Sciatica is a general term for conditions that cause irritation or compression of the sciatic nerve. Traveling from the lower spine through the posterior hip, down the back of the leg and all the way to the foot, the sciatic nerve is the longest in the body. A painful sciatic nerve can cause symptoms ranging from tingling to sharp, severe pain. Symptoms might occur in the hip and buttocks, or the pain and tingling can travel the length of the leg. Many factors can contribute to sciatica, so it's important to know what's happening before you decide whether to exercise with a painful condition.
Spinal Disk Injuries
The most potentially serious cause of sciatic pain is compression or inflammation where the nerve exits the spinal column. Causes may include anything from arthritic changes to a herniated disk. In the definitive text "Clinical Massage Therapy," authors Fiona Rattray and Linda Ludwig urge caution with any movements that cause pain. Spinal conditions may require treatment such as massage, physical therapy or surgery to avoid permanent nerve damage. Painful movements are a sign that the nerve is being compressed and further irritated, so any exercise that causes severe sciatic pain should be avoided until a doctor can determine the cause.
Piriformis Syndrome
A more common cause of sciatic pain is a condition called piriformis syndrome. The piriformis is a pencil-shaped muscle that runs from the sacrum to the top of the femur. Its job is lateral rotation of the hip, and many people have tight piriformis muscles. Someone with a "duck walk" -- meaning her toes are always turned out -- likely has short piriformis muscles. The sciatic nerve sits very close to the piriformis muscle, and the nerve travels through the fibers of the muscle in as much as 20 percent of the population, according to Rattray and Ludwig. In piriformis syndrome, the tight piriformis muscle irritates the sciatic nerve, and the first treatment is stretching and releasing the piriformis. Depending on the severity of the condition, some sufferers may be able to exercise without aggravating their sciatic pain. The American Academy of Family Physicians says patients should avoid running, cycling or other exercises that cause pain until the condition improves. Remember that pain is a sign of the nerve being compressed and irritated, which could cause further pain or injury if not addressed.
Helpful Exercises
Patients with disk or spinal conditions may be given traction and other stretches to relieve pressure on the affected structures. Sometimes, abdominal exercises are prescribed to strengthen the core muscles that protect and support the back. With piriformis syndrome, home treatment usually involves stretches for the piriformis and other muscles of the buttocks and posterior hip. To stretch the piriformis muscle, lie on your back and hug one knee to your chest. Next, use the opposite arm to pull the knee across your body while you try to keep your hip from rising from the floor. Rattray and Ludwig recommend a standing stretch with one foot on a chair and the knee bent at 90 degrees. From there, bend forward at the waist to stretch the back of the hip.
Other Treatments
Patients may be advised to use over-the-counter anti-inflammatories and self-massage to manage sciatic pain. The American Academy of Family Physicians recommends applying an ice pack for 15 minutes several times a day and then alternating ice with heat packs after a few days. When piriformis syndrome persists, doctors may use anti-inflammatory injections to manage the sciatic pain.
References
- "Clinical Massage Therapy"; Fiona Rattray & Linda Ludwig; 2000
- FamilyDoctor.org: Piriformis Syndrome
