The Pain in the Butt – how to heal Sciatica
Are you currently experiencing sciatica – also called the “pain in the butt”?
Sciatica pain is very common nowadays. As most of us now have jobs that requires to sit all day long, many muscles can get chronically tight, discs degenerate and herniate and compress the sciatic nerve.
Luckily, there are home remedies to reduce symptoms and beat sciatica. In this article, I will explain what sciatica is and my best tips on how to heal sciatica.
Meet your sciatic nerve
The sciatic nerve, also called ischiadic nerve (Nervus ischiadicus in medical language) is one of the largest nerves in humans and animals.
It begins in the lower back region (L3 to S3) – the part where most disc herniations occur – and runs down along your legs, all the way down to your limbs.
This makes it the longest and thickest nerve in the human body. In our body, there are nerves responsible for movement and those relaying sensation from the body (skin, organs etc.) to the central nervous system.
The sciatic nerve contains fibers of both the motoric and the somatosensoric nervous system (makes you feel pain, touch on the skin, temperature etc.).
If this nerve cannot function properly, you will not only experience immense pain but also not be able to move your entire lower body. Thankfully, there are other nerves innervating some parts of your legs too but the fibers of the ischiadic nerve play the biggest role in somatosensoric and motoric functions in the lower body.
The science behind sciatica
The term “Sciatica” is not a diagnosis in itself. It does not explain the cause of the pain. In fact, it is used to describe a series of symptoms that doctors cannot find one direct cause for because there could be multiple reasons.
Generally speaking, whatever the cause might be, when you are having sciatic pain it means that the sciatic nerve is irritated or compressed. The medical term for sciatica is “Radiculopathy”, which means that the nerve is compressed at its roots in the lower back.
Symptoms of sciatica
If you have sciatic pain, you might experience the following sensations:
- Pain in ONE buttock, especially when sitting on it
- Pain description: Burning, tingling, “dull ache”: you can’t exactly point to a region where the pain occurs
- Weakness or numbness of the leg/ foot
- A sharp pain when standing up or walking for a longer time
There are some tests of clinical examination to find out the causes of sciatica. Some test indicate that it might be a herniated disk, for example. I will not cover those tests here, as you can’t really assess this condition on your own.
What are the causes?
1. Tight Piriformis muscle
In the part of the lower back where the sciatic nerve has its roots, you can find a small muscle called “piriformis”. It is part of the deep hip muscles and has various function for external and internal rotation of the leg (depends on the position of your leg) and abduction.
While human anatomy is the same in all individuals in its basics, the exact position of the sciatic nerve, how thick it is and the position of the piriformis muscle is different for everyone.
Thus, some people might never experience sciatica because there is enough distance between the piriformis muscle and the nerve. However, in some people, this distance is very small. On top of that, most people’s piriformis muscle is very weak. In fact, the piriformis muscle is often referred to as the 4th gluteal muscle. Sitting all day and hardly moving will cause this muscle to get chronically tight and weak.
When this muscles tightens up, it gets dangerously close to the sciatic nerve. If it is so tight that it starts to put pressure on the nerve, sciatica begins.
A tight piriformis muscle can be found in nearly all patients dealing with sciatica.
2. Herniated disk
The same principle as for the tight piriformis muscle applies for spinal disc herniations as well. Unfortunately, most herniations occur in the lumbar region, L3-L5, which is exactly the root of the sciatic nerve. Thus, once the disk is herniated, it will start to compress the sciatic nerve.
One of the main symptoms of patients with a herniated disk is the sensation of numbness and weakness in the leg. If the cause is not treated right away, your muscles of the leg will weaken and the nerve gets damaged.
3. Spinal stenosis
Another form of compression of the sciatic nerve. Spinal stenosis is one of the most frequent reasons for back pain in older generations.
Other causes include
- Degenerative disk disease
- Isthmic spondylodisthesis
What is the difference between sciatica and SI joint dysfunction?
SI (sacroiliac) joint dysfunction can lead to sciatic pain as well.
As I mentioned above, sciatica is not a diagnosis itself. The term SI joint dysfunction indicates the inflammation of the SI joint. Whenever inflammation occurs in our body, the immune system is activated to a high degree and cytokines are released. These cytokines can irritate the nerve and they are also responsible for sensations like fiever and pain.
I will address SI joint dysfunction and tips for treatment in the next article.
How to treat sciatica
First of all, you need to find the cause of the pain.
