8 Sciatica Exercises for Leg Pain Relief

Anatomy of the Sciatic Nerve

I think it’s important to begin by explaining where the Sciatic nerve is located within the body. Sciatic nerve pain can easily be confused with other lumbar nerve pain diagnoses. There have been several times in the past where I have had to educate my patients who are convinced that they have Sciatica when they were actually describing nerve pain that did not follow the distribution of the Sciatic nerve. It’s all about understanding the true pathway of the nerve, so you can differentiate where the problem is likely to be coming from.

At the most basic level, think of nerve pain as pain that travels from the origin of irritation at the nerve, linearly down the nerve towards the end of the nerve. The distance that the pain travels down the nerve depends on the severity of the compression or irritation of the nerve.

The Sciatic nerve is a large nerve that is composed of the nerve roots from L4-S3. That means the 4th lumbar vertebra nerve root all the way down to the 3rd sacral nerve root.  Once these nerve roots combine together to form the Sciatic nerve, it then exits the pelvis in-between the hip external rotators or in some people, the nerve actually pierces directly through the muscle belly itself (the Piriformis muscle). The nerve then continues down the back of the leg past the knee towards the foot.

Causes of Sciatica Pain

There are 3 common causes of Sciatica pain:

1. Disc herniation in the lumbar spine

2. Degeneration of the lumbar spine (stenosis)

3. Muscular impingement as the nerve exits through the hip musculature (Piriformis Syndrome)

A lumbar spine disc herniation occurs when the outer ring of the disc (fibrous material) tears and allows the gelatinous nucleus material to leak out. Think of tearing a piece off the edge of a donut and the jelly starts to come out of it.

The nucleus material sometimes comes into contact with the spinal nerves as they are exiting both sides of each level of the spine. When this material touches the nerve, the never becomes irritated and inflamed sending pain, numbness, and tingling down the nerve.

Lumbar spine joint degeneration (also known as spondylolysis or degenerative joint disease) is basically another way of saying osteoarthritis of the lumbar spine. As we age, our bodies wear down and repetitive stresses through joints cause excessive bony growth in these areas of wear. This type of joint degeneration is usually not seen until someone is 60 years of age or older.

The extra bone growth can cause problems in the lumbar spine as it may crowd the foraminal space (think of foramen as the windows on each side of the spine). If the windows gradually get smaller due to the extra bone growth, eventually it will begin to pinch the nerve that exits that window. Thus sending pain signals down that nerve. This gradual narrowing is called Lumbar Spinal Stenosis.

These individuals would also benefit from daily low back stretches to maintain lumbar flexibility due to the chronic stiffness that is caused by osteoarthritis in the spine. If you haven’t already checked out my low back pain stretches for pain relief article, you can check it out HERE.

Muscular impingement in the hip is fairly common. Especially in those that sit a lot throughout the day. I see this type of impingement a lot in those that have tight hips. Excessively tight hip external rotator muscles in the buttock can and will pinch the Sciatic nerve that travels amongst them.

This pinching will cause a deep, dull, buttock ache-type pain that can travel down the back of the thigh towards the knee.

If you find yourself sitting for several hours throughout the day with a deep, central buttock ache-type pain, then I highly recommend that you do the following 3 things:

1. Set an alarm to remind you to stand up every hour on the hour

2. Do my physical therapy hip stretches below twice per day

3. Purchase a seat cushion for your chair that is specially designed to decrease the compression of the Sciatic nerve in your buttocks

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Symptoms of Sciatica

Sciatica symptoms can include dull, ache-type pain, numbness, and tingling that follow the path of the Sciatic nerve. Therefore, these symptoms can occur in the following areas:

1. Low back

2. Deep, central buttock

3. Back of the thigh and knee

4. Back/outside areas of the lower leg towards the foot

How to Diagnose Sciatica?

During my physical exam with a patient, I look for the symptoms of Sciatica to closely match the symptoms described above. In addition to the presentation of symptoms, you may present with increased pain with sitting for long periods of time, lifting that leg into the air while lying on your back, or with sustained standing activities.

Additionally, there are some clinical tests that a doctor or physical therapist can perform in-person in order to place increased tension along the Sciatic nerve to assess if it truly is the Sciatic nerve that is being aggravated.

Medical Imaging

There are several different types of medical imaging that a doctor may request.

1. X-Ray

   • An x-ray may show osteoarthritis (arthritis of the bone) along the spine that may be impinging the Sciatic nerve. Keep in mind that x-rays can only show bone, not soft tissues like nerves and muscles.

2. MRI (Magnetic Resonance Imaging)

   • An MRI is not usually ordered unless there is notable leg weakness on the painful side, or if you have already tried physical therapy with no improvement in the symptoms. MRIs show detailed pictures of the soft tissue and bone in the body, so this will be able to assess if there is a herniated disc in the spine that is pressing on the Sciatic nerve, or if the nerve is simply being pinched by the muscles as it exits the pelvis.

3. CT Scan

   • CT Scans create 3D x-ray images that provide much more detail than a normal x-ray. These are rarely ordered in the case of a typical Sciatica diagnosis as they do expose the patient to increased amounts of radiation. CT scans are more regularly ordered prior to spine surgery to provide the surgeon a more detailed 3D view of the spine.

Sciatica Treatment Options

Physical therapy can provide relief from Sciatica pain in all but the worst cases. A trial of physical therapy stretching and strengthening exercises should be started as an initial intervention with Sciatica (unless progressive weakness in the leg is observed in which a medical doctor should be consulted for diagnostic imaging).

An oral steroid pack may be prescribed by your medical doctor as it can help to relieve the inflammation in the Sciatic nerve. The inflammation along the nerve is actually what produces the pain down the nerve.

Surgical decompression of the nerve is required in the most severe cases. As mentioned before, if there is increasing weakness in the painful leg, difficulty walking, or significant numbness present, then a referral to an orthopedic surgeon or neurosurgeon should be considered.