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Sciatica Exercises - the Good and the Bad
Sciatica exercises are an important part of both short and long-term treatment, but it is critical to choose the right exercises. Even commonly-recommended exercises for sciatica may not be indicated during times of severe acute symptoms, and some exercises may only make things worse.
McKenzie practitioners use the word "centralization" when the pain and other symptoms are relieved in the areas the greates distance away from the spine. To give an example, in a person with sciatica all the way down the leg to the foot, centralization might occur in which the pain left the foot and lower leg and then only extended down to the knee. Or, if sciatica symptoms started out going as far as the knee, centralization would be if the symptoms left the thigh and only went as far as the hip area.
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During the acute phase of sciatica pain, McKenzie exercises provide one of the best and safest treatment approaches available - more effective than medication and epidural steroid injections in many people. Though often associated with spinal extension and mistakenly called the "McKenzie Extension Exercises", McKenzie method may involve any number of spinal positions/movements. The whole point of the McKenzie method is to evaluate different positions/exercises to find what best produces "centralization" of symptoms.
The simplest of the McKenzie exercises for alleviating sciatica is done by simply lying on one's stomach on the floor or a firm surface and propping one's chest up on the elbows. This places the lower spine in a gentle extension, which can help relieve sciatica by pushing bulging spinal discs forward, and away from the nerve roots that form the sciatic nerve, reducing pressure and irritation. Although you can maintain this position for relatively long periods of time, I recommend doing it for short periods of one or two minutes with a rest break of at least a few minutes in between. The frequent breaks prevent the low back muscles from tightening up as much, and yet still allows for good overall results. For more complex sciatica exercises, getting detailed instructions either through an illustrated guide or an experienced health care practitioner is advised. Writing on exercises for sciatica pain proved to be a gamble to us. This is because there simply seemed to be nothing to write about in the beginning of writing. It was only in the process of writing did we get more and more to write on exercises for sciatica pain.
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A position or exercise that results in symptom centralization is one that will be beneficial, even in situations where symptoms increase for a time in areas closer to the spine. For example, if you had sciatica and low back pain and tried one of of the McKenzie exercises and the sciatica completely went away but the back pain got worse, the exercise would still be considered beneficial and it would be recommended to continue using it. In the long run, a sciatica exercise that produces centralization will usually eventually result in improvement in all symptoms, even if more central (closer to the spine) symptoms get worse at first.
For example, while commonly recommended to people with sciatica, exercises such as hamstring stretches and the yoga position, "downward facing dog" can be beneficial as part of managing one's condition once the pain is reduced, these exercises can place tension on the sciatic nerve and aggravate an already inflamed and sensitive condition. In general, any exercise that causes pain to increase in the leg and/or extend further down the leg should be completely avoided during the acute phase of sciatica.
About the Author:
Dr. George Best has been treating sciatica patients for over 15 years. For a free e-book on sciatica exercises and to access his informational online video series on sciatica and the treatment options for it, visit his website on sciatica self care.
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