sciatica exercises

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Sciatica Exercises Page 1 of 17 This Article is copied from: http://www.spine-health.com/ Sciatica Exercises ﻟﻌﺮق ﺗﻤﺎرﻳﻦﺴﺎ اﻟﻨBy: Ron S. Miller, PT In This Article : -Overview: Sciatica Exercises ) ﺧﻼﺻﺔ: ﺗﻤﺎرﻳﻦ اﻟﻨ ﻌﺮق ﺴﺎ( A- Exercise for Sciatica from a Herniated Disc ( ﻟﻌﺮق ﺗﻤﺎرﻳﻦﺴﺎ اﻟﻨ ﺑﺴﺒﺐ ا ﻧﺰﻻق اﻟ ﻐﻀﺮوﻓﻲ) B- Exercise for Sciatica from Spinal Stenosis ) ﻟﻌﺮق ﺗﻤﺎرﻳﻦﺴﺎ اﻟﻨ ﺑﺴﺒﺐ اﻟﻔﻘﺮي اﻟﻌﻤﻮد ﺿﻴﻖ( C- Exercise for Sciatica from Degenerative Disc Disease ) ﺴﺎ اﻟﻨ ﻟﻌﺮق ﺗﻤﺎرﻳﻦ ﺑﺴﺒﺐ ﺿﻤﻮر اﻟﻐﻀﺮوف( D- Exercise for Sciatica from Isthmic Spondylolisthesis ) ﺴﺎ اﻟﻨ ﻟﻌﺮق ﺗﻤﺎرﻳﻦ ﺑﺴﺒﺐ اﻟﻔﻘ اﻧﺰﻻق ات( E- Exercise for Sciatic Pain from Piriformis Syndrome ) ﺗﻤﺎرﻳﻦ ﺁﻻم ﺘﺨﻔﻴﻒﺴﺎ اﻟﻨ ﻋﺮق ﺑﺴﺒﺐ ﺑﻴﺮﻓﻴﻮرﻣﻴﺲ ﻣﺘﻼزﻣﺔ) اﻹﻟﻴﺘﻴﻦ ﻋﻨﺪ اﻟﻨﺴﺎ ﻋﺮق اﻧﻀﻐﺎط( ( F- Exercise for Sciatic Pain from Sacroiliac Joint Dysfunction ) ﺗﻤﺎرﻳﻦﺴﺎ اﻟﻨ ﻋﺮق ﺁﻻم ﻟﺘﺨﻔﻴﻒ ﺑﺴﺒﺐ ﺿﻌ واﻟﺤﺮﻗﻔﺔ اﻟﻌﺠﺰ( G- Hamstring Stretching Exercises ) ﻟﺒﺴﻂ ﺗﻤﺎرﻳﻦ واﺳﺘﻄﺎﻟﺔ اﻟﺮآﺒﺔ وﺗﺮ( Overview: Sciatica Exercises By: Ron S. Miller, PT Before reviewing specific sciatica exercises, it is first important to explain what sciatica ( اﻟﻮرآﻲ اﻟﻌﺼﺐ أﻟﻢ, ﺴﺎ اﻟﻨ أﻟﻢ) is, as the term sciatica is often misused and its definition misunderstood. Sciatica is a set of symptoms, not a diagnosis in itself (meaning it does not explain the cause of the pain). Sciatica is a general term that refers to pain caused by compression or irritation of one or more nerves exiting the lower spine that make up the sciatic nerve. There are a number of different conditions that can cause sciatica pain. The medical term for sciatica is a radiculopathy ) ﻗﻄﻨﻲ( , which means that a spinal disc has extended beyond its normal position and is irritating the radicular nerve (nerve root) in the lower back, which connects with the sciatic nerve. The sciatic nerve branches off as it travels down the lower extremity through the back of the leg. Sciatic pain can be experienced along this nerve route.

