Today's Daily Tip
One day 25 years ago Candy Doran, an avid cyclist and competitive runner, bent over to pump a bike tire and was struck by lightning. Not literally, but that's how she describes the searing pain that shot through her lower back and leg and made her collapse to the ground in agony. The pain quickly subsided, and she resumed her routine of training for half marathons and vigorous cycling competitions like the California Death Ride, for which she biked through five mountain passes in a single day. Over the years, the pain would return, sometimes not as severe; sometimes she just had trouble getting comfortable while seated. It always went away and didn't interfere with her regular activities, so she just "ran and cycled through the pain," she says. When it was gone, it was forgotten. Eventually, after hearing her running and cycling buddies complain about sciatica and reading about the condition in fitness magazines, she put two and two together and realized that she too was suffering from inflammation of the sciatic nerve.
When she tried to address her pain, the results were discouraging. A chiropractor and physical therapist weren't helpful. So she consulted her running magazines and tried the back exercises they recommended. Her hope was that strengthening the muscles of the lumbar area would lessen the frequency or severity of the attacks. But it didn't, and at times the exercises made matters worse.
It wasn't until a knee operation ended her running career a few years ago that she became determined to control her sciatica. "I was physically deteriorating and I knew I needed to preserve what I had left," says Doran, who still cycles about 100 miles each weekend around San Francisco. "And I knew I had to go outside my Western experience of physical therapy to do it."
She found solace at the Iyengar Yoga Institute and with her teacher, Kathy Alef. For the past four years, her twice-weekly practice has taught her to stretch correctly, concentrate on proper alignment, and focus on her overall physical needs. This has been a departure from her physical therapy exercises, which she says are often designed just for specific areas. Now she fights the entire fire instead of individual flames. "Yoga has taught me to pay attention to how my body moves and how it relates to my sciatica," Doran says.
For the first time in decades, Doran's sciatica is almost nonexistent. Besides an occasional flare-up, the equivalent of a 24-hour cold, she is practically pain free. Best of all, at 55, she's able to stay active at an age when most people have to slow down. "Now when my sciatica does occur, I know what to do to ease the pain—stretch and strengthen like crazy."
Of All the Nerve
The sciatic nerves are the body's two largest nerves. They are about as thick as your pinkie and emanate from the lower lumbar spine. They thread through the buttocks down the back of each leg to the soles of the feet and big toes. Pain strikes when a root that helps form one of the sciatic nerves, or when the nerve fibers, become pinched or irritated. You can feel it anywhere along the nerve's branch: low back, buttocks, leg, calf, or foot. It can be felt down one leg or both.
Sciatic pains are like snowflakes: no two are ever the same, and their severity can change throughout an attack. The pain can feel like a dull soreness, numbness, or tingling, or more like an electric shock, throbbing heat, or stabbing pain. It can begin as an annoying ache that makes it uncomfortable to sit, or turn into a variety of intense, and at times debilitating, sensations that make it nearly impossible to walk or stand. An episode can last anywhere from a few hours to several weeks. Some are frequent and consistent—you can almost set your watch by them—while others may arrive out of the blue after a long hiatus.
A common culprit for sciatic pain is a herniated disk (sometimes referred to as a ruptured disk, pinched nerve, or slipped disk). "Your disks can get fatigued like a wire hanger being constantly bent back and forth. Eventually, a disk may weaken and perhaps break," says Loren M. Fishman, M.D., the coauthor with Carol Ardman of Relief Is in the Stretch: End Low Back Pain Through Yoga. "Or a vertebra can slip forward and the nerve fibers may become compressed that way, much like a kink in a garden hose." This can happen due to an injury or trauma, long bouts of physical activity (as is the case with many athletic people who suffer from sciatica), or simply from years of constant bending or sitting for long stretches. It's possible to ignite pain with the simplest movement, much like what happened with Doran. "People may aggravate their sciatica with a sneeze or reaching for a box of cereal," Fishman says.
Yet sciatica is not always related to back issues. "You can have back pain without having sciatica, and you can suffer from sciatica without back pain," Fishman says. For instance, osteoarthritis can narrow the opening through which the nerve roots exit the lower spine, injuring the fibers that make up the sciatic nerve. Another cause is piriformis syndrome, in which the piriformis muscle in the buttock compresses the sciatic nerve. "It's commonly caused by overuse and oversitting, and is seen in people with sedentary jobs like bus drivers and office workers," Fishman says.
