How to Treat Sciatica

Man experiencing sciatica pain, holding his lower back and grimacing.

Pain caused by pinching of the sciatic nerve can cause sharp, burning, intense pain that, at times, feels hard to alleviate. This article will explore sciatica, what may be causing it, and possible treatment options.

What is the Sciatic Nerve?

The sciatic nerve is the largest nerve in the body. It is formed from nerve roots that come from the lumbar spine (L4, L5) and sacrum (S1,S2, S3).²

These nerve roots come together to form the sciatic nerve, which is actually compromised of two main components- the tibial nerve and the common peroneal nerve.

The sciatic nerve travels through the pelvis at the greater sciatic notch and down the back of the hip (buttocks). It runs underneath a muscle called the Piriformis. The sciatic nerve continues down the back of the thigh. Towards the lower third of the thigh, the nerve divides into the tibial and common peroneal nerves, which innervate muscles of the lower leg.

What is Sciatica?

Woman experiencing sciatica sitting at a desk.

Sciatica is caused by irritation of the sciatic nerve, which is usually caused by a condition of the discs or vertebrae in the spine.^1,2

It is commonly associated with pain that runs down the back (posterior) side of a leg.

Pain may be sharp or dull, and numbness/tingling may or may not occur.

Sciatica pain generally worsens following bouts of prolonged sitting.

While sciatica is often self-treated, it’s important to know that if you experience severe symptoms, including loss of bowel and bladder function, it’s necessary to go to your primary care provider, as you may need surgery.^1,3

What Causes Sciatic Nerve Pain?

Disc Herniation

Disc herniation is the most common cause of sciatica.³

Think of a disc like a jelly donut. There’s a gel-like substance in the middle and then the outer layers form a wall to keep the gel inside.

The vertebrae put pressure on the discs, and overtime, or with injury, the outer layers weaken. So when pressure is applied to the disc, the jelly pushes against the weakened outer layers, causing a “bulge” or herniation of the disc.³

A herniation in the low back where the sciatic nerve originates can press on the sciatic nerve and cause pain.

Bone Spurs

Another fairly common cause is osteoarthritis (OA), which can cause bone spurs.

Bone spurs, or “osteophytes”, occur due to the rubbing of bone against bone after the smooth cartilage layer is worn down. The bone is trying to repair the cartilage, but can’t, so bone growth occurs instead.⁴

Another form of arthritis is called Degenerative Disc Disease (DDD), which is a decrease in height and supportive function of the discs, can also cause sciatica and/or the formation of bone spurs, due to less cushion between the vertebrae, allowing for the bones to rub.³

While the word “spur” triggers the image of something sharp, a bone spur is actually a round, smoother growth of bone. However, just because it isn’t sharp, doesn’t mean it can’t cause pain.

Like a disc herniation, bone spurs can encroach upon the space nerves have to travel through the vertebrae, which essentially “pinch” the nerve. Bone spurs can also lead to spinal stenosis, which is the narrowing of the spinal canal (where the spinal cord lives), which also decreases the space the nerves can travel through.³

What About Piriformis Syndrome?

Man seated at disk having pain in his buttocks region, possibly due to piriformis syndrome.

Piriformis syndrome occurs when the sciatic nerve is irritated by the piriformis muscle. The general idea is that the piriformis “clamps down” on the nerve as it runs beneath the muscle, causing pain.

While it seems logical, and technically is possible, piriformis syndrome is actually rare.⁵

It’s much more likely that the pain in the leg is actually coming from the back. While it’s okay to still stretch the muscles in the back of the hip (including piriformis), it’s likely that sciatica symptoms won’t improve if the actual cause isn’t addressed.

Since disorders of the back are the most common causes, this article will focus on treatment methods that strengthen the core muscles, including those of the back, to help alleviate sciatica pain.

Treatment Approaches for Sciatica

The tricky thing with sciatica pain is the treatment approach is dependent on the origin.

For example, if you’re having sciatica pain as a result of stenosis, you will want to focus on the flexion and neutral spine exercises below.

