How Pilates Exercises Can Ease Sciatic Pain

An expert explains which exercises to do and which to avoid

The Pilates roll over.
The Pilates roll over. annebaek/Getty Images

What is sciatica and what causes it? Are there Pilates exercises that will help relieve the pain? Brent Anderson has answers to these questions. He's a doctor of physical therapy, an orthopedic certified specialist, and the founder of Polestar Pilates, one of the leaders in Pilates instructor training focusing on rehabilitation. He explains the role of the Pilates method, which was developed as a rehabilitative program, in easing this common pain.

The Sciatic Nerve

Sciatica is an injury that results from any obstruction, restriction, or irritation to the sciatic nerve. One of the largest and longest nerves in ​the body, it provides the majority of the motor and sensory activity for the lower extremities.

The sciatic nerve originates from vertebrae in the lower back and hip area, then journeys from inside the pelvis to outside the pelvis through the sciatic notch, a little hollow in the pelvis. It then runs under the piriformis, a small muscle in the buttocks, extends down the back of the leg behind the knee, and eventually splits, going inside and outside the calf and along the top and bottom of the foot. Hence the reason one classic sign of sciatica is pain or numbness that radiates down the leg to the web of skin between the big and second toe.

Causes of Sciatica

Anything that puts pressure on the sciatic nerve or its roots can create the irritation referred to as sciatica. This pressure can come from a myriad of sources. For instance, a disc that provides cushioning between the vertebrae can herniate (bulge) and pinch the nerve, or a problem can arise in the sciatic notch. An injury—say, falling on your butt—can traumatize the nerve as it passes through the notch, causing it to swell. Pressure on the sciatic nerve from an overactive piriformis muscle is also a common reason for sciatic irritation.

Another frequent cause of sciatic pain is neural tension. In this case, rather than gliding smoothly through the sheath that surrounds it like a bicycle brake cable gliding through its casing, the sciatic nerve becomes restricted.

Whatever the cause, sciatica can be extremely uncomfortable, resulting in weakness, numbness, tingling, and burning, as well as moderate to extreme pain.

Protecting the Sciatic Nerve in Exercise

With nerve injuries, you want to be careful not to irritate the nerve more than it already is, and the same is true with sciatica. As Anderson points out, the nervous system is continuous through your whole body from the crown of the head to the toes and fingertips, so any way you move the body, you are in essence moving the nervous system. The goal is a gentle movement that doesn't overstretch the nerve.

For this reason, Anderson cautions against the idea of over-recruiting muscles. For example, doing Pilates from a more classical perspective, where you tuck your bottom a little and squeeze the hip extensors (aka your glutes), could be inappropriate for someone with sciatica—it can increase pressure on the sciatic nerve and decrease space around the nerve. The solution, says Anderson, would be to work in a more neutral spine, which is when all three curves of the spine—the cervical (neck), thoracic (middle), and lumbar (lower)—are present and in good alignment.

Exercise Care With Disc Injuries

If sciatica is caused by a herniated disc, Anderson stresses the need to take all the disc precautions. These include avoiding:

• unnecessary flexion (forward bending), and sometimes extension (backward flexing). Too much flexion in the lower spine can irritate the nerve.

• overuse of the buttocks and the piriformis muscles.

• stretching the nerve.

Home Pilates Exercises for Sciatica

When any kind of pain is present, it's important to work with a qualified instructor to determine which exercises you can do at home.

Most of these pre-Pilates exercises, which are fundamental moves that many other exercises are built upon, are good for people to do on their own:

  • Quadruped exercises. They include moves like cat/cow and arm/leg reach where both hands and knees are on the ground.
  • Dead bugs
  • Femur arcs
  • Clam
  • Bridging exercises
  • Swan
  • Leg circles. To help relax the piriformis muscle, modify the move so the knees are bent and the hands or fingertips are on the knees.

There's no limit on the exercises though. According to Anderson, even exercises like a modified hundred and single leg stretch could work if they feel good.

Exercises to Avoid with Sciatica

Exercises that would probably bother a person with sciatica would be moves like rolling like a ball and intense stretches like spine stretchspine twist, and saw. At the same time, these exercises could likely be modified so they could be performed without discomfort—something a qualified instructor can help you learn how to do.

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