Pilates for Sciatica: How to Treat Sciatica

Find out more about why you might have sciatica and specialist Clinical Pilates for sciatica exercises. Pilates can be used to treat sciatica but it is important you understand what is causing your sciatica.

'I have sciatica' is a term I frequently hear my patients use to describe pain in their leg. What most people don't realise is sciatica is actually a symptom not a medical condition. We describe sciatica as an umbrella term for pain radiating down the back of the leg.

The sciatic nerve originates in the lumbar spine (lower back) and travels down into the buttock and down the back of the leg. Pain from the sciatic nerve can be felt anywhere from the lumbar spine down to the foot. People may describe sciatica as an ache or more often a sharp, burning and often excruciating pain. There can often be pins and needles or numbness associated with sciatica.

There are actually a number of reasons why you might be suffering with sciatica, which can be addressed with Clinical Pilates for sciatica exercises:

• Disc prolapse (slipped disc - see our blog on what is a disc prolapse). A lumbar disc that has prolapsed will press on a nerve root in the spine that will give you leg pain. These can vary in severity and I would always recommend seeing a physiotherapist if a disc prolapse is suspected.

• Piriformis syndrome. The piriformis muscle is a large muscle in the buttock that has the sciatic nerve running underneath it. It arrises from the sacrum (part of the pelvis) to the hip. When the piriformis muscle gets tight and overactive it can press on the sciatic nerve to give you sciatica. The most effective treatment for this is to stretch the piriformis muscle. Read here how to stretch the piriformis. However the question has to be asked, why did the piriformis get tight in the first place? Do you have an underlying pelvic or lumbar dysfunction? It is highly likely you have some muscle imbalances around the hip and pelvis. If the piriformis muscles is overworking because of weaknesses in the other muscles around the hip, the only way to stop the pirifomis overworking is to retrain the weaker muscles. These muscle imbalances can be corrected with our pelvic workouts

• Spinal stenosis. Spinal stenosis is a narrowing of the structures around the nerve which will cause compression of the nerve and therefore result in pain. This may be caused by arthritic overgrowth of the facet joints (the joints that attach the spinal segments together), disc degeneration and loss of disc height. Typically the symptoms of stenosis are leg pain that is worse with walking (as you compress the stenotic area) and eased with bending forwards or sitting (as you open the spine up and ease the pressure on the nerve). This condition is usually degenerative and therefore treatment would be management of the condition. I always recommend my patients do core stability work with clinical Pilates to strengthen the muscles that support the spine. This allows the muscles to support the spine when standing and walking to reduce pain. We can tailor your workouts if you have a spinal stenosis. Sign up here for your free trial.

• Spondylolythesis. This is a condition where one vertebrae slips forwards. It usually occurs in the lumbar spine. As one vertebrae slips forward of another it can squash and compress the nerves that exit around the spine, causing sciatica. People with a spondylolythesis will typically complain of pain in lumbar extension (arching back or walking). The treatment for this is spinal stabilising exercises such as clinical Pilates. If you have a spondylolythesis you can let us know on your health questionnaire when you register so we can pick workouts suited to that problem.

Diagnosing the reason for sciatica is important in terms of how it is treated. If you need any advice on your problems/symptoms please email me on lyndsay@yourpilatesphysio.com 

It is important that if you have sciatica that you start with beginner Pilates exercises, I would always suggest you see a physiotherapist and work under the guidance of a physio. These exercises are a good place to start but following a specific program will benefit you much more. It is also important that you seek medical attention if your symptoms don't resolve and also important to stop if your symptoms get worse:

1. Pelvic tilting. This gentle exercise will help you to gently move the lower spine and pelvis. Often when people suffer sciatica they will become fearful of moving the spine, causing more restriction and pain. You can perform pelvic tilting in any position but you might find lying on your back most comfortable. Lay on your back with your knees bent so that your heels are in line with your sitting bones. Imagine there is a marble sitting between your tummy button and your pubic bone. Roll the marble towards your tummy button, feel your lower back flatten to the floor, roll the marble back towards your pubic bone to feel your lower back lift a little away from the floor. Repeat 6-8 times.

2. Lateral breathing. In the same position as above, arms rested by your side. Inhale into the base of your lungs, feel the rib cage expand out to the sides, then exhale as much as you can. You might feel your tummy muscles pull in as you do this. Repeat 6-8 times.

3. Cobra stretches. It is very important with this exercise that if you get any increase in your sciatica or leg symptoms that you stop. If you need to stop you might find it comfortable to stay laid on your tummy with a couple of pillows under your abdomen. Don't sustain any position for too long. Movement is best for the spine and for sciatica. If you are comfortable place your hands either side of your head, inhale, as you exhale push your head and chest away from the floor to extend the elbows. Only as far as you feel comfortable. Make sure you gently hold the tummy and buttock muscles in so as not to hinge on the joints in your back. Repeat 6-8 times so long as you feel comfortable with this.

If your sciatic symptoms don't ease, if you experience an increase in your symptoms, please seek medical attention. The majority of sciatic symptoms will ease but it is also important that if you experience an of the following that you seek urgent medical attention:

-Bilateral symptoms (leg pain, pins and needles)

-Change in bladder/bowel (either loosing control or retention)

-Saddle anaesthesia (altered sensation in your gentle area)

Clinical Pilates for sciatica teaches you how to correct movement dysfunctions and offload structures that are causing compression of the sciatic nerve. It will strengthen the muscles that support your lower back and reduce pain. It is a very effective treatment for sciatica. When signing up to your Pilates Physio we ask you to fill in a health questionnaire so we can create a tailored workout program based on your needs. Try our 14 day free trial today!