If you’re having sciatica pain as a result of a disc herniation/bulge, you will want to focus on the extension and neutral spine exercises below.

How do you know? Well, you really should get evaluated by a physical therapist to know for sure.

In general, if your pain is eased by sitting, leaning forward, or bringing your knees towards your chest while lying on your back, you may be experiencing discomfort from stenosis/arthritis/bone spurs.

If your pain feels better lying down (particularly lying on your abdomen), or when you walk, and gets aggravated sitting up for extended amount of time, or when you bend down, you may be experiencing discomfort from a disc herniation/bulge.

Remember! It’s important to see your physical therapist before starting any exercise routine to ensure you’re doing the right ones for your body!

Click HERE for a video of Dr. Katie Landier, PT, DPT, Geriatric Specialist demonstrating all of the exercises.

Neutral Spine Exercises for Sciatica

Finding Neutral Spine

The base of our spine is our pelvis. Most of us live in either an anterior tilt of the pelvis (low back is more arched) or a posterior tilt of the pelvis (low back is more rounded).

Our spine actually functions better with a neutral pelvis. Since the pelvis is the base of the spine, a neutral spine produces a neutral pelvis.

You can find neutral spine in standing, seated, and lying on your back. I recommended trying to find neutral throughout the day- while you’re brushing your teeth, waiting for the coffee to brew, driving, walking in the grocery store, etc.

The key is that we want to be able to find neutral spine and move/live in neutral spine, but it takes time to make this new position a natural habit, so practice it!

The following instructions are for finding neutral in supine (on your back). However, this can be applied to all positions.

Lie on your back with your knees bent, feet on the floor.
Place your hands on your hips and your index and middle fingers on the front of the hip bones.
Imagine you’re laying in the middle of a clock. Twelve is in front of you, and six is behind you.
Rock your pelvis forward toward twelve o’clock (this may feel like you’re arching your back. You ideally want this motion to come from the pelvis, not the back or the legs, but it will take some time and practice).
Now rock your pelvis backward toward six o’clock (this may feel like you’re flattening your back towards the mat/floor).
Repeat this rock from 12 to 6 a few times.
Then relax. Your pelvis should be in a position that’s in between 12 and 6 o’clock. This is neutral spine.
You should feel that it’s not a lot of effort, but some muscles may be turned on that you’re not used to feeling. Also, your abdominals should kick on too.

Modified Dead Bug

A Dead Bug exercise promotes abdominal strength. The modified version uses a stable surface to help support the legs.

This is a good idea if you’re experiencing pain, as lifting the legs requires a lot of abdominal and low back strength. Using a stable surface will help to ensure the form is correct, which will help decrease pain and increase strength.

Lay on your back in front of a couch/bed/table (any surface you can put your legs up on, so your hips are about at 90 degrees).
Find neutral spine alignment.
Keeping neutral spine, lift one leg on to your surface, then the other.
Slide right heel away from you, keeping your hips level and maintaining neutral spine (if you feel your back moving, don’t slide the heel as far).
Slide the right heel back to the starting position.
Slide the left heel away from you, keeping your hips level and maintaining neutral spine (if you feel your back moving, don’t slide the heel as far).
Slide the left heel back to the starting position.
Perform 4-6 repetitions on each leg.
Rest for 1-3 minutes.
Perform 3 sets total.

Hamstring Curls

Hamstring strength is really important to back health, because the hamstrings attach to the pelvis.

Many of us don’t properly work the hamstrings, so they often become weak and tight, which can cause unwanted pull on the hips.

Lie down on your back on a mat with left knee bent, foot on the floor, and a ball under your right heel.
Find neutral spine.
Dig your right heel into the ball as your bend your knees, bringing the ball towards your bottom.
Straighten your right leg, rolling the ball away from you.
Perform 6-8 repetitions.
Repeat on left side.
Rest as needed.
Repeat for a total of 3 sets.

Push Ups

One of my favorite exercises is push ups. That is because they can be modified to fit many different fitness levels and rehab needs!

