- If you are currently
experiencing shooting pains in your buttocks or down
the back of your legs, and you're finding it
difficult to walk, sit, stand for any period of time, then there's a good chance that you might be experiencing sciatica. So in today's video, I'm gonna explain
everything you need to know about what sciatica is, what causes it, and what exercises or stretches you can do to help relieve your pain. So the first thing is what is sciatica? What sciatica is, essentially, irritation of the sciatic nerve. So the sciatic nerve
starts in your lower back. So it starts from the last two nerves that come out of your lumbar spine. So the lumbar spine are
the five bottom vertebra of your spine. So it comes from the
bottom two nerve roots. So you've got L4 and L5. And then it comes out from the top three of the sacral nerves. So S1, S2, and S3. They form together to
create the sciatic nerve. So the sciatic nerve then comes
out through this gap here, and then down through your buttock, down the back of your leg, and then branches off at the knee. So there are two main areas
that the sciatic nerve can get compressed or irritated. The first is in the lower back, so around the lumbar spine, and then the second is
through the buttocks. So I'm gonna explain
now how the lower back affects the sciatic nerve, and then we'll go into how the buttocks affect the sciatic nerve. So let's just spend a minute
looking at the lower back, and how this can cause you sciatic pain. So as you can see, the nerves that come
out of the lumbar spine come out through some of the little holes. These are called foramen or foramen, depending on how you wanna pronounce it. If one of these holes becomes narrowed, then that can cause
compression on the nerve. So this can happen if, let's say, the discs have become thinner, so the vertebra become closer together. That would then make the
holes slightly smaller. So this can happen if you've got history of disc
bulges or disc prolapses. It could also happen as you get older, because your discs become more dehydrated. So any narrowing or any
thinning of the discs can cause narrowing of those foramen. Then we could also get
what's called bony growth, so deposits of bone around the area, that can cause narrowing of those holes. If you have a look just here, these are called facet joints. Now, if any of these facet joints become compressed or irritated, that can cause inflammation. And as you can see, the facet joints are quite close to where the nerves come out. So any irritation of the facet joints can cause irritation of
one of these nerve roots. Now, I know I'm showing you up here, and that's not technically where the sciatic nerve comes from. but this bone here gets in the way, so it's just easier to
show you from up here. So the facet joints can become irritated and that can cause
inflammation of the nerves. So then we can have the
actual discs themselves causing problems. Now, normally with a normal, healthy disc, the center of the disc is made
up of a gel-like substance. Around that are rings, a bit like layers of an onion. Now, if those layers become weakened through poor usage or poor body mechanics, then what can happen is
that gel-like substance can end up bulging out through the back. It can be a bulge or a prolapse, where the substance comes completely out. So any disc bulges, disc prolapses can cause direct
compression on the nerves, but also as a disc prolapses, it causes a lot of inflammation as well. So any inflammation caused
from the discs can, again, cause you sciatic pain. So as I've already mentioned, the sciatic nerve is formed
of the last two lumbar nerves, and the top three sacral nerves. They form together to
form the sciatic nerve. As I've wonderfully
demonstrated here by some cable, the sciatic nerve then comes out of this sciatic notch, and runs down the back of your leg. In relation to the second place that the sciatic nerve
can become irritated, it can become compressed by a
muscle called the piriformis, which I'll show you now. So here we have a model of the buttocks, or here we have a model
of the hip and pelvis. This is the right side. So this is your femur. So this is your thighbone. This muscle here is your gluteus maximus, that's been cut away. So this is your bum cheek muscle that you have about here. Underneath that, we've got the
gluteus minimus and medius, which are, again, gluteal muscles, but they are more responsible for walking. This muscle here is called the piriformis. So if I take this away, you can see the piriformis comes from the underside of the sacrum, runs all the way along here, and attaches onto the greater
trochanter of the thighbone. So this muscle helps to
externally rotate your leg. So as you're standing and
looking down at your foot, if you turn your foot all the way out or your thigh all the way out, the piriformis is one of those muscles that is responsible for that. So the sciatic nerve comes out
of this gap here in the bone, and, generally speaking,
underneath the piriformis muscle, So here we now have the sciatic nerve coming underneath the piriformis. In the majority of people, this is how the nerve would come out. So generally speaking, come out underneath the piriformis muscle. What can happen is this
can become spasmed, this piriformis muscle can become spasmed, and potentially that can cause compression of the sciatic nerve. Now, in some individuals, there is a genetic variation
in how the sciatic nerve comes out in relation to the piriformis. In some people, the sciatic
nerve might come out through the middle. In others, it might come
out above and below, or above and through the middle, or below and through the middle. I'll put a picture up
on the screen just here, so you can see how the
sciatic nerve can vary. But what can happen in some individuals is they may do something
that causes a spasm or irritation of the muscles, and this irritation or inflammation that you would expect in the area would cause irritation of the nerve. And then that would cause you
sciatic type symptoms as well. Now, when it comes to the risk factors involved with sciatica, you're generally more
likely to get sciatica as you get older, if you're overweight, if you're unfit, if you're pregnant, or you have diabetes. And, of course, this is
not an exhaustive list of risk factors, but they tend to be
the main ones involved. So how do you know if sciatica is coming from your
lower back or your buttocks? Well, I'm gonna show you
some really simple tests that you can do right now. So the first thing we're gonna look at is whether it's coming
from your lower back. Now, if your sciatica is coming
from a disc related problem, then as you bend forward, you would expect that disc bulge or disc prolapse to become
slightly more exaggerated. So potentially flection or forward bending in your spine could make
that sciatic pain worse. So the first thing we're gonna look at is called a slump test. So to do a slump test, what you need to do is sit on a chair, put your hands behind your back, drop your head down, so your chin is towards your chest, and then try and bend at the
spine as much as you can. If this causes an exaggeration of pain, then that as a positive result. So potentially that could be coming from a disc related problem. Now, as I mentioned earlier, there's a possibility that you can also get
facet joint compression or foraminal stenosis, which is the narrowing of the holes where the nerve roots come out. So if that is the case, then extension of your lower back would cause an aggravation of symptoms. So you could do this lying on your front and do like a McKenzie-style pushup, or just on the chair, you can arch yourself
back as far as you can. And if, when arching back, you get aggravation of symptoms, then that could be a positive. And that could represent the pain coming from the facet joints or compression somewhere
within the joints. Now, if both of those tests are negative, so forward bending or backward bending don't cause you any worsening of symptoms, then the pain could be
coming from your buttock. So all you really need to do
is find the greater trochanter, so that's the bony part, the outside of your thigh bone. From there, run your fingers backwards and start pressing into the muscle. If when you press it's sensitive, and especially compared to the good side, then there's a good chance
that there's irritation within the muscles in here. So there's a good chance
that that could be causing your sciatic symptoms. Another thing you could do
while sitting on a chair is bring your leg up on top of your knee, hold onto your knee, and put it up towards
your opposite shoulder. This would cause a stretch
within the piriformis and buttock muscles. So if there's any compression of the psychotic nerve through here, then that stretch would
cause more compression of the sciatic nerve here. So that would cause you pain. And that could reflect that the pain is coming from your piriformis or one of your buttock muscles. So another way you could do this test is called the FAIR test. And that basically stands for Flection Adduction Internal Rotation. So if you're testing this buttock as the cause of your sciatic, then lie on your side, bring your knee up, and then put it down towards the floor. If that causes you an
aggravation of symptoms, then, again, that's a good
chance that the sciatic pain that you're experiencing is
coming from your buttock. So when it comes to treatments, what I want you to make sure you're doing is that you're keeping yourself moving. The more you can move, whether your pain is coming
from your back or your buttocks, the more you move, the more you're gonna get blood moving around those areas, the more you're gonna get
those muscles working, the less likely those
muscles will stay spasmed. So it's really gonna help
to reduce inflammation. It's really gonna help to reduce
some of that spasm as well. So all you need to do is
just go out, keep walking. I know it's gonna be a bit painful, but the more you can just keep moving, the better the chances
are it's gonna help you. Obviously, don't go out for too long. Don't walk for too long, because the more you walk, the more you might irritate
those muscles or those nerves. The next thing you can
do is hanging from a bar or hanging from a doorframe. The reason this is good is because, whether it's coming from your spine or from your buttocks, this is not gonna cause you any problems, whether it's disc related, facet joint related or muscle related. So all you're gonna do is
grab hold of a doorframe or a pull-up bar. And you can get pull-up bars quite cheap from your local fitness store. Grab the bar and just
drop your weight down. Keep your feet on the floor, but just allow your knees to soften and allow your spine to
take some of that weight. My feet are still on the floor, so I'm supported, and I'm not going to
feel like I'm gonna drop, but just hang there and
your spine just relax. This is gonna help to cause
traction through the spine. It's gonna help to reestablish
some of that thickness within the vertebra. If there's any joint compression, such as a facet joint compression or stenosis within the
exits of the nerve roots, that's gonna help to relieve
some of that compression. So if you find that you can't
be hanging from something, because maybe you haven't got
the strength in your hands or your arms, then that's no problem. You can use something
like a chair with arms. So if you don't have a chair with arms, it doesn't matter either. You could get two chairs
next to each other, so you've got something to push against. But what you wanna try
and do is put your hands on the arms of your chair and lift yourself up. Once you get up here, you wanna try and relax
as much as you can. So just spend a bit of time, just breathe, just let the muscles in your
back and your abdominals relax, and just let that weight
pull your pelvis down, so it gives you that
traction through the spine. I would do about a minute on this. Now, if you can't do a
minute all in one go, it doesn't matter. All you need to do is, as long as you can, so let's say 15 seconds, and then have a little rest, and then repeat. What I will just say is, as you start to reload
yourself back into the chair, so as you go from here and put yourself down, just do that very slowly
and very carefully, because you don't want to
suddenly compress your spine and make anything worse. So next we have an exercise called the Cats and Cow from yoga. And I really like this exercise, because it doesn't put much
compression through your spine. So what you need to do
is come onto the floor, get your knees underneath your hips and hands underneath your shoulders. And then from here, stick your bum out, so you're rounding your spine. You can look up as well. And then from here, you
tuck your tailbone under, you try and bend, or try and round your
spine as much as you can, and drop your head down. And you repeat as many times as you want. When you starting this exercise, one thing to just make sure
is you start very small, so very, very small movements. Just make sure that that's not causing you any pain in your back or down the back of your legs. And as you start to loosen up, then you can start to push the amount that you're going a little
bit further each time. So this exercise will help to loosen up the muscles in your back and your hips, and it will help to get your spine moving and your spine looser. So if there's any restrictions
within your spine, or any tightness within the muscles, then this will help to
loosen both of those. So the next exercise is
called a McKenzie press up. If you've decided that your
issue is coming from a disc, or flection that aggravates it, so it could be disk related, then this is gonna really help you, 'cause it's doing opposite movement. So what you do is you
start off on your front, hands underneath your shoulders, and then just gently push yourself up, so you're bending through the lower back. From here, just hold and breathe. Really important to breathe. Breathing will help to
relax those muscles. So just stay there for
a while, just breathe. And then come down. And then you repeat. So you can come up a bit further, if the last one felt okay. And over time you can
gradually push yourself up further and further, and hold and just breathe. Personally, I would just hold, rather than going up and down, because a repetitive movement, such as going up and down, could potentially irritate things further. So by holding this position
or holding this position, you would just allow your
body to relax and calm down. And you just stay there and breathe. And then reset whenever you need to. So you can do this... You can hold this for up to a
minute or a couple of minutes, find a nice, comfortable
position and just breathe. And this one is really good
for disc related sciatica. Now, if you have established that your pain is coming
from your buttocks or possibly the piriformis, movement is one of the things that's gonna really help
to loosen that muscle up. So what I would suggest you do is get yourself a something
that you can stand on, just a small step, could be a pile of books or whatever. In my case, I've got a yoga block. So I'm just gonna stand on that. And the affected side is
gonna be hanging off the side. All I want to do is just move. So I'm just gonna move
my hip and my thigh. And what I'm trying to
do is get the muscles around the buttock and the hips working, because the more you
can work those muscles, the more that's gonna help
encourage those muscles to loosen up and overcome any spasm. So I'm not going too aggressively. You can swing if you want to. Just be careful about
swinging too far back and causing too much
extension through your back, and therefore maybe pinching
something in your back. But you could swing. Make sure it's controlled. Or you can keep it more slow and just focus on contracting
the muscles a bit more. If you do have pain in the buttock, then this could just cause you a little bit more pain initially, just while those muscles
are starting to warm up. Eventually, because it's quite low impact, it should allow those muscles to ease. Make sure you're holding onto something, so you're not gonna fall over. But the more you can move, the more blood you're gonna
get through the muscles. And that's just gonna help
those muscles to relax. So I would do this for a period of time. I would work my way up to one minute. You could start off by
just doing 20 seconds, and then pause. If that feels okay, then you could do another 20
seconds and another 20 seconds. Once you get familiar with this exercise, then you can just go straight
into doing one minute at a time. And this can be done as many times throughout the day as you like. Because it's low impact, because it's not putting too much strain through the muscles, you won't overdo it, perhaps. All I would say is just don't
do it too long all in one go, so no more than one minute at a time. Sometimes when the performance
is affected, it is in spasm. Now, if you try and stretch it too much then that could potentially
cause more pain. So it's worth trying to just
shorten that muscle passively, so you're not trying to contract it, but you're just shortening it by putting it in a
position where it's short. That can help the muscle to relax. So let's say it's this
side that's affected, I would lie down on my back, and then drop. Doesn't matter what you
do with this leg so much, but I would drop this leg down and out to the side. You can experiment with
different positions, so you can have as almost straight and just drop your knee out to the side, or slightly more bent. Find a position that works for you and just hold it in that position. Now, because you're not doing anything, because you're not putting
a stretch on the muscle, you could potentially hold
this for as long as you want, as long as comfortable. If it starts causing you
pain, then you just stop. But potentially you could
hold this for a minute, two minutes, five minutes, 10 minutes, whatever works for you. Play around with it and experiment. See what works. Then if you want to stretch
that piriformis muscle, what you could do is bring
your foot or your ankle onto the other leg. And then slowly start bringing this foot, the other foot, up towards your buttock. The more you bring your foot in, the more you start getting the stretch. Now, in this position,
it's not really stretching. What you could do is grab your knee and you can bring it across
towards the other shoulder. So this will directly
stretch the piriformis. You can hold this for 20 seconds, build it up to 60 seconds over time. And you could do this one to
three times in any one go. If you then want to do a
slightly different variation, you could bring this knee up towards you, and hold on to your thigh, and pull that knee in. So this is kind of a modified pigeon pose, which you get in yoga. If you can't grab this leg, what you could do is put a towel or a belt or band or
something behind this thigh, so you could hold onto it. But you grab that thigh and pull it up toward you and just hold. So you don't wanna be
stretching into pain. You want that pain to be enough, so you could feel it doing something, but not so much that you feel like it's gonna make the
piriformis pain worse. So hold that for about 20 seconds and build that up over
time to about 60 seconds. And, again, you could do this
a few times in one setting, but just don't do too much in one go, because, potentially, you could make that more inflamed again. Now, when it comes to
other treatment methods, you could try hot or cold packs. If you feel like your buttocks, or your sciatic nerve, or your back has really inflamed and sore, then you could try applying cold packs. The cold will help to
reduce any inflammation and blood to the area. My advice would be don't
do it for any longer than 10 to 15 minutes at a time. Because the last thing you want to do is restrict blood flow to the area, because although you're getting
rid of the inflammation, you're also restricting
other normal, healthy blood coming to the areas help to repair. So you could try cold packs. Or if your buttocks or your back or the area is feeling
just generally tight, but you're not feeling so inflamed, then you could try hot packs, and this is gonna help
to relax the muscle. But, again, you don't wanna
be doing this for too long, so no more than about 15 minutes, because the heat will
bring blood to the area, which is good because, one, it helps to bring new, fresh,
healthy blood and nutrients to the area, but also that heat helps
to relax the muscles. But because it bringing blood to the area, it also brings inflammation
with it as well. So potentially if you leaving
the hot pack on for too long, you could also make your
inflammation slightly worse. So, again, hot packs could be useful, but only for about 10 to 15 minutes. Now, another thing you could try is over-the-counter anti-inflammatories. Now, I'm not prescribing this to you. So please don't go out and start taking that
based on my suggestion. But anti-inflammatories
can temporarily help to reduce the inflammation in the area. So it's a good thing to try
and use for the short term, but bad thing to use in the long-term, because inflammation is an essential part of the healing process. So if you suppress
inflammation for too long, potentially you could slow
down the repair process. Now, when it comes to taking medications, speak to pharmacist or
speak to your doctor, just to make sure that you're
taking the right medications. Now, if hot or cold stretching
and medications do not work, then the next option could
be to speak to your doctor regarding something
like a steroid injection or even surgery. Now, surgery sounds quite extreme, but it depends on what's
causing your sciatica. If there is some form of bony compression within your spine, say, spinal stenosis, or arthritis, or even a spondylolisthesis, potentially you might need
a surgical intervention to take that pressure off of the nerves. And as far as steroids go, steroid injections are,
again, anti-inflammatory, or help to suppress that
inflammatory response. So that could potentially
be useful for you if over-the-counter
medications haven't worked. So hopefully now you understand what's causing your sciatica. Now, bear in mind, there are loads of different stretches that
you can do for sciatica. What you need to do is figure out which ones work best for you. You don't have to do a whole
load of them all in one go. Pick the best two or
three that works for you and just stick with them for a while. So hopefully by now you understand what could be causing your sciatica. As you've seen, there are many different reasons
that could cause sciatica, and probably several that I haven't even
mentioned today as well. But what I want you to do is go away and try those exercises,
try those stretches. And then in the comments section below, let me know which one you
have found the most useful. So until the next, video stay safe and I will see you soon.