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Page 1: Sciatica Exercises

Sciatica Exercises

Page 1 of 17 This Article is copied from:

http://www.spine-health.com/

Sciatica Exercises الّنساتمارين لعرق

By: Ron S. Miller, PT In This Article: -Overview: Sciatica Exercises

)ساعرق الّنلتمارين : خالصة( A- Exercise for Sciatica from a Herniated Disc

( غضروفيالنزالق ال ابسبب الّنساتمارين لعرق ) B- Exercise for Sciatica from Spinal Stenosis

) ضيق العمود الفقري بسبب الّنساتمارين لعرق ( C- Exercise for Sciatica from Degenerative Disc Disease

) الغضروف ضموربسببتمارين لعرق الّنسا ( D- Exercise for Sciatica from Isthmic Spondylolisthesis

) اتر انزالق الفقبسببتمارين لعرق الّنسا ( E- Exercise for Sciatic Pain from Piriformis Syndrome

)) انضغاط عرق النسا عند اإلليتين( متالزمة بيرفيورميس بسببعرق الّنسا تخفيف آالم تمارين ل( F- Exercise for Sciatic Pain from Sacroiliac Joint Dysfunction

)ف العجز والحرقفةضعبسبب لتخفيف آالم عرق الّنسا تمارين ( G- Hamstring Stretching Exercises

) وتر الرآبة واستطالةتمارين لبسط(

Overview: Sciatica Exercises By: Ron S. Miller, PT

Before reviewing specific sciatica exercises, it is first important to explain what sciatica ( ألم الّنسا, ألم العصب الورآي ) is, as the term sciatica is often misused and its definition misunderstood. Sciatica is a set of symptoms, not a diagnosis in itself (meaning it does not explain the cause of the pain). Sciatica is a general term that refers to pain caused by compression or irritation of one or more nerves exiting the lower spine that make up the sciatic nerve. There are a number of different conditions that can cause sciatica pain. The medical term for sciatica is a radiculopathy ) قطني ( , which means that a spinal disc has extended beyond its normal position and is irritating the radicular nerve (nerve root) in the lower back, which connects with the sciatic nerve. The sciatic nerve branches off as it travels down the lower extremity through the back of the leg. Sciatic pain can be experienced along this nerve route.

Page 2: Sciatica Exercises

Sciatica Exercises

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Sciatica Exercises for Sciatic Pain Relief

While it may seem counterintuitive, exercise is usually better for healing sciatic pain than bed rest. Patients may rest for a day or two after their sciatic pain flares up, but after that time period, inactivity will usually make the pain worse. Without sciatica exercises and movement, the back muscles and spinal structures become deconditioned and less able to support the back. The deconditioning and weakening can lead to back injury and strain, which causes additional back pain. Sciatica exercises are also important for the health of the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy. Many sciatica exercises focus on strengthening the abdominal and back muscles in order to provide more support for the back. Stretching exercises for sciatica target muscles that cause sciatic pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and can help to prevent future episodes of sciatica pain. Specific sciatica exercises depend on the cause of the pain

A physical therapist, certified athletic trainer (ATC), chiropractor, physiatrist or other spine specialist who treats the back pain and leg pain associated with sciatica may recommend exercise as part of a treatment program. It is important to first get an accurate diagnosis for the cause of sciatic pain, as the specific back exercises recommended will depend on the cause of the sciatica. It is also important to get a diagnosis before starting any sciatica exercises because, while rare, sciatic pain can be caused by some serious medical conditions (such as an infection or tumor) that require prompt medical attention. Sciatica exercises for the common causes of sciatica or sciatica-like symptoms are explained in the next pages sections of this article listed in the menu near the bottom of this page. It is recommended that all patients consult a physician or physical therapist prior to beginning any exercise program. A Daily Routine of Sciatica Exercises is Part of Treatment

To be effective, the sciatica exercises recommended for specific conditions must be done regularly (typically two times daily) and correctly. Close attention to posture and body mechanics is the key to getting the maximum benefit from the sciatica exercises. Continuing with a program of gentle exercise and stretching is beneficial for a current episode of sciatic pain but also for overall back health and for preventing future back problems. Caring for sciatica pain should be considered part of one's daily living, not just something to add to the routine at the end of the day. In addition to a routine of sciatica exercises, patients with sciatica should minimize everyday stress on the lower back, including using good ergonomics while lifting, maintaining good posture, making sure the lower back is supported while sitting, and avoiding standing for long periods of time.

