Top Tips for Sciatica Relief

Sciatica isn’t really a diagnosis but a term used to describe a symptom – pain down the back of the leg (following the path of the sciatic nerve.) There are many different potential causes of sciatica and each case needs to be managed accordingly. This articles describes the three most common causes of sciatica and discusses the best exercise, self-care and treatment options for sciatica relief.

1) Disc herniation

The spinal discs sit between and separate each segment (or vertebra) of the spine. They act as spacers, allowing the vertebrae of the spine to move freely. The discs are built a little like a jam donut – they have a strong fibrous outer layer, the annulus, which surrounds a jelly-like centre, the nucleus (see image).

If the outer portion of the disc weakens, the jelly-like nucleus can start to seep out. If it travels far enough it can start to compress the nerves exiting the spine. As the nerves from the lower back travel down to the legs and feet, compression from a disc herniation often gives rise of the typical ‘shooting’ sciatic pain down the legs.  Compression of the nerves of the lower back can also cause numbness and weakness into the leg(s) and, in severe cases, patients may have difficulty walking.

Increased time spent sitting, working with vibrating machinery and repetitive motions (especially repeated forward bending) are all associated with an increased risk of lower back disc injury.

Self-care & treatment options

• Firstly, avoiding further injury to the disc is key. Read more about dealing with disc pain here.
• Certain exercises such as the cobra position can also be helpful for relief from sciatic pain due to disc herniation.
• Fortunately, injections and surgery are rarely needed for the treatment of disc herniation and it can be successfully resolved in 95% of cases with self management strategies (such as those described above) and conservative care (such as spinal mobilisation, repeated movements, soft tissue work, traction and exercise rehabilitation) .

Sleep tips for sciatica from disc herniation

Sciatica due to disc herniation is often associated with severe pain at night pain. Supporting the lower back in a well alligned position can help.

Supine (on your back)

Support under your lower back can help to prevent your lower back flexing into the mattress which is often a trigger for lower back disc problems. Use either a well-fitting pillow or the PropAir Sleeper support.

Foetal position (side lying)

If you like to sleep on your side a support under your trunk can help to reduce painful side bending. Try laying on the side of your sciatica with a support (such as a small pillow or the PropAir Sleeper) positioned betwen you ribs and pelvis.

A pillow or support between your knees can also help to reduce sciatic symptoms when side lying.

Foetal position (side lying)

Although this not a generally recommended long-term sleeping position, it can be comfortable in the short term for many patients with sciatica due to disc pain.

Supplements for Sciatica

If you have nerve damage as a result of sciatica from a disc herniation, supplementation can help with repair. Learn more here.

2) Joint referral

The joints of the lower back and pelvis are also common sources of sciatic pain, mimicking the symptoms of disc herniation.  The picture to the right shows the typical referral pattern for the sacroiliac joint (the joint that links the spine to the pelvis). As you can see, if irritated, the sacroiliac joint can refer pain all the way down to the feet in some cases. Joint irritation can result from a number factors such as chronic poor posture, muscle imbalance or weakness, repetitive strain or following lower back injury (such as a fall onto the buttocks).

Self-care & treatment options

• Self-treatment of a restricted sacroilliac joint is very difficult. It is initially best treated with manual therapies such as spinal manipulation or mobilisation.
• For patients with pain as a result of weakness or instability of the pelvis, such as pregnancy-related pelvic pain, an SIJ belt can be an effective way to support the pelvis and help to reduce pain.
• Once the initial pain has resolved, underlying issues such as poor posture and muscle imbalances can be addresed with ergonomic changes and stabilisation exercises.

3) Muscle referral

Similarly to the joints, particular muscles of the lower back and pelvis can refer pain down the leg. One of the most common culprits is the gluteus minimus muscle. Hip or back problems can irritate this muscle which will then often refer pain down the side or back of the leg (see image).

Self-care & treatment options

• Stretching this muscle effectively can be difficult so direct approaches such as dry neelding or massage tend to be the best first–line treatment options.
• Self-massage, or myofacial release, with a trigger point ball or foam roll can also be used to treat the gluteus minimus. Click here to see how to perform self-myofascial release for the gluts.
• For those looking to learn more about myofascial release the book ‘Becoming a Supple Leopard’ by Kelly Starret is a great resource.

Related articles

• Cobra exercise for sciatica
• Side bridge exercise for lower back pain
• Lower back pain

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‘Top Tips for Sciatica Relief‘ was written by Steffen Toates. Steffen is a Chiropractor at Dynamic Health Chiropractic in Jersey CI. For more information about Steffen click here.

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