How We Approach Sciatica
‘Sciatica’ is a term that gets thrown around quite often but the reality is that sciatica is a catch all term for symptoms that go down your leg. Without getting into the weeds too much, we’d just like to point out that symptoms like that could usually benefit from seeing a professional such as a physiotherapist, who can make individual recommendations for you. However, in this blog post, we’ll give you an idea of how we approach sciatica at The Movement and teach you about how to move the nerve with exercises called neuromobility exercises. We have also included a free download of 5 exercises to improve sciatic nerve tension!
*note - these stages often have overlap
Step 1: We teach our clients about the sciatic nerve
Anatomy
It’s so incredibly important to learn about the sciatic nerve itself, so we almost always start with teaching our clients about the anatomy, mechanics, and function of the sciatic nerve. This helps our clients understand how to calm down their symptoms. The first thing we want them to understand is that the nerve travels from the lower back and all the way down the back of the leg and into the bottom of the foot, as shown in the photo here. It’s important to realize that the nerve is a real physical structure that runs throughout your body much like a muscle or tendon and where it is typically makes a difference.
Mechanics
Nerve is on slack
Nerve is on tension (stretch)
In terms of mechanics, the sciatic nerve is wound up with particular movements, namely with hip flexion, knee extension, and dorsiflexion. These movements can all be seen in the images above. It’s important to highlight here that if the sciatic is related to a lower back problem, there may be some other considerations here but for the purposes of this blog post we won’t go into too much detail about that. Understanding that these movements wind up the sciatic nerve is important when modifying our clients activities to help calm the nerve down.
Key Points
When it comes to function, there are a few main points we like to teach our clients about.
Nerves like blood flow - have you ever felt you leg go numb when you sit on a hard chair…that’s because blood flow is being lost in the nerve. Generally speaking, nerves love blood flow and it helps them function. Changes in circulation that reduce blood flow can increase the sensitivity of the nerve.
Painful nerves are sensitive to stretch - when a nerve is sensitive, it’s often painful in the wound up position as described above.
Nerves are sensitive structures in general - there entire purpose is to feel, so generally speaking we take this into consideration when recommending dosage of exercise to our clients…slower and relatively pain free is generally recommended especially early on.
Step 2: Avoid positions of stretch
Since painful nerves are sensitive to stretch, once we’ve identified that it’s the sciatic nerve that’s painful, we’ll start identifying movements at can be avoided or modified to reduce stretch. We’ve put the image here again for reference. This will always entirely depend on the client in front of us because they may present with slightly different activities and habits. For example, recommendations for someone who drives a lot versus someone who goes for lot’s of walks will be completely different. However, the key is identifying when they may be putting the nerve on stretch and how they can alter activities to help calm the nerve down. If we have someone who has to drive a lot, we may try moving the seat a little higher or closer to the wheel (not to the point where it’s dangerous) enough to take the slack off a little bit. Or is someone goes for walks, we may recommend a shoe with a little more heel-toe drop and walking on relatively flat ground.
Step 3: Encourage blood flow
There are so many ways to work on circulation and blood flow, ranging from movement and activity to nutrition and stress management. Typically, we discuss all of these aspects with our clients but given our focus on movement and exercise we tend to focus quite a bit on this. When it comes to movement and activity we tend to attack it from two fronts…
General activity - we typically encourage any activity such as walking, training upper body, swimming, that isn’t painful.
Non-painful exercise - this is usually more directed by assessment to figure out which lumbar spine movement, lower body movements, and lower body exercises are currently tolerated really well
Step 4: Restore normal nerve function
At some point, we typically try to gradually restore the ability for the sciatic nerve to tolerate being completely wound up. The way we do this is by implement what are called neuromobility exercises. These exercises are also sometimes called ‘flossers and tensioners’ or even ‘sliders and gliders’. Either way, the intension is to carefully move the nerve through it’s range of motion. These are not really intended to be a stretch, we don’t ‘lengthen’ nerves. Moreso, they’re intended to help encourage the nerve to move and groove throughout all the tissues in your lower extremity. We’ve attached a PDF below with a series of 5 sciatic neuromobility exercises that go from less tension to more tension. These are some of the common movements we implement with our clients.
Step 5: Restore normal activity
This will also be completely individual depending on the individual we’re working with. However, this is arguably the most important step because while it’s nice to get our clients to not have pain every time they stretch their sciatic nerve, our goal is to get them back to what they love. So we need to make sure that their sciatic nerve is tolerating what they love to do, whether that’s climbing, hockey, running, powerlifting, or simply picking up their kids. This last phase generally involves higher level strength and conditioning to help them bridge the gap to their goal. For example, if the client is a hockey player, we know they’re going to be fatigued and also bent over for a long time. So we try and train these qualities with our programming. Further, we’d try to have a graded return to the activity itself.
Closing comments
Something like sciatica can be a stubborn problem, can be quite distressing, and can take some time. It takes a high level of patience, persistence, and confidence in uncertainty to get through an issue like this. So the reality is that these steps don’t always go perfectly as planned, which is why it’s really beneficial to get help if you’re struggling with sciatica from someone who can help you navigate the uncertainty.