Page 3: Sciatica Exercises

Sciatica Exercises

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A- Exercise for Sciatica from a Herniated Disc By: Ron S. Miller, PT Leg pain or sciatica (also known as radiculopathy) from a herniated disc is commonly caused by disc material protruding backwards and irritating or compressing a nerve root, which in turn causes pain to radiate along the sciatic nerve.

Specific lower back exercises for sciatica pain relief from a herniated disc are prescribed according to which positions will cause the patient’s symptoms to move up the lower extremity and into the low back. Sciatica Pain Relief: Extension Exercises

For many patients, getting the sciatica pain to move up from the leg to the low back is accomplished by getting into a backwards bending position, called extension exercises or press-ups.

During these sciatica exercises for a herniated disc, the low back is gently placed into extension by lying on the stomach (prone position) and propping the upper body up on the elbows, keeping hips on the floor (Figure 1). This sciatica exercise should be started slowly, since some patients cannot tolerate this position at first.

Hold the press-up position initially for five seconds, and gradually work up to 30 seconds per repetition. Aim to complete 10 repetitions.

After practicing this sciatica exercise, the spine specialist may recommend a more advanced form of the extension:

From the prone position (lying flat on the stomach), press up on the hands while the pelvis remains in contact with the floor (Figure 2). Keep the lower back and buttocks relaxed for a gentle stretch.

This position is typically held for 1 second, repeated 10 times. If the patient is unable to lie flat, similar sciatica exercises can be done standing by arching backward slowly with hands on hips (Figure 3). However, the prone position described above is usually preferred. These extension exercises are done regularly, about every two hours. More importantly, the spine specialist may recommend that the patient with this condition should avoid getting into a forward flexed (bent over) position. This tends to counteract the effects of the extension exercises. The specialist may ask the patient to correct any forward flexed positions immediately by doing an extension exercise.

Page 4: Sciatica Exercises

Sciatica Exercises

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Advanced Sciatica Exercises for the Abdominal and Back Muscles As the patient’s pain works out of the lower extremity (leg) and centralizes in the low back, the sciatica exercises typically are advanced to strengthen the low back and abdominal muscles to prevent recurrences of sciatic pain caused by a herniated disc. Low back, muscle strengthening, sciatica exercises:

Upper back extension. In the prone position with hands clasped behind the lower back, raise the head and chest slightly against gravity (Figure 4) while looking at the floor (stay low). Begin by holding position for 5 seconds, and gradually work up to 20 seconds. Aim to complete 8-10 repetitions.

In the prone position with the head and chest lowered to the floor, lightly raise an arm and opposite leg slowly, with the knee locked, 2-3 inches from the floor (Figure 5). Begin by holding position for 5 seconds, and complete 8-10 repetitions. As strength builds, aim to hold position for 20 seconds.

Abdominal muscle strengthening exercises:

Curl-ups. For the upper abdominals, the patient should lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the floor (Figure 6). Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls. Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head.

For the lower abdominals, tighten the lower stomach muscles and slowly raise the straight leg 8 to 12 inches from the floor (Figure 7), keeping the low back held flat against the floor. Hold leg raise for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten lifts.

Water exercises are also excellent to strengthen the lower abdominal muscles, and even just walking in waist-deep water can be helpful.

Other Forms of Sciatica Exercises

In addition to the above sciatica experiences, aerobic conditioning may also be encouraged for general body fitness and sciatica pain relief. In general, walking is an excellent form of exercise for the low back because it is relatively low impact but can provide all the benefits of an aerobic workout. Walking tends to relieve pain from radiculopathy. If possible, it is best to gradually progress to doing up to three miles of exercise walking at a brisk pace each day.