The following are triceps push ups, which work the back of the arms, as well as force the abdominal and back muscles to stabilize, thus making push ups a full body exercise!

Get down to all fours on a mat.
Place hands under shoulders, knees under hips.
Find neutral spine (make sure your back isn’t arched or rounded, and your belly button is floating up to support your spine).
Bend the elbows, keeping elbows narrow, pointed towards your thighs.
Imagine you are trying to touch your forehead between your hands (like a bow motion).**Elbows won’t touch the ground but you want to feel the work in the back of the arm**
Straighten elbows.
Repeat 5-10 times.
Rest for 1-3 minutes.
Complete 3 sets.

Extension Exercises for Sciatica

Bridges

Bridges promote strength in the whole back of the body- back extensors, hip extensors, and knee and ankle stabilizers.

Make sure you’re not “rolling” your spine into the bridge. This ensures the exercise is extension focused. Rather, keep your back flat and lift the hips towards the ceiling.

Lie on your back with knees bent, feet on the floor/stable surface.
Pressing into your feet, lift your hips off the floor/stable surface.
Slowly lower hips back down.
Repeat 8-10 times.
Rest for 1-3 minutes.
Complete 3 sets.

Swan

Swan is an exercise to help increase strength in the back extensors as well as the abdominal muscles.

You can also do a smaller version, called “Mini Swan.” Instead of pressing away from the floor on the hands, you can press away using your forearms.

With Swan or Mini Swan, you want to focus on feeling length in the low back, rather than a crunchy sensation. You may feel some discomfort if you have a disc bulge. A little discomfort is okay, but if the pain is intense or causing additional symptoms, like tingling/numbness, decrease your range of motion. You can increase the range as your back gets stronger.

This exercise recruits a lot of muscles that likely haven’t been activated consistently. So it’s definitely some work, but it will help improve your back strength and health.

Lay on your abdomen (on a mat or padded surface) with hands under shoulders.
Float your belly button away from the mat.
Use your back muscles to lift your chest off the mat (only as much as you can), keeping your eye-line down towards the floor to protect your neck.
Press through your hands to lift further from the mat.
Check in with your belly button- make sure it’s still floating towards your spine.
Take 3 deep breaths, making sure shoulders are away from the ears.
Slowly lower yourself towards the mat.
Repeat 3-5 times.

Flexion Exercises for Sciatica

When it comes to arthritis or stenosis, flexing the spine helps to open up the spine. This reduces the pressure on the nerves that is caused by the arthritis. The following exercises help to alleviate discomfort with flexed positions.

It’s important if you have stenosis/arthritis to complete the neutral spine exercises as well. Those exercises will help more with strengthening, whereas these exercises will provide more temporary relief.

Single Knee to Chest

Lie on your back on a mat, couch, bed, etc.
Keep your left leg straight.
Bend your right knee towards your chest.
Place your hands under your thigh to support your leg under the knee.
Check in with your hips. Make sure you’re not rotating or twisting. Hips should be level.
Hold for 30 seconds.
Repeat on left side.
Complete 3 times on each side.

Double Knee to Chest

Lie on your back on a mat, couch, bed, etc.
Bend both knees in towards your chest (you can lift them one at a time to decrease stress on the back).
Place your hands under your thighs to support your legs under the knees.
Check in with your hips. Make sure you’re not rotating or twisting. Hips should be level.
Relax your shoulders so you’re not overworking your upper body. This should feel relaxing.
Hold for 30 seconds.
Lower one leg and then the other down to the mat.
Take a 30 second rest.
Complete 3 sets total.

Cat

Start on all fours.
Find neutral spine.
Imagine your tailbone is heavy and allow it to round down towards the floor.
As your tailbone rounds, allow your spine to round as well.
Look at your belly button to get a deep scoop sensation in your belly.
Take 2 breaths.
Imagine your tailbone is getting lighter as you allow it and your spine to gently move back to neutral.
Repeat 4-6 times.

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