The Sciatic Scoop
Answers to all your questions
Core Exercise
Activation Exercise
The foundation of spine support
What does this target?
Transverse abdominis and multifidi core muscles.
Why is this important?
These muscles work together to stabilize the spine but can be difficult to activate, particularly for people in pain.
How many sets and repetitions?
20 repetitions performed at least 3 times per day - 10 second holds alternating with 10 second rests (Huber et al., 2011)
More Information:
Training specific core muscles, such as the transverse abdominis and multifidi, has been shown to decrease sciatic pain (George et al., 2021). These muscles work together to stabilize the spine, but are often underused especially by people experiencing pain. It is important to be able to activate these muscles and develop a strong base before advancing to more complex exercises. Most people find that this exercise is easiest to learn while lying down. However, the same exercise can be done while sitting, on hands and knees, or in standing.
The video above recommends a specific rep scheme, but research suggests that performing this exercise more often is beneficial (Richardson & Jull, 1995). Instead of using a timer, you can also measure contraction and rest times with two full breaths for each.
Bird-dog Exercise
Stabilizing the spine in space with movement
What does this target?
Transverse abdominis and multifidi core muscles.
Why is this important?
The core must be able to stabilize the spine in space while the limbs work to complete functional movements.
How many sets and repetitions?
20 repetitions performed 3 or more times per day
More Information:
Once you are able to activate the transverse abdominis and multifidi without difficulty, more advanced movements are appropriate (Hahne et al., 2017). The bird-dog exercise teaches the core muscles to stabilize the spine without external support and counteract the movement introduced by the limbs during functional activities. To promote appropriate motor patterns this exercise should be repeated as many times as possible throughout the day (Richardson & Jull, 1995).
Dead Bug Exercise
Creating a base for arm and leg movement
What does this target?
Transverse abdominis,multifidi, and rectus abdominis core muscles.
Why is this important?
The core is vital for stabilizing the spine while the limbs are moved for functional activities.
How many sets and repetitions?
20 repetitions performed 3 or more times per day
More Information:
The dead bug exercise recruits the core musculature to stabilize the spine while the limbs move in space, providing support for functional activities. To ingrain appropriate motor patterns this should be repeated as many times as possible throughout the day (Richardson & Jull, 1995).
This video offers exercise variations to increase the intensity that may be used if this exercise becomes too easy. If the baseline option is too difficult, begin with heels resting on the floor as the default position, alternating which one is raised to the position shown.
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Nerve Exercise
Nerve Flossing
Moving and desensitizing the Sciatic nerve
What does this target?
The Sciatic nerve as it emerges the lumbar spine and travels the length of the lower extremity
Why is this important?
Nerves function best with adequate space, blood flow, and movement. This movement reintroduces all three across the length of the nerve which can help reduce nerve sensitivity.
How many sets and repetitions?
15 repetitions performed for 3-5 sets once per day
More Information:
The entire nervous system is connected from the brain all the way to the pinky toe. Nerves have to be able to move within their surrounding tissues as we move our bodies to maintain normal physiological function (Bhatia et al., 2017). The motion of this exercise alternates the direction of tension placed on the nerve, first from one end and then the other. While the video mentions a specific rep scheme, research indicates that the rep scheme outlined above is safe and effective (Bhatia et al., 2017).
General Activity
Aerobic Activity
Walking, Running, Hiking, Biking, Swimming
In previous years medical practitioners would recommend bed rest for low back pain. Through extensive research we now know that maintaining activity is an important element for all types of low back pain, including sciatica.
Stay as active as possible within tolerable pain limits, but respect any increase in leg pain as a warning to decrease vigor (Albert & Manniche, 2012).
Lower impact exercises like walking or swimming may be most comfortable.
Resistance Activity
Strength, Power, Endurance
People with Low Back Pain are often advised to forego the weight room to promote recovery. However, research has found benefit in maintaining resistance exercise (Moustafa & Diab, 2015).Â
Respect increased leg pain as a sign to decrease vigor (Albert & Manniche, 2012). Consider upper extremity exercises and decreased intensity for lower extremity exercises.
Activities of Daily Living
Work and Play
Maintaining activity is an important element for all types of low back pain, including sciatica.
Stay as active as possible within tolerable pain limits, while respecting any increase in leg pain as a warning to decrease vigor (Albert & Manniche, 2012).
References
1. Albert HB, Manniche C. The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine (Phila Pa 1976). 2012;37:531-542. https://doi.org/10.1097/BRS.0b013e31821ace7f
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2. Bhatia SS, Bid DD, Thangamani Ramalingam A. Effectiveness of nerve flossing technique in chronic lumbar radiculopathy. Indian J Physiother Occup Ther. 2017;11:44-49
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3. George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. The Journal of orthopaedic and sports physical therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304
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4. Hahne AJ, Ford JJ, Hinman RS, et al. Individualized functional restoration as an adjunct to advice for lumbar disc herniation with associated radiculopathy. A preplanned subgroup analysis of a randomized controlled trial. Spine J. 2017;17:346-359. https://doi.org/10.1016/j.spinee.2016.10.004
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5. Huber J, Lisiński P, Samborski W, Wytrążek M. The effect of early isometric exercises on clinical and neurophysiological parameters in patients with sciatica: an interventional randomized single-blinded study. Isokinet Exerc Sci. 2011;19:207-214. https://doi.org/10.3233/IES-2011-0418
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6. Moustafa IM, Diab AA. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. J Manipulative Physiol Ther. 2015;38:167-178. https://doi.org/10.1016/j.jmpt.2014.11.009
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7. Richardson, C. A., & Jull, G. A. (1995). Muscle control-pain control. What exercises would you prescribe?. Manual therapy, 1(1), 2–10. https://doi.org/10.1054/math.1995.0243