What types of exercises do you recommend for sciatica? One of my members is suffering from it, and I’ve recommended stretching, swimming and abdominal workouts. His whole back is a bit messed up, and he’s being treated by a chiropractor and gets a massage once a week as well.
First, we highly recommend consulting with your client’s chiropractor! Ask the chiropractor questions about the possible cause of your client’s condition (the effect is sciatica). There’s no such thing as sciatica exercises - if someone tells you different, they are oversimplifying this amazing, highly sophisticated, integrated body! However, we can supply you with a guideline. Use this information to communicate with the chiropractor and massage therapist while designing the exercise program.
Sciatica is pain in the buttocks and the back of the legs due to irritation of the sciatic nerve or nerve roots. Sciatic pain (sometimes called a “pinched nerve”) occurs when a herniated disc compresses the nerves of the lumbar spine. Because these nerves supply the sensation and strength to the lower extremity, a disc problem in the low back can cause symptoms in the legs such as weakness or numbness. Sciatica can also transpire from an irritated nerve that is not under compression.
Unfortunately, back and neck pain is interwoven into our lives. They are common yet unpleasant experiences that, if mismanaged, can become chronically disabling.
Chiropractic adjustment may be the most effective treatment for quick pain relief. Most experts will agree that manipulation is just a part of the rehabilitation process. Manipulations, in combination with exercises and home education, have proven to be far superior to traditional prescriptions of prolonged bed rest and medication.
Below you will find a list of points specific to your question. Use the points as an adjunct to your current program design.
- Always perform a movement analysis on your client. The analysis will clearly show what your client can and cannot do. All exercises should be created based on the client’s level of control. The active tissues (muscles) need to support the passive structures (bones, joints, ligaments). Safety and technique is the key!
- If your client has been misusing exercises, start by teaching functional technique! Think patterns, not muscles! Always stay away from painful patterns. Pain equals damage! If your client is free to move while performing an exercise, he will unconsciously migrate from pain. Use his movement to assess functional abilities, and do not train on fixed equipment.
- Many traditional exercises encourage dysfunctional movements. Examples include angled leg press. Next time you're in the gym, observe the exerciser’s spine. Without much thought, it is easy to see the spine curl up. Ask yourself, "When in life do we press objects away from our body with both legs, simultaneously?" Also, stay away from the seated abductor machine. When the hip is flexed 90 degrees, the piriformis becomes a prime mover in abduction. Increasing tension in the piriformis will most likely exacerbate your client’s condition. Do not perform stiff legged dead lifts. This position over emphasizes the hamstrings and under utilizes the glutes.
- Watch out for:
- Hip flexors substituting for abdominals in abdominal exercises
- Hyperextension of the low back when performing hamstring exercises (butt blaster, lying leg curls, etc.).
- The head jutting forward while performing pulldowns, lateral raises, abdominal crunches, squats, curls, etc.
- Many times when getting and returning weights, people forward flex with heavy loads – teach proper lifting, in and out of the gym.
Aerobic exercise is excellent, under certain conditions:
- Stair-climbing is risky if a client has weakness of the gluteus maximus, medius or over-activity of erector spinae, quadratus lumborum, or tensor fascia latae.
- Stationary bike may not be advisable after a day of sitting at a desk or in a car.
- Train all surrounding healthy tissues through functional patterns:
- Multi-directional lunging
- Climbing stairs
- Balance Drills
- Bend and reach/lift
- If the legs(s) are affected at the same time of training, decompress the body and stimulate the healthy tissues. Examples:
- Swiss ball – Supine hip extension with knee flexion
- Swiss ball – Supine hip extension
- Swiss ball – Forward ball roll
- Swiss ball – Prone jack knife
- De-weighted squat – Use a cable cross over system, which allows you to de-weight your client. The cable(s) handle is placed above the head with an appropriate load to assist the squat.
- Research has shown that uni-lateral training benefits the injured side.
- Stay away from isolation training techniques (i.e., fixed machine training).
Read the many functional articles posted on the site. Your client will benefit greatly from a whole body, functional approach!