How Pilates Exercises Can Ease Sciatic Pain

Sciatica is a common condition that can be improved with movement, but physical activity can also be uncomfortable for people with this nerve pain. Brent Anderson, a doctor of physical therapy with a specialist certification in orthopedics and the founder of Polestar Pilates, recommends trying Pilates, which was originally developed as a rehabilitative program. Anderson is one of the leaders in Pilates instructor training focusing on rehabilitation. Below, he explains the role of the Pilates method in easing this common pain.

Overview

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.

Causes of Sciatica

Anything that puts pressure on the sciatic nerve or its roots can create the irritation referred to as sciatica, explains Anderson. 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 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.

Sciatic Pain and Exercise

With nerve injuries, it's important to be careful not to irritate the nerve more than it already is, and the same is true with sciatica. The nervous system is continuous throughout your whole body, from the crown of the head to the toes and fingertips. So whenever you move the body, you are in essence moving the nervous system. If you have sciatica, 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 (your glutes), could be inappropriate for someone with sciatica, as this type of movement can increase pressure on the sciatic nerve and decrease the space around the nerve.

The solution, says Anderson, would be to work in a more neutral spine. This is when all three curves of the spine—the cervical (neck), thoracic (middle), and lumbar (lower)—are maintained and in good alignment.

Exercise With Disc Injuries

If sciatica is caused by a herniated disc, which is common, Anderson stresses the need to take important precautions to protect the disc from further injury or irritation. These steps include avoiding the following:

• Overuse of the buttocks and the piriformis muscles
• Stretching the nerve excessively
• Unnecessary flexion (forward bending), and sometimes extension (backward flexing), as too much flexion in the lower spine can irritate the nerve

Home Pilates for Sciatica

When any kind of pain is present, it's important to work with a qualified instructor to determine which exercises you can safely do at home, says Anderson. Most of these are pre-Pilates exercises, which are fundamental moves that many other exercises are built upon and are suitable for people to do on their own:

• Bridging exercises
• Clam
• Dead bugs
• Femur arcs
• 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
• Quadruped exercises, which include moves like cat/cow and arm/leg reach where both hands and knees are on the ground
• Swan

There's no limit on the exercises that can help, though. According to Anderson, even exercises like a modified hundred and single leg stretch could work if they feel good. In fact, whether or not an exercise causes you any discomfort is a good indicator of whether or not it's advisable to do. So, if it feels good while you perform the exercise, that's a good sign.

Exercises to Avoid

Exercises that would probably bother a person with sciatica would be moves like rolling back and forth like a ball and intense stretches like spine stretch, spine 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.