Sciatica is a common issue and one that can cause a lot of discomfort to the sufferer. Sciatica pain occurs when the sciatic nerve is compressed or pinched in some way. The nerve originates in the lower back and branches out to run down each leg (as shown below). Usually the pain occurs in one leg but can occur in both. The compressed nerve becomes inflamed, and along with pain, can also cause tingling, numbness and weakness along its path. The compression on the nerve can be caused by a herniated disc or a narrowing of the spine, called spinal stenosis. Arthritis or other issues with the sacroiliac joint may also be a cause.
Another cause of sciatic nerve pain is pressure from the piriformis muscle (a deep glute muscle that is responsible for various movements of the hip and leg bone). It can become very tight and then press into the sciatic nerve. This is actually referred to as piriformis syndrome. In some cases the nerve actually runs through the piriformis muscle which would predispose an individual to piriformis syndrome. The pain can be similar to sciatica but the cause of the pain is slightly different.
It is helpful to know what the root cause of the sciatica pain is...whether it is a disc, spine issue or muscular in origin, as in the case of piriformis syndrome. The approach in treatment can vary in this case and it is an important distinction. There are certain movements we want to avoid depending on the root cause. For example, if the issue is a herniated disk, we avoid forward bending and if it is spinal stenosis we avoid back bending (in general).
Yoga Therapy can work quite well in alleviating the discomfort associated with sciatica and piriformis syndrome. However, further to the above, as Yoga Therapists, we work in consultation with a General Practitioner and potentially other medical professionals as well. Yoga Therapists do not diagnose or medically treat conditions, but provide practices that help to alleviate the symptoms associated with them.
In general, our goal with sciatic nerve pain, will be to strengthen the glutes and hamstrings and also stretch and strengthen the low back, hips and hip flexors. In Yoga Therapy with physical ailments, we aim to strengthen weak muscles and stretch the tight ones in conjunction. Stretching will need to be done carefully and thoughtfully. In this case an emphasis should be more on strength of the hamstrings and glutes. Stretching the hamstrings may provide some temporary relief but will not do much to alleviate the issue. We also need to create space and balance in the low back, which is achieved through a combination of strengthening and stretching the muscles in that area as well.
Some yoga postures we might use in the case of sciatica are below. Included are benefits as it relates specifically to managing this condition:
Warrior One (hands can remain on hips if needed or on a chair or wall for balance)
Strengthen: Hips, glutes, quads, hamstrings, back
Stretch: Hip flexors
Low Lunge (use blocks under hands if needed)
Strengthen: Glutes (should be engaged)
Stretch: Hip flexors, quads, inner thighs
Bird Dog (for added hamstring emphasis, lifted leg can bend, toes pointed straight up toward ceiling)
Strengthen: Glues, Hamstrings, low back, abs (core stabilizer)
Stretch: Passive hip flexors, quads
Child’s Pose (add blanket between back of thighs and calves if needed)
Stretch: Low back, hips, quads
Upward Facing Boat
Strengthen: Back, glutes, hamstrings, quads
Stretch: Abs, passive hip flexors
Bridge (a block can be used in between legs for further activation)
Strengthen: Glutes, hamstrings
Stretch: Hip flexors
Seated Twist:
Strengthen: Inner thighs
Stretch: Outer hips
Lying Bound Angle (add pillows or blocks underneath knees for more support)
Strengthen: Passive outer hips
Stretch: Inner thighs
Poses shown below in order:
In a practice for sciatica, we might string these poses together in a bit of a flow, or we might move in and out of each one with breath, and include a static hold at the end. The time spent holding each pose will depend on current strength and comfort level. To build strength we will look to increase the duration of the hold in key postures (starting with 3-5 breaths). Child’s pose can always be inserted in between the more vigorous postures to stretch and release the low back and rest the body.
Another important thing to note is that we do not work through pain in Yoga Therapy. We might work through slight muscle discomfort during a strengthening pose. This is important for building strength. However, we never work through any sharp, or burning pain, or anything that causes too much disruption to the natural flow of breath. Being able to comfortably breathe throughout each posture is really important. If any pose causes discomfort, a client is instructed to release it and we look to find another posture that accomplishes the same goal pain free. Yoga Therapy is also not meant for any acute pain conditions and as noted earlier, consultation with a medical professional is almost always indicated in the case of sciatica and piriformis syndrome.
As always, if you have any questions please feel free to contact me!
Peace,
Lauren
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References and for further info on these conditions:
Mayo Clinic article (and photo credit) HERE
Spine Universe article HERE