Page 5: Sciatica Exercises

Sciatica Exercises

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B- Exercise for Sciatica from Spinal Stenosis By: Ron S. Miller, PT Sciatic pain from nerve root irritation or impingement can be caused by spinal stenosis, a condition that causes the nerve’s passageway to narrow or constrict. A typical symptom of spinal stenosis is sciatic pain that radiates along the sciatic nerve down the leg while walking, with sciatic pain relief only felt when sitting down. The study of this leg pain (sciatica) is referred to as radiculopathy. For more information on spinal stenosis, please see lumbar spinal stenosis and living with spinal stenosis. Sciatica Exercises for Spinal Stenosis

When treating sciatica from spinal stenosis, the spine specialist may encourage flexion exercises (forward bending). Flexing the lower spine (bending forward) increases the size of these passageways and allows the irritation or impingement to resolve. This is why people with spinal stenosis often feel better when bending forward (such as leaning on a cane, walker or shopping cart) than when standing up straight. Back exercises targeted at alleviating the sciatica pain caused by stenosis typically include a combination of specific stretching and strengthening exercises that focus on:

1. Stretching the muscles of the back that hold the spine in extension (backwards bending)

2. Strengthening the muscles that bring the spine into flexion (forward bending). Sciatica Exercises for Spinal Stenosis: Stretching

The stretches for the muscles of the low back that hold the spine in a backward bending position (the low back extensors) are typically held lightly for 30 seconds. These sciatica exercises include the following: Back flexion. Lie on the back and gently pull the knees to the chest until a

comfortable stretch is felt (Figure 8). After 30 seconds, slowly return to starting position. Aim to complete four to six repetitions of this flex.

Get down on the hands and knees, then sit back on the heels with the chest down and arms outstretched (Figure 9). After 30 seconds, slowly return to starting position. Aim to complete four to six repetitions of this stretch. Do not bounce on heels.

Sciatica Pain Relief Exercises for Stenosis: Strengthening

Strengthening exercises for spinal stenosis focus on strengthening the lower abdominal muscles and include the following: Lie on the back and press the low back into the floor by tightening the lower stomach

muscles, pulling the navel (or belly button) in and up (Figure 10), hold for 10 seconds. Aim to complete eight to ten repetitions of this press.

Page 6: Sciatica Exercises

Sciatica Exercises

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Hook-lying march. For a more advanced sciatica exercise, this position may be held while marching in place in the hook-lying position, slowly raising alternate legs 3 to 4 inches from the floor (Figure 11). Aim to ‘march’ for 30 seconds, two to three repetitions, with 30-second breaks in between repetitions.

Curl-ups. Another strengthening exercise that may be recommended by spine specialists to strengthen the lower abs is called a curl-up (Figure 6). These are done by folding arms across chest, flattening the back by tightening lower abs, then raising the head and shoulders from the floor. Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls.

These sciatica exercises alone will not necessarily make the patient with sciatica from spinal stenosis “better”, but they will allow the patient to more easily hold a posterior pelvic tilt during activities, especially standing and walking. This posture will allow the patient to perform more activities with less pain. The pelvic tilt is often very difficult for patients to learn and can take a good deal of practice with the guidance of a physical therapist before it is used effectively to treat sciatica resulting from spinal stenosis.

Page 7: Sciatica Exercises

Sciatica Exercises

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C- Exercise for Sciatica from Degenerative Disc Disease By: Ron S. Miller, PT While degenerative disc disease most often causes low back pain )آالم أسفل الظهر ( , if a degenerated disc impinges on a nerve root in the low back it can also cause a form of sciatica. With that said, a series of sciatica exercises for degenerative disc disease exist and may provide relief of sciatic symptoms. Degenerative Disc Disease (DDD) Exercises The form of sciatica exercises typically recommended for treating disc degeneration and the sciatica that results is a dynamic lumbar stabilization program, sometimes using the back exercises included in the McKenzie Method. Alleviating sciatic pain caused by degenerative disc disease includes finding the most comfortable position for the lumbar spine and pelvis and training the body to maintain this position during activities. In doing this correctly, one can improve the proprioception (sense of movement) of the lumbar spine and reduce the excess motion at the spinal segments. This will in turn reduce the amount of irritation at these segments, resulting in sciatica pain relief and protecting the area from further damage. DDD Sciatica Exercises: Lumbar Stabilization These dynamic lumbar stabilization exercises often require specific hands-on instruction because they offer much less benefit if done incorrectly. Furthermore, these sciatica exercises tend to be much more difficult than they appear. This type of exercise program is progressive, starting with the easier sciatica exercises and advancing to the more difficult exercises once the lower level program is mastered. The most important aspect of using these sciatica exercises is sensing and controlling motion in the spine. Once learned, the body can eventually take over and do this without the level of concentration it takes early on. DDD Sciatica Exercises: Lying on the Back Examples of the dynamic lumbar stabilizing exercises done while on the back include: Hook-lying march. While lying on the back on the floor, with knees bent and arms at

