Sciatica and Stretches for Sciatica Pain

Anatomy Overview

The sciatic nerve is the thickest nerve in the body. It develops from nerve roots in the lumbar and sacral spine, specifically L4, L5, S1-3. These roots join together to form the sacral plexus. The nerve runs through the middle of the buttock, in front of the piriformis muscle, before descending along the back of the thigh and into the lower leg to the foot. All of the muscles below the knee obtain their nerve supply from the sciatic nerve and injuries to the nerve may result in weakness in these muscles. 

The Nervous System; All Tied Together

Nerves are elastic and must be mobile and have the ability to bend and stretch as they run through our bodies between muscles and layers of connective tissue. They do not like compression. This is certainly true of the sciatic nerve, the largest nerve in the body. Nerves are surrounded by a sheath, the epineurium. The nervous system is really a continuous structure with the dura mater of the brain and spinal cord connected with the perineurium of the peripheral nerve. We see this in clinical practice when straightening a leg triggers pain in the neck or upper extremity or movement of the neck causes sciatic symptoms in a leg. 

Symptoms

True sciatica is a severe disabling nerve pain that may begin in the low back or buttock and then follows the route of the nerve, descending the back of the leg to the foot. It may be accompanied by muscle weakness in the foot, specifically resulting in difficulty pulling the foot up or walking on the heels. Severe weakness may also affect the calf muscle, the gastrocnemius, and the ability to walk on tiptoes. This may be accompanied by tingling (pins & needles) or loss of sensation (numbness) in the lower leg and foot. True sciatica usually results from compression or irritation of the nerve in or around the spine.

It is extremely common for individuals to have neuralgia in the distribution of the sciatic nerve. This is nerve pain in the areas where the sciatic runs, but of a lesser intensity. Think of this pain as a variation of true sciatica. It is frequently intermittent and may present as more of a pulling sensation or tension in the leg. Muscle weakness or other neurologic findings are usually absent although there may be mild tingling. Neuralgia in a sciatic distribution results from irritation of the nerve anywhere along its trajectory from the lower back to the buttock (piriformis syndrome), pelvis or leg. Often scarring from a previous inflammatory process may be responsible such as post disc injury, post-surgery, endometriosis or trauma. Rarely a tumor may be the cause.

Stretches for Pain Relief; The Risks

In an individual presenting with acute sciatica, the first diagnostic consideration is usually to think of a spinal origin, particularly an acute disc injury or herniation. Sitting is poorly tolerated as it loads the spine and lifting the leg, either when seated or lying down, may produce excruciating pain down the leg (straight leg raising). The temptation for an individual is to think that doing stretches for sciatica pain may be helpful. On the contrary, sciatic nerve stretches in an acute situation will usually aggravate the symptoms. Nerves enjoy being stretched, but not when they are inflamed. Gentle short duration repetitive stretches for sciatica when it is a more chronic condition resulting from scar tissue is however beneficial. Surgery for sciatic pain is usually not necessary as 92% of individuals with an acute disc injury get better with conservative medical treatment.

The Best Sciatic Nerve Pain Stretches

In an acute setting, always avoid stretching exercises to relieve sciatica as they will only aggravate symptoms. Any position that involves a straight leg stretches the nerve. Yoga should be avoided. When walking or doing other activities, keeping a slight bend in the knee may be helpful. 

It is always best to begin exercises for sciatica in a very indirect manner. This is definitely not a circumstance where “no pain, no gain” applies. A nerve must slide and glide through its entire length. If we lose the slide and glide, nerve tension arises. Initially sciatica nerve stretches are best done with a bent leg. Lie on your back on the floor with your leg in a bent starting position with your feet resting on a chair or couch. This puts the nerve to rest and takes tension out of the leg. In this position a stretch to help sciatica is to flex and extend the foot (nerve flossing). This stretches the sciatic nerve indirectly and is a useful way to begin stretching exercise for sciatica. Slowly this exercise can be progressed to a straight leg. (If stretching with a straight leg, the heel should be pushed into a surface to activate the hamstring and avoid overstretching the nerve).

The piriformis muscle crosses the buttock horizontally, attaching at the sacrum and greater trochanter of the femur. The sciatic nerve runs vertically beneath it. Stretching the piriformis is thus always one of the most important pieces of medical advice for pain in the sciatic nerve. A figure 4 stretch or pigeon pose in yoga is one means of stretching the piriformis muscle.

Supine Figure 4 Pose

Pigeon Pose

Seated Figure 4 Pose

Sciatic Nerve Floss in 90-90 Position

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