Yoga and Sciatica

Sciatica-a real pain in the butt!  Women tend to experience sciatica more often than men, with about 40% of adults experiencing sciatica at some point.

The sciatic nerve is the longest nerve in the human body, starting at the spine base and running right down through your thigh and calf muscles to your foot. It  is composed of five individual nerve roots originating in the sacral plexus of the lower back . The five individual nerve roots merge to join together to make up the larger sciatic nerve that travels down the posterior thigh towards the foot. Once this nerve is impinged, compressed or irritated pain can occur. The symptoms will express themselves in different places depending on where the nerve originates and where it is impinged, compressed or irritated:

 

 

  • the sciatic nerve root starting at vertebra L4 affects the thigh,
  • the nerve root at L5 will affect ankle, top of the foot and big toe,
  • and the nerve root at S1 affects the bottom of the foot and the smaller toes.

When sciatica pain hits, it can be tempting to stay sedentary out of fear that you might make the flare-up worse. Yet moving your body slowly and gently can be one of the best ways to ease your symptoms.

By definition, sciatica is tenderness and pain anywhere along the sciatic nerve. Each originates from several nerve roots that exit from the spinal cord, then thread through apertures in your sacrum and merge to form the main body of the sciatic nerve. The sciatic nerve passes between layers of the deep buttock muscles (gluteus medius and gluteus maximus), through the deep muscles of the back of the thigh, and down through the outer edge of your leg to your foot.

 

Sciatica frequently flares up while bending over, running, sitting (especially driving) and during many other everyday movements, both active and passive. Symptoms can include:

  • Pain anywhere along the sciatic nerve pathway: in the lower back, buttock, back of the thigh, and/or calf.
  • Fatigue, numbness, or loss of feeling in your legs and/or feet.
  • An electric, tingling, burning, pinching, or pins-and-needles feeling known as paresthesia.
  • Weakness that can cause your knees to buckle when you stand up from sitting.
  • Foot drop: a condition in which you are not able to flex your ankles enough to walk on your heels.
  • Reduced reflexes in your Achilles tendon and knee.

But there are solutions, according to fellow Yogi Jennilee Toner ‘ Yoga is by far one of the best preventative measures you can take in order to lower greatly your chances of experiencing the debilitating pain of sciatica’. And Yoga offers us lots of opportunities to relieve this debilitating pain.

Finding the Cause of Your Sciatica is Very Important

Typically, sciatica symptoms can be traced back to two different reasons:

One of the most common causes is Piriformis Syndrome, which happens when the piriformis—a small muscle deep in your hips that externally rotates (turns out) your thighs—becomes tight and compresses the sciatic nerve, leading to pain in the bottom muscles.

The other main cause of sciatica is compression in the spine, usually between the L4 and L5 vertebrae (the lowest two vertebrae in your lumbar spine, or lower back), that can lead to the disc between those vertebrae bulging (or herniating) and compressing the sciatic nerve.

Therefore presence of sciatic pain often leads doctors to look for a herniated disk in the lumbar spine, which may be pressing against the sciatic nerve. This is a significant problem, and it’s especially important to have your disks checked out by a doctor if you are experiencing pain in your mid-lower back, painful electric shocks down your sciatic nerve, and/or tingling, burning, weakness, or numbness in your legs or feet. These can be signs that an acute herniated disk is pinching the nerve, which is a bigger problem than sciatic pain alone. But also can vary in severity.

If the source of your sciatica is a herniated or bulging disk. A yoga practice that progresses from gentle poses to standing poses and downward-facing dog will align, lengthen, and strengthen your lower back. The key thing is to get the severity assessed by your doctor and then start gentle movements. 

Some of the other causes of sciatica are:

  • Degenerative disc disease – this is attributed to the aging process and the natural wear and tear of the spinal column. Where weakened discs occur there is usually excessive micro-movements of the vertebrae which lead to inflammation and irritation of the nerves. Bringing a deeper awareness to patterns in the body can help relieve this inflammation, and back releasing and strengthening postures to help strengthen and protect will help to reduce further incidents.
  • Spondylolisthesis occurs when a stress fracture of a vertebra causes it to slip forward onto the vertebra below it compressing the disc between the two vertebrae and pinching the nerve.
  • Lumbar spinal stenosis is the narrowing of the spinal column due to the degeneration of vertebrae, soft connective tissue that supports the bones of the spine and the discs between them.

However, as mentioned above, Sciatica can also be caused by a small but significant muscle deep within your hip—the piriformis. In fact, another 2005 study in the Journal of Neurosurgery: Spine showed that nearly 70 percent of sciatica cases are caused by this muscle. The piriformis is one of a few small deep hip rotators that you use to turn your thigh out. It also extends your hip when you walk, and abducts the thigh (i.e., takes it out to the side) when your hip is flexed. The sciatic nerve is sandwiched between the piriformis and the small hard tendons that lie against the bone of the sacrum and pelvic bone. If the piriformis is tight (and it often is), it exerts pressure on the sciatic nerve and pushes it against the tendons beneath it, which can cause excruciating pain; this is known as the piriformis syndrome.

How can you tell if the problem originates in the piriformis? Here are a few indicators:

  • Pain and a pins-and-needles sensation down the outside of your calf to the web space between the little and fourth toes.
  • Difficulty walking on your heels or on your toes.
  • Burning in the back of your thigh and calf down to your heel, with stiffness in your legs. (Note: In some cases this can signal a problem in the spine instead of the piriformis.)
  • Pain from sitting, accompanied by a tingling sensation at the back of your thigh. The pain may be relieved by standing, but you still experience numbness in all of your toes even when standing.
  • Buttock and sciatic pain from exercising or sitting for long periods of time, with or without sensations of numbness, weakness, or tingling. While the pain may appear during standing activities, it gets worse when you sit down.

Fellow Yoga Therapist Doug Keller recommends using the F.A.I.R. test (in which the thigh is Flexed, Adducted, and Internally Rotated): Lie on your side with the affected leg on top. Is it painful in your hip to have the top leg bent with the knee resting on the floor in front of you? Does it hurt especially when you try to lift your knee away from the floor against a small amount of resistance, such as a bag of rice? Sharp pain in the hip is a sign that the piriformis may be causing the sciatica.

How Yoga Can Help Relieve Sciatica?

Hamstring stretches also play an important role in relieving sciatic pain, because tight hamstrings can gang up with a tight piriformis to constrict the vulnerable sciatic nerve.

Sciatic pain caused by a tightening of the hamstrings and surrounding muscles often comes from activities such as driving for long periods, especially when the car seat encourages a slumped or rounded posture, or during athletic activities.

If the source of your sciatica is a herniated or bulging disk, a yoga practice that progresses from gentle poses to basic foundational asanas like standing poses and downward-facing dog will align, lengthen, and strengthen your lower back. A herniated disk does not always require surgery, and yoga can help you manage and reduce the problems caused by the herniation, sometimes even reducing the herniation itself. However, it’s important to check with your doctor about the severity of the herniation: only severe cases surgery may be required.

If the source of your sciatica is pressure on the nerve due to a short, tight piriformis, focus on stretching this muscle. Your approach should be gentle and progressive, since overworking the piriformis may lead to spasms and deep buttock pain, which may or may not be accompanied by sciatic pain.

Start slowly and build the intensity of the stretch slowly, remember to accompany each movement with your Full Natural Breathe.

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