sides, tighten the stomach muscles and slowly raise alternate legs 3 to 4 inches from the floor (Figure 11). Aim to ‘march’ for 30 seconds, for two to three repetitions, with 30-second breaks in between repetitions.

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Sciatica Exercises

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Hook-lying march combination. This is the same sciatica pain relief exercise as described above, but includes raising and lowering the opposite arm over the head (Figure 12).

Bridging. Start by lying on the back with the knees bent, then slowly raise the buttocks from the floor (Figure 13). Hold bridge for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten bridges.

These sciatica exercises should all be performed with a rigid trunk. The pelvic tilt, tightening the lower stomach muscles and buttocks to flatten the back (Figure 10), can be used to find the most comfortable position for the low back. DDD Sciatica Exercises: Lying on the Stomach This same pelvic position (tightening the lower stomach muscles to flatten the lower back) is maintained while performing stabilizing exercises from the prone position (lying flat on the stomach): Raise one leg behind with the knee slightly bent and no arch in the back or neck

(Figure 14). Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.

Lying face down, with elbows straight and arms stretched above the head, raise one arm and the opposite leg 2 to 3 inches off the floor (Figure 5). Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of opposite side raises.

Similar stabilizing exercises can be done in the 4-point position (kneeling on hands and knees), raising the arms and legs only as high as can be controlled, maintaining a stable trunk and avoiding any twisting or sagging: Raise one leg behind with the knee slightly bent and no arch in the back or neck

(Figure 15). Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.

For a slightly more advanced exercise, raise one leg with the knee slightly bent and no arch in the back or neck and also raise the opposite arm (Figure 16). Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.

Practical point: Exercise has both mental and physical components. By increasing their conscious awareness of the position of their spine, patients can assume the most comfortable stance and better control their pain symptoms.

Page 9: Sciatica Exercises

Sciatica Exercises

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D- Exercise for Sciatica from Isthmic Spondylolisthesis By: Ron S. Miller, PT Sciatica can be caused by isthmic spondylolisthesis if the condition results in nerve root irritation or impingement. In most cases, if isthmic spondylolisthesis affects or pinches a nerve root it will affect the L5 nerve root. When treating sciatica resulting from isthmic spondylolisthesis with exercise, the spine specialist will typically recommend a program of sciatica exercises that is a hybrid of:

Flexion based exercises (as when treating spinal stenosis), and Stabilization program (as when treating degenerative disc disease).

The goal of this type of sciatica exercise program is to teach the lumbar spine to remain stable in a flexed position. Therefore, the sciatica exercises for isthmic spondylolisthesis are a combination of both programs. Sciatica Exercises for Isthmic Spondylolisthesis

These sciatica exercises often require specific hands-on instruction because they offer much less benefit if done incorrectly, and the exercises tend to be much more difficult to do than they appear.

Three sciatica exercises for isthmic spondylolisthesis that are commonly prescribed for sciatica pain relief include: Pelvic tilt. Specialists treating patients with sciatica pain from isthmic

spondylolisthesis frequently recommend the pelvic tilt (Figure 10), as it will hold the lower spine in the flexed position. This includes lying on the back with knees bent and flattening the back by tightening the lower stomach muscles, pulling the navel in and up. Hold this position for 10 to 20 seconds, then relax the muscles. Aim to complete a set of 10 pelvic tilts to strengthen the lower stomach muscles.

