighten lower stomach muscles and raise one leg slowly -* inches from floor.
)ig *-" !latten back to floor, then slowly raise one leg while lowering the opposite arm.
Fig 13: With arms to sides, tighten lower abs and slowly raise buttocks off floor.
Fig 10: "ighten lower stomach muscles and buttocks to flatten back.
)ig *1" +eep leg straight and lift leg 2- inches off floor.
Fig 5: With knee straight, raise one leg and opposite arm 2- inches off floor.
)ig *:" Raise one leg behind with knee slightly bent, keeping neck and back straight.
)ig *L" Raise one leg and opposite arm,with knee slightly bent,keeping neck and back
straight.
Sciatica from degenerative disc disease
7egenerative disk disease can also cause a form of sciatica.
See &verview of lumbar degenerative disc disease
The form of exercise typically recommended for treating disc degeneration is a dynamic
lumbar stabiliOation program. This includes finding the most comfortable position for the
lumbar spine and pelvis and training the body to maintain this position during activities. #n
doing this correctly, one can improve the proprioception (sense of movement of the lumbar
spine and reduce the excess motion at the spinal segments. This will in turn reduce the
amount of irritation at these segments, relieving pain and protecting the area from further
damage.
These exercises often reSuire specific handsRon instruction because they offer much less
benefit if done incorrectly, and they tend to be much more difficult than they appear. This type
of program is progressive, starting with the easier exercises and advancing to the more
difficult exercises once the first lower level program is mastered. The most important aspect is
sensing and controlling motion in the spine. &nce learned, the body can eventually take over
and do this without the level of concentration it takes early on.
(xamples of these stabiliOing exercises done while on the back include"
%ookRlying march, with knees bent, arms at sides, tighten stomach muscles and slowly
raise alternate legs +R1 inches from the floor ()igure **.
%ookRlying march with arms, lowering the opposite arm over the head ()igure *-.
Tridging from a back lying position with knees bent, slowly raising the buttocks from
the floor ()igure *+.
These should all be performed with a rigid trunk. The pelvic tilt ()igure *, will be used to find
the most comfortable position for the low back.
This same pelvic position is maintained while performing stabiliOing exercises from the prone
(on the stomach) position"
$ith elbows bent and hands under the shoulders, raise one leg - to + inches from the
floor ()igure *1
$ith elbows straight and arms stretched about the head, raise an arm and the
opposite leg - to + inches off the floor ()igure :.
Similar exercises can be done in the 1Rpoint position (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"
Uaise one leg behind with the knee slightly bent and no arch in the back or neck
()igure *:
Uaise one leg with the opposite arm with the knee slightly bent and no arch in the
back or neck ()igure *L.
Fig 10: "ighten lower stomach muscles and buttocks to flatten back.
Fig 6: !old arms across chest, flatten back by tightening lower abs, and raise head and
shoulders from floor.
Fig 11: "ighten lower stomach muscles and raise one leg slowly -* inches from floor.
)ig *-" !latten back to floor, then slowly raise one leg while lowering the opposite arm.
Sciatica from isthmic spondylolisthesis
#sthmic spondylolisthesis can cause nerve root irritation or impingement.
See &verview of isthmic spondylolisthesis
See #nteractive spine animation ' spondylolisthesis
#sthmic spondylolisthesis is typically treated with a program that is a hybrid of the flexion
based exercises (as in stenosis and the stabiliOation program (as in degenerative disk
disease. The goal of this method is to teach the lumbar spine to remain stable in a flexed
position. Therefore, the exercises are a combination of both programs.
Specialists treating patients with spondylolisthesis freSuently recommend the pelvic tilt
()igure *,, as it will hold the lower spine in the flexed position. 9ay on the back with
knees bent and flatten the back by tightening the lower stomach muscles.
Strengthening the abdominals with the curlRups ()igure L will also help maintain a
proper lower spine position. 9ay on the back with knees bent, fold arms across the
chest, tilt the pelvis to flatten the back, and curlRup lifting the head and shoulders
from the floor. 7o not attempt to lift too high, and bring the head and chest towards
the ceiling. )or patients with neck pain, place the hands behind the head.
The hookRlying marching ()igure ** and hookRlying combination ()igure *- are again
useful here as well.
)ig *M" -upport back of thigh with both hands and slowly straighten knee to feel a stretch
in back of thigh.
amstring stretching
Another important consideration is hamstring stretching. The hamstrings are muscles located
in the back of the thigh. They help bend the knee and extend the hip.
Tightness in the hamstrings will place increased stress on the low back, aggravating or even
causing low back pain. 0ost patients with back pain will benefit from hamstring stretching by
lying on the back and supporting the thigh behind the knee, slowly straighten the knee until a
stretch is felt in the back of the thigh, trying to get the bottom of the foot to face the ceiling,
one leg at a time ()igure *M.
!y: "on S. #iller$ %&
7ecember *1, -,,, (Vpdated &ctober Q, -,,*