Exercises for Sciatica : For Special Conditions:
It is recommended that every one consults with a physician or physical therapists prior to beginning any exercises program. A physical therapist, certified athletic trainer (ATC), or other spine specialist who treats the back pain and leg pain associated with sciatica may recommend exercise as part of a treatment program. The specific exercises recommended will depend on the cause of the sciatica. They must be done regularly and correctly to be effective. Close attention to posture and body mechanics is the prime key to maximum benefit from the exercises.
The major causes of sciatica include:
- Sciatica from a herniated disc
- Sciatica from spinal stenosis
- Sciatica from degenerative disc disease
- Sciatica from isthmic spondylolisthesis
Sciatica From A Herniated Disc:
Herniated discs commonly involve disk material protruding backwards and irritating or compressing a nerve root.
Exercises to treat this condition are prescribed according to which positions will cause the symptoms to move up the lower extremity and into the low back.
The low back is gently placed into extension by lying on the stomach (prone position) and propping the upper body up on the elbows, keeping hips on the floor (Figure 1). This should be started slowly, since some patients can not tolerate this position initially. This position is typically held from five to 30 seconds per repetition, for 10 repetitions.
After practising this exercise, the spine specialist may recommend a more advanced form of the extension :
o From the prone position, press up on the hands while the pelvis remains in contact with the floor (Figure 2).
o This position is typically held for 1 second, repeated 10 times.
A similar exercise can be done standing by arching backward slowly with hands on hips if the patient is unable to lie flat (Figure- 3). However, the prone position is usually preferred. These “extension” exercises are done regularly, about every two hours. More importantly, the spine specialist may recommend that the person with this condition should avoid getting into a forward flexed (bent over) position. This tends to counteract the effects of the extension exercises. The specialists may ask the patient to correct forward flexed positions immediately with an extension exercise.
As the pain works out of the lower extremity, the exercises typically are advanced to strengthen the low back and abdominal muscles to prevent recurrences of the condition. To strengthen the Low Back muscles:
o In the prone position and hands clasped behind the lower back, raise the head and chest slightly against gravity (Figure -4) while looking at the floor (stay low).
o In the prone position with the head and chest lowered to the floor, lightly raise an arm and opposite leg slowly, with the knee locked, 2-3 inches from the floor (Figure 5).
To strengthen the abdominal muscles:
o For the upper abdominals, lay on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the floor (Figure 6). Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head.
o For the lower abdominals, tighten the lower stomach muscles and slowly raise the straight leg 8 to 12 inches from the floor (Figure 7), keeping the low back held flat against the floor.
o Water exercises are also excellent, even just walking in waist-deep water.
o Aerobic conditioning may also be encouraged for general body fitness.
o Walking is an excellent form of exercise for the low back, working up to three miles per day at a brisk pace if able.
Sciatica From Spinal Stenosis:
Spinal stenosis can also cause nerve root irritation or impingement through a narrowing of the nerve’s passageway.
When treating stenosis, the spine specialist may encourage flexion exercises. Flexing the lower spine increases the size of these passageways and allows the irritation or impingement to resolve. This is accomplished by stretching the muscles of the back that hold the spine in extension (backwards bending) and strengthen the muscles that bring the spine into flexion (forward bending). Stretches for the low back extensors are typically held lightly for 30 seconds.
Lay on the back and gently pull the knees to the chest until a comfortable stretch is felt (Figure 8).
From all fours, sit back on the heels with the chest down and arms outstretched (Figure 9). Strengthening Exercises for the Lower Abdominal muscles.
o Lay on the back and press the low back into the floor by tightening the lower stomach muscles (Figure 10), hold for 10 seconds.
o For a more advanced exercise, hold this position while marching in place in the hook-lying position, slowly raising alternate legs 3 to 4 inches from the floor (Figure 11).
o Curl-ups (Figure 6) may be recommended by the specialists here as well.
These exercises alone will not necessarily make the patient better, but they will allow the patient to more easily hold a posterior pelvic tilt during activities, especially standing and walking. This posture will allow the patient to perform more activities with less pain. The pelvic tilt is often very difficult for patients to learn and can take a good deal of practice with the guidance of a physical therapist before it is used effectively.
Sciatica from degenerative disc disease:
The form of exercise typically recommended for treating disc degeneration is a dynamic lumbar stabilization program. This includes finding the most comfortable position for the lumbar spine and pelvis and training the body to maintain this position during activities. In doing this correctly, one can improve the proprioception (sense of movement) of the lumbar spine and reduce the excess motion at the spinal segments. This will in turn reduce the amount of irritation at these segments, relieving pain and protecting the area from further damage. These exercises often require specific hands-on instruction because they offer much less benefit if done incorrectly, and they tend to be much more difficult than they appear. This type of program is progressive, starting with the easier exercises and advancing to the more difficult exercises once the first lower level program is mastered. The most important aspect is sensing and controlling motion in the spine. Once learned, the body can eventually take over and do this without the level of concentration it takes early on.
Examples of these stabilizing exercises done while on the back include:
o Hook-lying march, with knees bent, arms at sides, tighten stomach muscles and slowly raise alternate legs 3-4 inches from the floor (Figure- 11).
o Hook-lying march with arms, lowering the opposite arm over the head (Figure 12).
o Bridging from a back lying position with knees bent, slowly raising the buttocks from the floor (Figure 13).
These should all be performed with a rigid trunk. The pelvic tilt (Figure 10) will be used to find the most comfortable position for the low back.
This same pelvic position is maintained while performing stabilizing exercises from the prone (on the stomach) position:
o With elbows bent and hands under the shoulders, raise one leg 2 to 3 inches from the floor (Figure 14)
o With elbows straight and arms stretched about the head, raise an arm and the opposite leg 2 to 3 inches off the floor (Figure 5).
Similar exercises can be done in the 4-point position (on hands and knees), raising the arms and legs only as high as can be controlled, maintaining a stable trunk and avoiding any twisting or sagging:
o Raise one leg behind with the knee slightly bent and no arch in the back or neck (Fig.- 15)
o Raise one leg with the opposite arm with the knee slightly bent and no arch in the back or neck (Figure 16).
Sciatica from isthmic spondylolisthesis:
Isthmic spondylolisthesis can cause nerve root irritation or impingement.
Isthmic spondylolisthesis is typically treated with a program that is a hybrid of the flexion based exercises (as in stenosis) and the stabilization program (as in degenerative disk disease). The goal of this method is to teach the lumbar spine to remain stable in a flexed position. Therefore, the exercises are a combination of both programs.
Specialists treating patients with spondylolisthesis frequently recommend the pelvic tilt (Figure 10), as it will hold the lower spine in the flexed position. Lay on the back with knees bent and flatten the back by tightening the lower stomach muscles.
Strengthening the abdominals with the curl-ups (Figure 6) will also help maintain a proper lower spine position. Lay on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the floor. Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head.
The hook-lying marching (Figure 11) and hook-lying combination (Figure 12) are again useful here as well.