Sciatica may seem like a pain to treat, but Fishman says more than half of all sufferers can soothe and reduce flare-ups by combining some form of exercise, in particular yoga, to strengthen the back and help relieve the pressure on the nerve root, with the judicious use of nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or naproxen. Many people have also relied on other complementary approaches to manage attacks. (See Sciatica Strategies) Of course, more intense pain may need stronger medications to ease the inflammation, such as oral steroids or epidural injections, and severe or recalcitrant cases may even require surgery to remove the portion of the disk that irritates the nerve root. But a yoga mat and a clear plan may be all that a sciatica sufferer needs.
Can you "cure" your sciatica with yoga? The answer is yes and maybe. "It's wrong to say that your sciatica can never be relieved," Fishman says. But it's also unfair to blindly believe that if you simply put in the time and effort, your pain will disappear forever, says certified Iyengar yoga teacher Anna Delury. That's why she recommends a management-style approach, with the intention to keep your pain at bay, which is more realistic and won't set you up for disappointment.
"You definitely can use the Iyengar method to bring your sciatica under control and make flare-ups less and less common," says Delury, who has trained with B.K.S. Iyengar since the early 1980s and now teaches yoga in her home studio in Los Angeles. "But it is also possible to cure your sciatica with yoga." She speaks from experience. Delury suffered from sciatica for years—the result of a series of childhood falls and an active, sports-oriented youth. It wasn't until she fully embraced Iyengar Yoga, however, that her sciatica withered and eventually vanished. She has been pain free now for 11 years.
Delury emphasizes that managing your sciatica with yoga is not something you can accomplish in a few weeks, or even months. "Everyone is different, but it may take, on average, six months to one year to be able to control your sciatica," she says. "The reason is that it takes longer for nerve and spinal-related problems to heal from injury. It can be painful at times, and you may have setbacks along the way, but you'll also feel relief too."
Sciatica Action Plan
There are different approaches to using yoga to manage your sciatica. It depends on your yoga experience and the severity of your pain. Delury believes that the sequence below is ideal for most people because it focuses on beginner-level poses. "I've found that 80 to 85 percent of the time, sciatica sufferers benefit from this sequence," she says. Since everyone's sciatica is different, Delury has her students follow a three-tier approach, based on Iyengar's teaching, while doing each pose. They are like individual check marks so students can gauge what they need to focus on, how deep they should go into a pose, and how long they should hold it. Here's a look at the steps and how they are connected.
Step 1: Pacify the pain
Step 2: Understand proper alignment
Step 3: Build muscle strength to maintain alignment
When you use yoga to manage your sciatica, Delury advises that you cut back on all other activities at first. This means taking a break from strenuous physical activities like skiing or running, or even your usual intense yoga practice. "You have to go to the baseline," Delury says. In her case, she gave up running, dancing, and even sit-ups. "All I did was focus on the sequence given to me by Mr. Iyengar for a year," she says.
This is sometimes more difficult to endure than the sciatic pain itself. It's a big psychological hurdle for active people, especially serious yoga practitioners. But it's necessary, Delury says. The reason is twofold: First, any strenuous activities may inadvertently aggravate your sciatica and cause a setback, and second, you need to break any bad habits you may have picked up in how you move and bend, so you can learn proper alignment.
If you find this complete abandonment too difficult, Delury suggests that you take a trial-and-error approach. If possible, eliminate your most extreme activity first, like marathon running or cycling, or a "lopsided" sport like golf or tennis that emphasizes one side of the body, and monitor how your sciatica reacts.
"Sometimes just eliminating the most intense activity is enough. If it's not, and you find your sciatica still flares up, cut back on another activity, and then another, until your sciatica is OK," she advises. Even if you have to stop doing all sports, you can still stay active with gentle walking, Delury says, while you focus on your sciatica yoga routine.
That's what Toby Brusseau, 27, did. In 2003, he fell 15 feet onto a bed of rocks while climbing in Malibu Creek in Southern California. It caused a herniated disk that triggered painful bouts of sciatica, sometimes so intense that the mere pressure of the keys in his pants pocket was too much to bear.
He took up Delury's yoga sequence, with some modifications to fit his experience level and sciatica. He stopped all other physical activities for several months and focused on just the yoga, sometimes practicing several times a day. This regimen meant he could do no rock climbing, cross-country running, weight lifting, skiing, or mountain biking. Brusseau even stopped going to his regular group yoga class. He admits it was hard to suddenly slow to a crawl like that, but after just one month he noticed a difference and within 10 months felt 100 percent cured.
