Dealing with sciatica can be a real pain in the butt. Literally. It can also be a pain in the low back, the hamstring, and even the foot. Sciatica is the general term given to a collection of symptoms associated with an irritated sciatic nerve. In addition to pain there may be weakness, tingling, and numbness in the muscles the sciatic nerve travels through. It is often the reason why some bodybuilders give up squats and deadlifts, and why some people give up working out all together. This is because symptoms often flare after physical activity. If you are not using optimal movement patterns during your workouts, then you are reinforcing muscular imbalances that may be contributing to sciatica.
There are many causes of sciatica and if you are having serious symptoms it’s always best to see a doctor first. Remember, sciatica is a collection of symptoms that can arise from a number of underlying causes. The way to address the sciatica will be dependent on the root cause. Certain treatments may be very beneficial in some cases while causing further damage in others.
Some of the causes are related to aging or disease such as tumors, spinal stenosis, and degeneration of discs. These may require surgical intervention, and the physiotherapy treatment is beyond the scope of this article. However, when talking about the healthy bodybuilding population there are a few main causes of sciatica that can typically be self treated and fixed within 1-6 months depending on severity.
Herniated lumbar discs are the most common cause of sciatica. The vertebrae have tiny cushions between them that act as shock absorbers when the spine is placed under compressional force during lifting and high impact activities such as running or jumping.
These discs can become damaged over time from poor posture and biomechanics. Compression can also result from compressive trauma like a car wreck. Bulging discs occur when the fibrous outer ring tears and the gel-like nucleus of the disc spills through and pushes the disc past its normal anatomical position. This may not cause sciatica or any pain at all, or it could be localized to the lower back. Often as a result of the tear the disc nucleus spills out onto the sciatic nerve, causing irritation, which is known as a herniated disc.
Since these are the most common source of sciatica, this should be our first stop in our diagnosis. Remember, herniated discs are caused by excessive compressional force which almost always means excessive flexion of the lumbar spine. So if you feel sciatica after deadlifts and squats or after doing something (like moving furniture) that requires a lot of bending over then there’s a good chance a herniated disc is the cause. Lack of extension in the lumbar spine is very often due to a posteriorly tilted pelvis and, although possible, it’s much more rare to have herniated lumbar discs if you have an anterior pelvic tilt.
An easy method to help determine if the sciatica pain is originating from a herniated disc is the straight leg raise test. To perform this test, lie on your back with your legs straight. Hold onto a towel or yoga strap and place it a foot at the toes. Slowly lift your leg passively using the strap. Repeat on the other leg. If you feel sciatica initiating from the lumbar spine regardless of the leg you use, you can be pretty sure a herniated disc is the cause. The pain will likely start with your leg lifted somewhere between 30-70 degrees.
If you feel sciatica and it is originating in the glutes, it may still be a herniated disc if lifting either leg causes it. To rule out glute dysfunction as the culprit, perform a hip flexion test. If hip flexion with a bent knee is more painful that straight leg extension it is likely piriformis syndrome or another pathology of the hips/glutes.
Foam Rolling and Stretching
Trunk: Roll out all areas of your back and sides. After rolling place the roller on the low thoracic spine and reach over your head letting your back go into extension.
Glutes: This area is better suited for a lacrosse ball. When you find tight areas, flutter the knee side to side through internal and external rotation of the hip. To stretch the glutes try a pigeon stretch, crossing your leg in front of you and leaning towards your knee. You can also do a standing variation if you lack the mobility to do it from the ground.
Hamstrings: Hamstrings are tough muscles to loosen up, so use something dense like a barbell for rolling. This hamstring stretch will get much deeper with your lumbar spine in extension. Pull your toes towards you and lock out the leg while arching the back and driving the hips backwards.
Traction: Using an inversion table or simply hanging from a pullup bar will help decompress the spine.
