How Pilates Exercises Can Help Relieve Sciatica

How Pilates Exercises Can Help Relieve Sciatica

The Pilates roll over. annebaek/Getty Images

What is sciatica and what causes it? Are there sciatica exercises that will help relieve the pain?

Dr. Brent Anderson has answers to our questions. He is a physical therapist, Orthopedic Certified Specialist, and the founder of Polestar Pilates, one of the leaders in Pilates instructor training focusing on rehabilitation. He tells us all about sciatica, and the role of Pilates exercise in relieving sciatic pain.

Dr. Anderson begins our conversation with this definition of sciatica: Sciatica is any obstruction, restriction, or irritation that is applied to the sciatic nerve. If you understand what the structure associated with sciatica is, you can understand where an irritation could come from. We start there, move on to exercises, and finish up with tips for teachers.

The Sciatic Nerve

Anderson: The sciatic nerve is one of the largest nerves in ​the body. It provides the majority of the motor and sensory activity for the lower extremities. It is made up of a nerve plexus originating from L1 to S1 and passes from inside the pelvis to outside the pelvis through the sciatic notch - a little hollowing in the pelvis. The sciatic nerve then typically goes under the piriformis muscle, runs down the back of the leg behind the knee and splits, going inside and outside the calf and along the top and bottom of the foot.

Causes of Sciatica

Anderson: Anything that puts pressure on the sciatic nerve or its root can create the irritation we refer to as sciatica. This can happen from a vertebral disc putting pressure on the nerve root, and that root feeding into the sciatic nerve creating pain. Or you could have some problem in the sciatic notch - an accident or fall on your buttocks that caused a trauma to the nerve passing through the sciatic notch.

The injury could cause swelling and that could cause sciatic pain. Pressure on the sciatic nerve from an overactive piriformis muscle is also a common reason for sciatic irritation.

Another common cause of sciatic pain is neural tension (NT). NT is thought to be caused by restriction on the sheath that surrounds the nerve. The nerve should glide smoothly through the sheath like a bicycle brake cable gliding through its casing. But sometimes the nerve does not glide through the sheath well and this can cause restriction.

An example of NT impeding movement can be seen in an exercise class when a student appears to have tight hamstrings. They might have, for example, a very short straight leg raise. Then, after their Pilates session, they have a very nice straight leg raise. In this case, the muscles were not physiologically short - they were actually trying to protect the nerves. Once the nerve was mobilized, tension decreased, and good range of motion was restored.

Having been reminded of the many causes of sciatic nerve pain, I quickly toss out the idea that we are going to get one or two miracle stretches or exercises that apply to sciatic nerve pain across the board. I ask anyway. But Dr. Anderson goes on to guide us through a more nuanced approach to exercise for sciatica that illustrates the adaptability of the Pilates method, and its roots as a rehabilitative program.

Protecting the Sciatic Nerve in Exercise

Anderson: Sciatica is a nerve injury. With a sciatic injury, you want to be careful not to irritate the nerve more than it already is. Consider that the nervous system is continuous through your whole body from the crown of head to the toes and fingertips. Anywhere we move the body we are in essence moving the nervous system. So what you want is a gentle movement without over-stretching the nerve.

I caution people about the idea of over-recruiting muscles. For example, if you are doing Pilates from a more classical perspective, where you are tucking your bottom a little bit and squeezing the hip extensors (glutes), it could be inappropriate for somebody with sciatica.

That would increase the pressure on the sciatic nerve and decrease the space around the nerve. You want to work in a more neutral spine. We often use the phrase: As much as necessary, as little as possible.

If the sciatica is coming from a herniated disc, then we have to take all the disc precautions. Disc precautions include not going into unnecessary flexion, and sometimes extension. Avoid overusing the buttocks and the piriformis muscles. Avoid putting the nerve on stretch. Avoid too much flexion [forward bending] in the lumbar spine which could irritate the nerve if there is a disc lesion. Again, work from a neutral spine, get things to move and relax, and get the core strong. You can do a lot of Pilates and still remove stressors on the sciatic nerve.

When any kind of pain is present it is important to work with a qualified instructor, but Brett Anderson of Polestar Pilates says people with sciatica should do exercises at home too. Not only that, he says: I have clients who say "I feel great here but terrible when I go back to work", and I say, do Pilates at work!

Home Pilates Exercises for Sciatica

Anderson suggests that most of the pre-Pilates exercises are good for people at home to do. Specific examples he gave included:

• quadruped exercises [hands and knees like cat/cow and arm/leg reach]
• leg circles (modified with the knees bent, hands or fingertips on the knees can help get the piriformis to relax)

Dr. Anderson went on to say that there is no limit on the exercises. It's based on if they feel good. Even exercises like modified hundreds and single leg stretch could work.

Exercises to Avoid with Sciatica

Anderson: Exercises that would probably bother a person with sciatica would be exercises like rolling like a ball - if they were irritating the sciatic nerve where it exits the notch; and intense stretches like spine stretch, spine twist, and saw. At the same time, one could possibly modify those exercises so a person could perform them without discomfort.

I'm much more inclined to do whole body movement and do modifications to perform the movement successfully. As a teacher, I will modify the exercise and make corrections to provide a successful movement experience without pain. I'll tell the student it's their responsibility to let me know when you have discomfort, and my responsibility to modify the exercise so that they have a successful movement experience. That formula has been the best for dealing with those who suffer from back pain or for that matter, any kind of pathology or injury.

Tips for Pilates Instructors for Clients with Sciatic Pain

Dr. Anderson offered this sage advice for Pilates instructors, especially new ones, working with people who have sciatic pain:

You want to increase awareness of the core, increase mobility of the hips, and become efficient movers, minimizing over recruitment of the body's musculature. Teachers can use an exercise like segmental bridge to teach awareness of segmental movement.

The motto I use when teaching a special needs class: The purpose of this class is to have a successful movement experience, without pain. I think if that could be the motto of all of our classes we would be surprised at how our teaching style evolves to be much more proficient and accurate. Rather than just following a sequence, we can teach our students to be responsible, and say to them if something feels uncomfortable, please let me know so I can modify it or give you something else to do.

The more I learn, the more I know I don't know. And the reverse of that is true: The less we know, the more we think we know. I would caution young Pilates teachers against thinking they know too much. Be humble and don't be afraid to ask professionals or more senior teachers for help.

In our office, we say: Your primary objective is to do the best you can by the client. If your objective is to look like you know what you are doing or to show how much you know, then you have failed as a Pilates teacher. It's always better to take a little bit more cautious approach as we grow as practitioners. You'll see more advanced practitioners being more aggressive but that's because they've been doing it for 20 or 30 years and feel confident in their experience.

More with Brent Anderson: Where Pilates and Physical Therapy Meet.

Polestar Pilates offers Pilates instructor training around the world. Their programs include comprehensive certification for rehabilitation as well as extensive continuing education classes.

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