Curl-ups. Strengthening the abdominals with the curl-ups (Figure 6) will also help maintain a proper lower spine position. Lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back by pulling the navel (or belly button) in and up. Then curl-up, lifting the head and shoulders from the floor. Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head to support the neck. Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls.

Hook-lying march. As another form of stabilization exercise, the hook-lying march (Figure 11) and hook-lying combination (Figure 12) are again useful here as well. ). Aim to ‘march’ for 30 seconds, two to three repetitions, with 30-second breaks in between repetitions.

Practical point: The pain from isthmic spondylolisthesis can be minimized by training the lumbar spine to remain stable when flexed, such as it is when picking something up off the floor or tying one’s shoes.

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Sciatica Exercises

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E- Exercise for Sciatic Pain from Piriformis Syndrome By: Ron S. Miller, PT A common symptom of piriformis syndrome is pain along the sciatica nerve, so it is often thought that piriformis syndrome causes sciatica. However, piriformis syndrome does not involve a radiculopathy - a disc extending beyond its usual location in the vertebral column that impinges or irritates the nerve root - so it is technically not sciatica.

Instead, with piriformis syndrome, it is the piriformis muscle itself that irritates the sciatic nerve and causes sciatic pain.

The piriformis is a muscle located deep in the hip that runs in close proximity to the sciatic nerve. Piriformis syndrome is used to describe when the piriformis muscle becomes tight and/or inflamed; which may cause irritation of the sciatic nerve. This irritation leads to sciatica-like pain, tingling and numbness that run from the lower back, to the rear and sometimes down the leg and into the foot. Learn more about piriformis syndrome. Sciatic Pain Exercises for Piriformis Syndrome: Stretching

Stretching the piriformis muscle is almost always necessary to relieve the pain along the sciatic nerve and can be done in several different positions. A number of stretching exercises for the piriformis muscle, hamstring muscles and hip extensor muscles may be used to help decrease the painful symptoms along the sciatic nerve, return the patient’s range of motion and provide sciatic pain relief.

Several of the stretching exercises commonly prescribed to treat sciatica symptoms from piriformis muscle problems include: Supine piriformis stretches. Lie on the back with the legs flat. Pull the affected leg up toward the chest, holding the knee with the hand on the same side of the body and grasping the ankle with the other hand. Trying to lead with the ankle, pull the knee towards the opposite ankle (Figure 17) until stretch is felt. Do not force ankle or knee beyond stretch. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches. Other variations of supine piriformis stretches: Lie on the floor with the legs flat. Raise the affected leg and place that foot on the

floor outside the opposite knee. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed (Figure 18), until stretch is felt. Do not force knee beyond stretch or to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

Lie on the floor with the affected leg crossed over the other leg at the knees and both

legs bent. Gently pull the lower knee up towards the shoulder on the same side of the body (Figure 19) until stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

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Sciatica Exercises

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Piriformis muscle problems may also be treated by:

Buttock Stretches. Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk. Extend the non-affected leg straight back behind the trunk and keep the pelvis straight. Keeping the affected leg in place, scoot the hips backwards towards the floor and lean forward on the forearms (Figure 20) until deep stretch is felt. Do not force body to floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

Practical point: Stretching the piriformis muscle a few times a day, especially when combined with hamstring stretches, will prevent tightening of the lower back and relieve tension from hip to foot.

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Sciatica Exercises

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F- Exercise for Sciatic Pain from Sacroiliac Joint Dysfunction By: Ron S. Miller, PT Inflammation of the sacroiliac joint is believed to be caused by a disruption in the normal movement of the joint, despite the fact that the sacroiliac joint (also called the SI joint) naturally has a very limited range of motion. If the sacroiliac joint becomes inflamed, the portion of the sciatic nerve that runs directly in front of the joint can be irritated. Learn more about sacroiliac joint problems and treatments for sacroiliac joint pain. Sacroiliac Joint Dysfunction and Sciatica Differences Sacroiliac joint dysfunction affects the sciatic nerve and has similar symptoms to sciatica. However, pain along the sciatic nerve caused by sacroiliac joint dysfunction is not caused by a compressed nerve root as it exits the spine as occurs with true sciatica. Stretching Exercises for Sciatic Pain Relief Performing range of motion exercises directed at the SI joint can often restore normal movement and alleviate the irritation of the sciatic nerve. Three helpful exercises are described below: Single knee to chest stretch. Pull one knee up to the chest at a time, gently pumping

the knee three to four times at the top of the range of motion. Do 10 repetitions for each leg (Figure 21).

