In my blog posts about stretching and warming up I noted that there were some exceptions to the rule of thumb that stretching is mostly not worth the effort. Sciatica is most definitely one of those exceptions. So let’s jump straight in and find out more about it.
What is sciatica?
We should start with the sciatic nerve. It’s formed from a number of nerve roots from the lumbar spine and has some really important functions, including moving your legs and feet, and letting you feel sensations from them. It’s the longest and largest nerve in the body. All nerves can get pinched – or trapped – where they pass through tight spaces, and there are lots of these potential entrapment points along the route of the sciatic nerve. This pinching of the nerve tends to lead to inflammation, and when this happens, you get sciatica. This typically manifests as radiating pain, numbness, burning or a kind of deep itch in the back of the buttock, thigh and lower leg, sometimes even to the big toe. There may also be some weakness of the leg.
Interestingly, not everyone’s sciatic nerve takes exactly the same route. This kind of anatomical variation is common in the human body but it means that some people are more prone to sciatica than others.
sciatic inflammation (courtesy of ChatGPT)
What causes sciatica?
So now we can see that sciatica isn’t a condition, it’s a symptom. It’s therefore important to find out what’s causing it, and there are many potential factors, the most common ones being:
- Herniated Disc – A bulging disc in the lumbar spine pressing on the sciatic nerve
- Spinal Stenosis – Narrowing of the spinal canal, which can compress the nerve
- Other “space occupying lesion” – such a tumour
- Piriformis Syndrome – Tightness in the piriformis muscle irritating the sciatic nerve as it passes through
- Degenerative Disc Disease – wear and tear on spinal discs (and vertebrae) that can contribute to nerve compression
- Spondylolisthesis – When a vertebra slips forward, the sciatic nerve can be pinched
- Trauma or Injury – Accidents such as falls can directly impact the nerve and the structures through which it passes
- Facet joint cysts – small cysts which can appear on the surfaces of facet joints in the lumbar spine
- Compression of the spinal cord in the neck (cervical spine) – this may produce sciatica-like symptoms
Diagnosis is usually by a combination of clinical testing (reflexes, power, straight leg raise and so forth) and MRI scanning. MRI was at one point routine for all patients with sciatica-like symptoms, until studies such as this one found that many people have disc injuries in their lumbar spines without any symptoms. It’s generally thought that people without symptoms don’t need treatment, but it’s worth noting that sometimes incidental findings on imaging reports do require follow up.
Cauda Equina Syndrome (CES)
We should also mention cauda equina syndrome (CES) at this point. CES is a very serious medical emergency which occurs when some critical spinal nerves are compressed and it can be irreversible, so if you have any of the symptoms listed here: https://www.spinal.co.uk/get-informed/cauda-equina-syndrome/ you must immediately visit your nearest accident and emergency department so that they can help you.
What can be done?
As well as spinal mobilisation and manipulation (which date back to Hippocrates as treatment for sciatica), sciatic nerve stretching is very helpful. Amongst other things, it reduces nerve compression, improves flexibility, enhances blood flow, promoting healing, relieves muscle spasms, promotes mobility and activates the supporting muscles.
Sciatic nerve gliding, also called nerve flossing, is a technique that gently mobilizes the sciatic nerve, helping to reduce pain, improve flexibility, and prevent adhesions (nerve entrapments). These exercises are beneficial for people experiencing sciatica due to nerve irritation or compression. Here’s an article discussing how we think it works.
How to do it:
- Sit upright on a chair with both feet flat on the floor or hanging if you prefer.
- Extend the affected leg straight while keeping the other foot flat.
- Simultaneously, flex your foot (toes pointing toward you) and look up toward the ceiling.
- Then, lower your leg back down and tuck your chin to your chest.
- Repeat 10-15 times in a slow, controlled motion.
Other useful stretches include the piriformis muscle stretch, and various other suites of simple, quick low back stretches.
Finally, some tips to stretch safely
- Always warm up before stretching to avoid injury
- Don’t stretch before exercise
- Stretch gently and never force a movement that causes pain
- Perform these stretches daily to maintain flexibility and reduce discomfort.
- Don’t overstretch
Stretching should form part of a multimodal treatment programme for sciatic pain, and it is usually tailored to each patient depending on the cause of their sciatica. But all in all, incorporating these simple stretches into your routine can help manage sciatic pain and improve overall mobility.