This happens when the piriformis muscle irritates the sciatic nerve. The piriformis often becomes tight through something called synergistic dominance. Most people have underactive glute muscles due to sedentary lifestyles or sitting for long periods a time. The piriformis is meant to assist the glutes in external rotation of the femur and in stabilization of internal rotation. Synergistic dominance occurs when these glute muscles are weak or inhibited, resulting in excessive load placed on the piriformis and other accessory muscles. The result is a tight, hypertrophied piriformis that pinches the sciatic nerve. Piriformis syndrome is not technically sciatica since it does not originate from from the lumbar spine, but it causes the same symptoms.
If the straight leg test does not confirm a herniated disc then piriformis syndrome may be to blame. To test this, perform these two different stretches to see if pain occurs in your piriformis. Lie on your back and pull the affected leg across your body with knee bent. You can also try a sitting stretch placing your foot on the opposite knee. Press on the crossed knee and see if this elicits pain.
Keep in mind pain from a herniated disc can originate in the back, butt, or hamstring. Piriformis syndrome will almost always originate from the glutes. An anterior pelvic tilt is more likely to be associated with piriformis syndrome than a posterior pelvic tilt because the tight hip flexors will inhibit glute function. This is why the piriformis becomes overactive and hypertrophies to the point of irritating the sciatic nerve.
Foam Rolling and Stretching
Hip Flexor: A lacrosse ball is a good option for this area. Make sure the lumbar spine is not in extension. Perform the hip flexor stretch, contracting your glute for 5 seconds at a time with 5 second rests.
Quads: Foam Roll the quads while bringing your foot back towards your butt. To stretch the quads, get in the same position as for the hip flexor but bring yourself all the way upright. You may need to bring the knee away from the wall to keep a neutral spine.
Piriformis: Use a lacrosse ball to find this tiny muscle. When you feel it you should know from the instant sharp pain. Stay on it and go through external rotation by crossing your foot to the knee. Loosen this up by performing the same stretch that we used to test for piriformis syndrome.
There are different types of this condition but the one that is most relevant to the bodybuilder is isthmic spondylolisthesis.This is when a vertebrae suffers a fracture and slips forward over the vertebra below, pinching the sciatic nerve. Although more rare than the other two primary causes of sciatica, spondylolisthesis is not uncommon in athletes who regularly hyperextend their backs, such as gymnasts. People participating in crossfit are also more likely to suffer from this due to the high volume of overhead pressing and squatting movements. Crossfit is often performed at a near-frantic pace and form suffers as fatigue sets in. This can result in compensatory hyperextension during these overhead movements.
There are no easy tests to see if you are suffering from this. It can only be confirmed through imaging interpreted by a professional. Some common traits of those with spondylolisthesis are hypermobile spines and participating in activities with load under spinal extension. Also, when performing the straight leg test pain will typically initiate when the legs are lifted at less than 30 degrees.
Foam Rolling and Stretching
Psoas: Typically the psoas is tight in people with spondylolisthesis. Lay on your stomach with a lacrosse or softball positioned over the psoas. Lean back and stretch against the ball while actively performing a posterior tilt to keep the back from going into extension. You can also lift the leg up a few inches in the air behind you, There are many different psoas stretches but most of them take you into extension of the spine as well. With spondylolisthesis we need to avoid extension because it can make the pain worse. Try this stretch while lying on a table or bench and keeping your back from arching. Let the leg simply hang and gravity will stretch the psoas.
Other areas that need to be addressed will be dependent on the individual and their specific muscular imbalances. One thing to avoid is rolling the lower back.
Some Things To Remember
Now that we have covered the root causes of sciatica and how to mobilize the tissues, you may experience some alleviation of symptoms. However, mobility work is only half of the equation. Once you have loosened up your tight muscles you need to perform the necessary corrective exercises to fix the faulty movement patterns that are contributing to the pain. Be sure to check out Part 2 of this article to learn the exercises that will help relieve sciatica and keep it away.