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A large number of sciatica exercises are available to choose from, but if you are in signficant pain, it is a good idea to stick with a simple, easy to implement plan. One or two exercises done frequently can be far more effective than struggling with a complex program of multiple exercises. To figure out what exercise will be of most benefit, it is important to try to distinguish whether you have sciatica from a lumbar disc bulge /herniation, or whether you have a condition called "piriformis syndrome", which produces symptoms very similar to disc-related sciatica but is caused by contraction of the piriformis muscle in the buttock area. An easy method to help you determine what the problem is can be done by doing a couple of tests while sitting in a firm chair. In the sitting position, try straightening your knee on the painful side, so that your leg is parallel to the floor. If this increases your symptoms, chances are you have true sciatica related to a disc problem. The second test is to bend your leg to pull the knee toward your chest. Begin by first bringing the knee on the painful side toward the shoulder on the same side. Then release the leg slightly and pull the knee toward the opposite shoulder. If the symptoms increase more when you pull the knee toward the opposite shoulder than when you pulled it toward the same side shoulder, it is likely that you have piriformis syndrome. It should be noted that it is possible to have both true sciatica and piriformis syndrome at the same time. Once you determine whether you have true sciatica or piriformis syndrome, or both, you can usually get considerable relief from just a single exercise for either condition (two exercises if you have both). For true sciatica, most people will find relief through the basic McKenzie extension exercise (named for physical thearapist Robin McKenzie). This exercise is performed by lying face down on a firm surface and then propping yourself up on your elbows, creating an increase in the curve of the lower back. Getting into this position may be painful at first, but within about 30 seconds, most people will notice a decrease in the severity or the range of the sciatica, or both. Look for the symptoms the furthest from the spine to decrease first. As long as the symptoms are decreasing furthest from the spine, the exercise described is beneficial, even if the symptoms closer to the spine seem to increase at first (they'll usually improve with repetition of the exercise over time). I recommend staying in this position for 1 to 2 minutes at a time and then either lying flat or getting up and moving around for at least a few minutes in between to prevent the back muscles from getting tight. For piriformis syndrome, you can do a simple stretch of the piriformis muscle. I recommend you do this by lying on your back, pulling your knee on the painful side toward the same side shoulder for a few seconds, then partially releasing the leg and then pulling your knee toward the opposite shoulder. Hold this stretch for about 10 seconds at a time, then carefully release your leg for a a few seconds before repeating the stretch. Regardless of whether you are using the extension exercise or the piriformis stretching, or both, these sciatica exercises are most effective when done repeatedly - up to several times each day for as long as you are having a lot of pain. Once you are feeling better, it is important to learn the appropriate sciatica exercises and precautions you need to do in order to prevent a return of the pain. Don't be fooled! Just because the symptoms go away, it doesn't mean that everything is back to normal. All too often, sciatica sufferers go from one episode of pain to the next, with episodes becoming more severe and more frequent over time, because they fail to manage the problem correctly so you can avoid the common problem of developing chronic pain and disability.
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Dr. George Best has been treating sciatica and piriformis syndrome for over 15 years in his San Antonio, Texas practice. To obtain his free E-book with illustrated sciatica exercises and his free video course on understanding and treating sciatica, go to www.sciaticaselfcare.com.
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