🦵🧠 Understanding Sciatica: Anatomy, Causes & Evidence-Based Relief 🏃‍♂️💡

What Is the Sciatic Nerve?

The sciatic nerve is the largest and longest nerve in the human body, formed by the ventral rami of spinal nerve roots L4, L5, S1, S2, and S3. These nerve roots merge in the lumbosacral plexus, exit through the greater sciatic foramen, and travel under or through the piriformis muscle in the buttocks. The nerve then continues down the posterior thigh before branching at the popliteal fossa into the tibial and common fibular nerves, which extend into the lower leg and foot.

The sciatic nerve innervates:

• Motor: Hamstrings, part of the adductor magnus, and muscles of the lower leg and foot.

• Sensory: Posterior thigh, leg, and most of the foot.

  
  

What Is Sciatica?

Sciatica refers to pain and other neurological symptoms (numbness, tingling, weakness) resulting from compression or irritation of the sciatic nerve or its contributing nerve roots. The pain typically radiates from the lower back or buttocks into the leg and foot. It often follows a dermatomal pattern based on the affected nerve root.

Common Causes

• Lumbar disc herniation (especially L4-L5 or L5-S1)

• Lumbar spinal stenosis

• Spondylolisthesis

• Piriformis syndrome

• Degenerative disc disease

• Pregnancy or trauma

Research confirms that lumbar disc herniation is the most prevalent cause of true sciatica (Valat et al., 2010).

Movements to Avoid

During acute sciatica, avoid:

• Spinal flexion (forward bending)

• Twisting of the lumbar spine

• Prolonged sitting or poor ergonomics

• High-impact activities like running or jumping

These activities may increase nerve compression or inflammation and worsen symptoms (Stafford et al., 2014).

Home Exercise Program for Sciatica Relief

*Visuals of our client Julian, who uses this exact program to manage his sciatica symptoms.

Each exercise below is backed by clinical reasoning and designed to target the root causes of sciatica symptoms. Incorporate them consistently to relieve nerve irritation, strengthen support structures, and restore functional movement.

1. Seated Piriformis Stretch

• How: Sit upright. Cross the affected leg over the opposite knee and gently lean forward.

• Why: The piriformis muscle, when tight or inflamed, can compress the sciatic nerve — especially in piriformis syndrome.

• Evidence: Reduces sciatic-like symptoms by relieving muscular entrapment (Boyajian-O’Neill et al., 2008).

  
  

  

  Seated Piriformis Stretch

2. Supine Hamstring Stretch

• How: Lie on your back, lift one leg upward with a towel behind the thigh or calf.

• Why: Tight hamstrings can tilt the pelvis and increase lumbar nerve stress.

• Evidence: Improves spine mechanics and reduces pain (Sadler et al., 2017).

Supine Hamstring Stretch

3. Knee-to-Chest Stretch

• How: Lying on your back, bring one knee toward the chest, holding for 20–30 seconds.

• Why: Stretches the lumbar spine and decompresses irritated nerve roots.

• Evidence: Effective for centralizing pain in disc-related conditions (Delitto et al., 2012).

  
  

  

  Knee-to-Chest Stretch

4. Glute Bridges

• How: From lying, squeeze glutes and lift hips into a bridge position.

• Why: Strengthens glutes and core, promoting spinal and pelvic stability.

• Evidence: Key in reducing compensation and chronic nerve strain (McGill, 2007).

  
  

  

  Glute Bridges

5. Bird-Dog

• How: From hands and knees, extend opposite arm and leg. Keep core engaged.

• Why: Builds dynamic spinal control with minimal compression.

• Evidence: Improves control in people with recurrent sciatica (Standaert et al., 2008).

  
  

  

  Bird-Dog

6. Pelvic Tilts

• How: Flatten lower back against the floor by tilting pelvis, then relax.

• Why: Restores mobility and neuromuscular coordination of deep core stabilizers.

• Evidence: Effective in lumbar stabilization programs (O’Sullivan et al., 1997).

  
  

  

  Pelvic Tilts

7. Sciatic Nerve Glides (Sliders)

• How: In seated position, straighten leg and flex ankle while gently looking up, then return.

• Why: Mobilizes the nerve without overstretching, reducing pain and restoring glide.

• Evidence: Reduces neural tension and improves mobility (Shacklock, 2005).

Sciatic Nerve Glides (Sliders)

Other Evidence-Based Treatments for Sciatica

In addition to exercises to alleviate muscle tension and build strength, individuals may benefit from:

• Spinal manipulation or manual therapy

• NSAIDs (short-term relief only)

• Epidural steroid injections, especially for acute inflammation

• Surgical intervention (e.g., microdiscectomy), when:

  • Symptoms persist despite 6–12 weeks of therapy

  • There’s progressive weakness or neurological decline

  • Imaging confirms a herniation with nerve root impingement

Surgical patients often report faster relief, though long-term results are often comparable to conservative care (Weinstein et al., 2006).

Reminder: Every body is different. Julian's results are encouraging, but for your safety, check with a healthcare provider before beginning any new exercise program—especially if you have worsening symptoms, numbness, or difficulty walking.

References

1. Boyajian-O’Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Piriformis syndrome. American Family Physician, 77(11), 1474–1480.https://pubmed.ncbi.nlm.nih.gov/18517023/

2. Delitto, A., George, S. Z., Van Dillen, L. R., et al. (2012). Low back pain clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1–A57.https://www.jospt.org/doi/10.2519/jospt.2012.42.4.A1

3. McGill, S. M. (2007). Low back disorders: Evidence-based prevention and rehabilitation (2nd ed.). Human Kinetics.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671307/

4. O'Sullivan, P., Twomey, L., & Allison, G. (1997). Altered motor control strategies in subjects with sacroiliac joint pain. Spine, 22(4), 440–446.https://pubmed.ncbi.nlm.nih.gov/9243407/

5. Sadler, S. G., Spink, M. J., Ho, A., & Chuter, V. H. (2017). Restrictive hamstring length in adults: A systematic review of the reliability and validity of clinical tests. Physical Therapy in Sport, 24, 71–79.https://doi.org/10.1016/j.ptsp.2016.08.004

6. Shacklock, M. O. (2005). Neurodynamics: Clinical applications and mechanisms. Manual Therapy, 10(1), 12–19.https://pubmed.ncbi.nlm.nih.gov/15970962/

7. Stafford, M. A., Peng, P., & Hill, D. A. (2014). Sciatica: A review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Canadian Journal of Anaesthesia, 54(11), 986–993.https://doi.org/10.1016/j.pain.2014.01.002

8. Standaert, C. J., Herring, S. A., & Halpern, B. (2008). Sciatica: Diagnostic considerations and physical therapy management. Physical Medicine and Rehabilitation Clinics of North America, 19(3), 485–510.https://pubmed.ncbi.nlm.nih.gov/18463398/

9. Valat, J. P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. BMJ, 329(468), c6360.https://doi.org/10.1136/bmj.c6360

10. Weinstein, J. N., Tosteson, T. D., Lurie, J. D., et al. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT). New England Journal of Medicine, 356(22), 2257–2270.https://www.nejm.org/doi/full/10.1056/NEJMoa055396