Sciatica and Nerve-Related Pain: What to Avoid and What Helps

Pain that shoots, burns, or tingles down the leg has its own name: sciatica. It’s one of the most common forms of back pain, and also one of the most misunderstood. The strategies that help a typical low back ache can actually make sciatica worse. This week: what’s actually going on, what to stop doing, and what helps the nerve calm down.

What is sciatica?

I’m sure you’ve heard of it. Sciatica refers to the compression of the sciatic nerve (or one of its roots), which produces pain that ‘radiates’ from the back or glute down into the leg. Sciatic pain is often referred to as radicular pain and can also be called lumbar radiculopathy. The pain can be described as:

• Sharp
• Shooting
• Electric
• Burning
• Tingling
• Numbness
• Some describe a “pulling” feeling in their leg [1]

Anatomy

The sciatic nerve exits the spine at nerve roots L4 through S3. It innervates the posterior thigh, lower leg, and the foot. This is why people feel pain and altered sensations in their legs. The nerve is underneath the gluteal region and lies right next to a muscle called the piriformis. The piriformis muscle itself can compress the sciatic nerve and reproduce the same symptoms as sciatica without a nerve root being compressed. This is actually quite rare, and pain is more likely due to a compressed nerve root.

It’s no coincidence that radicular pain is so common. L4/5 and L5/S1 vertebral levels are common locations for disc bulges and herniations and the nerve roots exiting at these levels feed into the sciatic nerve.

What to avoid

Radiculopathy means that the sciatic nerve (or its roots) is irritated. We want to stop giving it reasons to throw a tantrum. That means we have to stop:

• Stretching the muscles of the hips (temporarily) until the nerve calms down
  • This includes hamstring, figure 4, “bend over and touch your toes,” and knees to chest stretches
  • Hamstring and figure 4 stretches are in my exercise library, but are not to be performed by those with active radiculopathy
• Bending over with a rounded back
• Prolonged sitting and slouching

These actions pull on the irritated nerve or feature postures that further compress the affected nerve roots. On the temporary stretching ban, it may seem counterintuitive not to stretch the glutes and hamstrings when they may need it, but there are other options to release muscle tension until the pain settles down. I normally don’t like recommending interventions that cost people additional money, but I think this one is worth it. Foam rolling your glutes and hamstrings is a fantastic way to release tension without tugging on the sensitive sciatic nerve.

What to do – for relief

• Nerve flossing
  • Gentle nerve flossing gets the nerve moving without violently tugging on it
  • Found to be effective for decreasing pain and disability in lumbar radiculopathy patients [2]
• Tummy lying
  • This is a simple way to unload if the posterior disc is a little too cozy with a nerve root
  • Gravity does the work for you
• Foam rolling
  • Release muscle tension without pulling on the nerve

What to do – for long-term improvement

• Walking + decompressions
  • Keeps us moving and adds rhythmic loading and unloading to the spine
• McGill Big 3 core exercises
  • Rebuilds core strength and stability without irritating the spine with flexion
• Hip hinging
  • Trains us how to bend without rounding
• Mid-range cat-cow
  • Mobilizes the spine without reaching painful end-ranges of motion

Summary

With sciatica, we want to stop angering the nerve. This means rounding less, avoiding stretching the nerve, retraining our movement, building stability, and keeping moving. This is a long-term strategy and certainly less catchy than a headline of “cure your sciatica instantly”, but it’s the truth. Keep at it. You’ve got this.

If you haven’t taken the triage quiz yet, it maps your pain to one of six patterns in about five minutes. That’s the starting point for the program itself.

As always, have a great weekend.

Best,

Mitch

References

[1] Berry et al. (2019) — Cureus — https://doi.org/10.7759/cureus.5934

[2] Lin et al. (2023) — Life — https://doi.org/10.3390/life13122255