In the first part of this article we covered some of the main causes of sciatica as well as how to properly roll and stretch the overactive muscles that are contributing to the pain. This allows tight muscles to relax so that underactive muscles can be recruited through corrective exercise. The purpose of this second part is to demonstrate the exercises that will help reprogram your posture and biomechanics in a way that will relieve pressure on the sciatic nerve.
As talked about in the other article, herniated discs are almost always caused by excessive flexion of the spine. This can occur during exercise or just from prolonged sitting. So our first priority in addressing excessive flexion is to strengthen the erector spinae muscles, the muscles that extend the spine.
This exercise is actually an active stretch which will put your spine into extension. If pain in the back is severe it is best to start with a passive version of this by placing a pillow or two under your chest and simply letting gravity stretch your low back. If pain is minimal try the active version by pushing off of your hands while inhaling deeply and holding for 3-5 seconds. Breath out on the way down and repeat. Make sure hips stay in contact with the ground and that the foot is in plantarflexion.
Another move from yoga that will help decompress your spine. Go to a table position on all fours. Breathe in deeply while arching your back and tilting your head. This is the cow position. Next, exhale and contract your abdominals by performing a posterior pelvic tilt and squeezing the butt. This is considered cat position. If sciatica is severe, avoid going into the cat position and instead only go to a neutral flat spine before hitting the cow pose.
For this exercise you will again be in the table position. Simply raise one arm and the opposite leg while engaging the abdominals. Make sure you chin is tucked and your head in line with the rest of your spine.
Straight Leg Bridge
In addition to working the back extensors this exercise will also engage your glute muscles which will help take the load off your back during hip hinging exercises. Lay on your back with legs straight on a ball or bench. Tighten your core and then lift up your hips while squeezing your glutes.
Reverse Hyper Extension
The famous powerlifter and founder of Westside Barbell, Louie Simmons, was told he would have to stop working out due to spinal compression and bulging discs. He came up with this reverse hyper machine as a way to achieve traction through an exercise that would strengthen the weak spine extensors and engage the glutes at the same time. This machine is not common in commercial gyms but you can do variations on a normal hyperextension machine or stability ball. Start with 90 degrees of hip flexion. Raise your legs, squeezing your butt as you reach the top. Pause for one second at the top.
Hip Hinge With Dowel Rod
This is a way to get your hips and back to work together. Any time you flex at the hips, your spine should be neutral. Many people are disconnected from this feeling of the hips doing work with the spine acting as a stabilizer. They tend to round the back as soon as the hips start hitting deep levels of flexion like during a squat or deadlift. To get a proper feel for what “loading the hips” should feel like, place a dowel rod along your spine. There should be contact with your head, between your shoulder blades, and on your butt. Perform a hinge of the hips, keeping the rod in contact with these three areas while maintaining space in between them as well.
The deadlift may be a scary exercise to try because it is likely the one that elicits the most pain. However, only in mastering it will we have fixed the issues that are causing sciatica to begin with. Avoiding certain exercises is not an option because it doesn’t directly address the problem. After a couple weeks of stretching, rolling, and doing the other corrective exercises you should be ready to give deadlifts a shot. Chances are you will have to start with a smaller range of motion to maintain a neutral spine so begin this out of the rack or on top of some plates. Pull the bar close to the shins and shift the weight backward to load the posterior chain. Make sure the spine does not round as you stand up. Start very light and you may need to use dumbbells or a hex bar in order to keep the spine neutral
When sciatica is caused by piriformis syndrome it means the butt muscles are underactive. The piriformis has become tight or hypertrophied to the point of irritating the sciatic nerve through synergistic dominance. The main role of the piriformis muscle is as an external hip rotator but it is also a stabilizer during hip extension. When the glute sare underactive the piriformis will take over the load. Thus we need to do exercises to isolate the glutes from the piriformis before attempting compound movements involving both.
Sounds kind of silly but the best way to start to get a connection to your glutes is to squeeze your cheeks together for 3-5 seconds. Do it often throughout the day and it will be much easier to activate during exercise.
Lay on your side with your legs straight on top of each other. To isolate the glutes the hips need to be in slight extension, so bring back the top foot so that the toe is near the heel of the bottom foot. Lift the leg up laterally with the foot flexed. Make sure it doesn’t move forward or backward or rotate. You can add ankle weights for more resistance.
When hips are semi-flexed, the glutes are responsible for internal rotation. Activating them will loosen the piriformis through reciprocal inhibition. Lay on your side with knees bent and hips flexed to about 30-60 degrees. Attach band to ankles and internally rotate by lifting the top foot.
Banded Lateral Walk
You can place a band around your legs or stand on one and hold the handles. Slightly bend your knees and reach laterally with one foot, keeping toes forward. Next step in with the other foot, keeping tension on the band.
Lay on your back with knees bent. Draw in your stomach and embrace your core, then lift the hips in the air while squeezing your butt. You can also do this on one leg to make it tougher and to further engage the glutes
Banded Hip Thrust
This exercise will help your body load the glutes when bending at the waist. Place a band around your hips and walk out until the tension makes it a struggle to keep from going backwards. Hinge at your hips, keeping the spine straight, then extend your hips and squeeze your butt while flexing your quads.
You can do these with a band during the corrective phase before shifting to normal squats once you are ready to resume normal training. You may need to hold onto something for support at first. Squatting below parallel while keeping the knees from turning inward ensures that the glutes and piriformis are working together optimally
If your sciatica is caused by this then you will most likely need to perform anti-extension exercises and movements that strengthen your spinal stability. Anti-extension exercises are where you fight gravity to keep the spine from going into extension.
The first exercise to try simply engages and connects you to the transverse abdominis. While on your back with knees bent, flatten the small part of your back and hold for 5 seconds
Nothing fancy here, just make sure the spine is neutral by squeezing your butt and flexing your quads. Keep your head down.
This targets the transversus abdominis as well as the internal obliques, both of which play large roles in spinal stability. Place your elbow directly below your shoulder and hold your hips in the air with your legs stacked on each other.
Once your core is strong enough, try the dead bug. Lie on your back with your arms straight in the air and knees bent. Lower one arm overhead while lowering and straightening the opposite leg. Make sure the lower back does not come off the ground. If this is too difficult then try it without lowering the leg as close to the ground.
For these corrective exercises perform 2-4 sets with the reps at 12-20. Issues that cause sciatica may take weeks or even months to fix. The important thing is to work through problems instead of just resting until the pain goes away. Simply waiting it out means the underlying issues remain and will ultimately cause sciatica again. If pain persists and worsens after a week or so, definitely see the doctor if you haven’t already. Once your pain is gone a routine consisting of squats, deadlifts, isometric core work, lunges, and thrusts will keep it from coming back. Make sure to take your Sheer Recovery to aid in recovery and prevent soreness.
It’s amazing how much you appreciate being pain free after you have been suffering for an extended period of time. So take the steps towards fixing yourself so you can get back to experiencing only “good pain” after heavy lifting in the gym.