Press-up. From the prone position, press up on the hands while the pelvis remains in contact with the floor. Keep the lower back and buttocks relaxed for a gentle stretch (Figure 2). Hold the press-up position initially for five seconds, and gradually work up to 30 seconds per repetition. Aim to complete 10 repetitions.

Lumbar rotation—non-weight bearing. Starting by lying on the back with both knees bent, keep the feet flat on the floor while rocking the knees from side to side. The thighs should rub together and the knees will not move very far. The lower spine should remain fairly still. Rock the knees for 30 seconds (Figure 22).

Practical point: The main objective of exercises for sciatic pain from sacroiliac joint dysfunction is to restore the range of motion in this joint which can be limited if the joint is inflamed.

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Sciatica Exercises

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G- Hamstring Stretching Exercises By: Ron S. Miller, PT As a final note, regardless of the diagnosis, most types of sciatica will benefit from a regular routine of hamstring exercise, especially hamstring stretching. The hamstrings ( وتر الرآبة, عرقوب, أوتار المأبض ) are muscles located in the back of the thigh. They help bend the knee and extend the hip. Tightness in the hamstrings will place increased stress on the low back and often aggravate or even cause some of the conditions that result in sciatica. When doing hamstring stretches, patients should avoid bouncing, which can trigger a muscle spasm. Hamstring Stretches While Lying on the Back

In addition to sciatica exercises, most patients with back pain will benefit from hamstring stretching exercises done while lying on the back. These are the least stressful types of hamstring stretches done for sciatica pain relief: Lie on the back, supporting the thigh behind the knee with the hand or with a towel,

slowly straighten the knee until a stretch is felt in the back of the thigh, trying to get the bottom of the foot to face the ceiling, one leg at a time (Figure 23). Hold the position initially for 10 seconds, and gradually work up to 20-30 seconds.

Lie back on the floor with the buttocks against a wall at a corner or by a door jamb. Keeping one leg on the floor, place the foot of the alternate leg against the wall and try to gently push the knee straight so the raised leg and the leg on the floor make a 90 degree angle. Hold the position for 10 to 20 seconds.

Hamstring Stretches While Sitting

Although they are less gentle than lying on the back, hamstring stretches can also be done in a sitting position, where the degree of stretch can be varied based on the placement of the leg: While sitting at the edge of a chair, straighten one leg in front of the body with the

heel on the floor. Then, sit up straight and try pushing the navel towards the thigh without leaning the trunk of the body forwards. Hold this stretch for 30 seconds, then repeat 3 times for each leg.

Many people – and especially women – tend to be more flexible and may need to elevate the foot on a stool or chair to get a deep enough stretch.

Hamstring Stretches: Getting Comfortable

The hamstring stretches done while lying on the back are gentler and place less stress on the back than those done while sitting. Depending on the patient’s specific medical condition and level of pain, the lying down position may be preferable and comfortable. In particular, patients with low back pain

)آالم أسفل الظهر( should choose whichever position is most tolerable for their back while still giving a gentle stretch.

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Hamstring and Sciatica Exercises: Working with a Medical Professional Before doing a sciatica exercise or beginning any other exercise program, patients should see a health professional to get a correct diagnosis for their pain and to rule out any more serious problems. The proper sciatica exercises differ based on the condition that is causing the sciatic pain, so patients should not try to self-treat their sciatica before consulting a professional. Additional Sciatica Info: Sciatica: An Overview Sciatica Causes Sciatica Symptoms Sciatica Treatments Sciatica Nerve Info

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