Thus, I highly recommend you to visit your doctor and explain to him all symptoms you have. If you have a herniated disc, the following exercises and stretches will certainly benefit you but if you have multiple discs herniated, surgery can be the only way of treatment. This is different for each individual, so make sure to assess the reasons.
However, as 99% of patients with sciatica (herniated disc or not) also have a very tight piriformis muscle, the following tips and stretches will not only relieve your pain but also help you to prevent sciatica in the future.
Acute Inflammation: Rest!
In the early stages of inflammation (first 2 days), you will experience a lot of pain and a hot burning sensation in your buttocks. This is the time to rest and stretch. Do not participate in any sports or training. You should also avoid walking for a long period of time or cycling, running. You could go swimming, as that puts no force on your joints.
Other than that, apply ICE to the region in the first two days.
After that, once the pain has decreased, apply heat to help the body repair tissue that has been damaged (heat increases blood flow to the region).
It has been proven that too much bed rest can actually worsen the pain. Thus, after the first day or two, you should start incorporating daily exercise to relieve the pain.
The reason for this is that moderate to light exercise that activates the sciatic nerve will prevent further damage to it. As I explained above, untreated sciatica can damage your nerve and muscles and you will always have a weaker side… .
1. Best stretches
Instead of posting numerous pictures here, it is best so see this in action on a video. I will certainly film my own version in the future, but for now I want you to visit this site:
2. Foam rolling
This will loosen up tight muscles, which will cause immediate relieve of pain. In the early stages of sciatica, you will need to repeat this sequence a few times a day. After a few days, the muscles will not tighten up anymore and it will be sufficient to roll once a day.
3. See a physical therapist
If you don’t have a foam roller, I highly recommend to purchase one (or use a tennis ball) or make an appointment with your physical therapist. Tell him you need a trigger point therapy. This means that he will apply pressure to specific parts of your muscles to release tension. It will hurt immensely, but afterwards you will not have pain anymore!
4. Strengthen the right muscles
– Core and Back strength –
The most important factor of training to reduce sciatica is core and back strength. Glute strength is important too but without a strong core, your glutes will not fire properly!
In terms of glute exercises, I recommend not to do any kind of Squats, Lunges, Deadlifts. These are compound movements that will require activation of many other stabilizing muscles. They could also activate or tighten the piriformis muscles even more, so stay away from those until your symptoms are gone completely!
– You workout schedule for sciatic pain relieve –
- Stretch the piriformis
- Foam rolling the lower body
Any time of the day:
5-10 min Cardio warm up (light walking or cycling is appropriate too)
- Leg Side Abduction (turn your toes in: this will prevent activation of the piriformis muscle)
- Side Clam Leg Raise : There are two versions of this exercise. For sciatica, you should do the external rotation and the internal rotation version to strengthen the piriformis (a strong muscle does not get tight!)
- Donkey Kicks bent leg
- Donkey Kicks straight leg
- Glute Bridge hold 40 sec.
- Glute Bridge
- One-legged Glute Bridge
Do all exercises for 40-50 seconds, 10-15 seconds rest, 2-3 times through.
Core and Back:
- Flutter Kicks – 20x
- Seated Row with Bands – 15x
- Pilates Toe Taps – 20x (10 each side)
- Reverse Fly – 15x
- Pilates Hundreds – 50 breath counts
- Reverse Crunches – 20x
- Plank Hold – as long as you can
- Back Bow – 20x
- Seated Row with Bands – 15x
- Reverse Fly – 15x
- Reverse Plank hold – as long as you can
Repeat this circuit 1-2x
Do this workout every day or every other day, but I would recommend to do at least 1 round each day. It does not take long, 20 min max. but it will help you relieve pain and build a stronger body.
Every night before going to bed:
- Foam Rolling
This will actually help you to sleep better. You will experience less pain and your circulation will improve.
I hope these tips will help you to decrease your pain.
I have dealt with sciatica myself for one whole year and it got so bad I was not able to walk or sit properly. Thus, I can relate to your pain but stay positive! I was able to get pain-free by following the workout plan above for 2 months.
I still stretch my piriformis daily and use the foam roller. If I don’t do this for a couple of weeks, symptoms start to occur again (though not as severe as before). It depends on the main cause of your sciatic pain, of course. My body is uneven because of scoliosis and will stay this way for ever, thus I need to do these stretches and exercises to prevent sciatica.
You might be lucky and never experience sciatica again!
If you liked this article and the exercises, leave me a comment below! Also, share your stories of how you dealt with sciatica!