When the pain began to subside, however, he didn't take it as a sign to throw a harness around the nearest boulder and hoist himself up. He literally took small steps. He began with walks, and when that didn't aggravate his sciatica, he began to run again in his old confines of Fryman Canyon near Hollywood. He began with flat surfaces and worked up to steep hills. When that was OK, he added another of his previous adventures but always gauged how his sciatica reacted. Eventually he made it back to rock climbing.
Brusseau's experience may be unusual, but he's an example of what may be accomplished with diligence and a plan. "So many people are looking for the quick fix for their sciatica, like a steroid shot, so they can get back to their life, but I wanted to feel my way through it," he says. "I wanted to test myself and my yoga to see if it could work—and it did."
Can Yoga Cause Sciatica?
Sometimes your yoga practice can be the culprit of your sciatic pain. This happens, says Anna Delury, when yogis develop bad habits in poses. "They overly rotate their back leg or twist their feet or square their hips too much, like in Warrior I," she says. This can cause pressure on the lumbar spine and may irritate the sciatic nerves. Her suggestion: In standing poses keep your feet flat on the floor, each knee facing in the direction of your toes, and let your hips move naturally. Unfortunately, people misunderstand directions from their teacher about where they should place their hips, which often results in squaring them too much, she says. "The hips should receive the movement, not initiate it. Don't force your body into a movement or position it's not ready for."
Sequence for Sciatica, by Anna Delury
Note: The following sequence is not designed for everyone with sciatic pain, but it has had a high success rate, and it is based on the teachings of B.K.S. Iyengar. As you do each pose, be mindful of the three steps outlined by Anna Delury above. They can help you gauge how deep you should go. This sequence has suggestions for how long to hold each pose, but stay in an asana only as long as it provides relief. "Holding longer doesn't mean betters," Delury says.
1. Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose), variation 1
Lie on your back beneath a doorway or next to a column. Raise your right leg and rest it against the door frame or column for support. The left leg is outstretched. At first, your raised leg may not be flush with the door frame. As the hamstrings release, you'll gradually move more toward a 90-degree angle. If you feel any pain, turn the raised leg out to see if that releases it. Over time you'll be able to bring your leg back to parallel. Resist overworking. Let the door frame help you relax while it teaches the legs and pelvis proper alignment. Hold the pose for 30 seconds or as long as it's comfortable. Repeat on the other side.
2. Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose), variation 2
This position is like variation 1, only instead of using a door frame for a prop, you lower your foot out to the side and support the outside of the foot on a chair. Make sure to keep your hips level. Again, allow the prop to pacify the lower back. Hold for 30 seconds on each side, or for as long as it's comfortable.
3. Utthita Trikonasana (Extended Triangle Pose)
Stand at a wall with your feet about four feet apart and the heel of your left foot pressing against the baseboard. Turn your right foot out 90 degrees. Reach your arms out to the sides, keeping your shoulder blades spread wide and your palms facing down. Firm your thighs and turn your right thigh outward,so that the center of the right knee is in line with the center of the right ankle. Exhale and extend your torso to the right directly over the right leg, bending from the hips, not the waist. Rest your right hand on a block or chair so both sides of the torso are even. Rotate the torso to the left, keeping the sides of the waist equally long. Hold for 30 seconds. To come out, push the back foot against the wall and pull up to standing with the back arm. Repeat two to three times on each side.
4. Ardha Uttanasana (Half Standing Forward Bend)
Stand in Tadasana (Mountain Pose) with your feet hip-width apart, facing a table or countertop. Your iliac crests (hip points) should be level with the edge. Lay your torso over the flat surface so that your hips fold over the edge and your back is long. You can stand on a block or other prop if you need more height; or if you're tall, place a support on the table on which to rest your torso. Turn your toes in and your heels out to release the muscles around the tailbone and lower body. Slowly unwind. Let your legs do the work, not the back. Stay here for as long as it's comfortable.
5. Utthita Parsvakonasana (Extended Side Angle Pose)
Stand at a wall just as you did for Triangle Pose, and place a block near your right foot. Press your left heel against the wall, and turn your right foot out 90 degrees. Reach your arms out to the sides, keeping your shoulder blades spread wide and your palms facing down. Firm your thighs and turn your right thigh outward, so that the center of the knee is in line with the center of the right ankle. