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The sciatic nerve originates in the low back and is comprised of a combination of 5 nerves: L4, L5, S1, S3, and S4. The sciatic nerve is the largest in the body, measuring around 2 cm at its thickest point.
The sciatic nerve splits after exiting the greater sciatic foramen (pictured below). The most common route is for one side to go through the piriformis muscle and one side to go under it.
However, after examining 3D nerve imaging of 137 patients, researchers found six deviations in the nerve pathway, which accounts for how varied sciatica symptoms are from person to person.
Nerves are highly irritable, and they do not have elastic properties like muscles do. So stretching is done for the muscles surrounding the sciatic nerve, not the nerve itself. In fact, any stretch that you feel is increasing nerve pain should be discontinued immediately.
Stretching is an integral part of managing sciatic nerve pain. Keeping the muscles of the low back and legs flexible increases blood flow and provides healthy tissue for the sciatic nerve to move through without restriction.
The piriformis is a small muscle deep in the buttocks that starts in the low back and attaches to the upper part of each thigh bone. It runs diagonally with the sciatic nerve running vertically beneath it(in most instances). However, due to the structural variations mentioned above, the sciatic nerve can pierce the piriformis.
The piriformis muscle can go into spasm, putting pressure on the sciatic nerve, if the sacroiliac joint, hip joint, or surrounding structures become irritated. Therefore piriformis stretches should always be done gently.
Sacroiliac joints are located where the sacrum meets the lower pelvis on either side of the spine. Because the sciatic nerve runs very close to these joints, it is essential to keep them moving freely without irritation.
Tightness in the muscles of the low back and buttocks can alter normal spinal movement resulting in irritation and swelling, which can put pressure on the sciatic nerve.
Lumbar Rotational Stretch - Increases the mobility of the low back and gluteal muscles.
How to: Lie faceup on the floor with knees bent and feet flat. Keeping knees together and feet on the floor rotate knees from side to side in about a 30-degree range. Keep low back flat on the floor and stay in a pain-free range. Hold for 5 seconds. Repeat 5 times on each side. Do 2 sets with a one-minute rest in between.
Press-Up SI Joint Stretch - Increased joint mobility in the low back and sacroiliac joints.
How to: Lie face down on the floor, place forearms at your sides with palms down. Gently push your chest up off the floor, keeping your forearms straight. Relax your low back and buttocks muscles. Hold for 5 seconds then return to starting position. Repeat 5 times. Do 2 sets with a one-minute rest in between.
Piriformis Stretch - Stretches the piriformis muscle.
How to: Lie faceup on the floor with both knees bent. Cross your left ankle over your right thigh. Clasp your hands around your right knee and pull your right knee toward your shoulder. Hold for 10 seconds, then switch legs. Repeat 5 times on each leg. Do 2 sets with a one-minute rest in between.
Single Knee to Chest Strech - Stretches the low back and upper gluteal muscles.
How to: Lie faceup on the floor with both knees bent. Clasp your hands around the back of one thigh and pull the leg straight up toward your head. Hold for 10 seconds. Repeat 5 times on each leg. Do 2 sets with a one-minute rest in between.
3 in 1 Low Back Stretch - Stretches the muscles of the low back and sides.
How to: Position yourself on your hands and knees. (1) Walk your hands up, so your arms are above your shoulders, then sit back on your calves, leaving your hands in place. Hold for 10 seconds, return to starting position. (2) Walk your hands over toward the right, then sit back on your calves, leaving your hands in place. Hold for 10 seconds, return to starting position. (3) Walk your hands over toward the left, then sit back on your calves, leaving your hands in place. Hold for 10 seconds. Repeat 5 times in each position.
Double Knees to Chest - Stretches the middle and low back muscles and the upper gluteals.
How To: Lie faceup with both knees bent. Bring one knee up toward your chest, followed by the other knee, and clasp your hands around both legs. Hold for 10 seconds. Repeat 5 times. Do 2 sets with a one-minute rest in between.
Hamstring Stretch - Stretch the muscles in the back of your legs.
How To: Lie faceup with both knees bent. Bring one knee up toward your chest and clasp your hands just beneath your knee. While pulling up on your knee attempt, you straighten your leg. Please don't force it beyond what feels comfortable. Hold for 10 seconds. Repeat 5 times on each leg. Do 2 sets with a one-minute rest in between.
The very last thing you want to do is make sciatica nerve pain worse. You certainly want to keep your hamstrings from getting tight. However, because the hamstrings run down the back of your legs and the sciatic nerve does too, it can be tricky.
Aggressive stretches that overstretch the hamstring and put tension on the sciatic nerve are never a good idea.
Standing Hamstring Stretch - Another way to stretch your hamstrings is to bend forward and try to touch your toes while standing. You want to avoid doing this because it can put tension on your sciatic nerve. Doing this will only increase sciatic nerve irritation.
Hurdler Stretch - This is an awkward stretch that looks just like a hurdler looks as he is clearing a hurdle. One hip is externally rotated with your knee behind you while the other leg is straight out in front of you. It is bad for your hips, bad for your knees, and can increased sciatic nerve pain.
Long Sitting Hamstring Stretch - Sitting up and reaching for your toes is another bad idea. As with standing and performing this same motion, you can overstretch the hamstrings and irritate the sciatic nerve.
All these stretches can be done on your bed if you are unable to get on the floor.
As I have cautioned before, anything that causes increased pain in your leg or low back should be eliminated from your exercise routine. And, a physician should address severe pain that does not subside in a reasonable amount of time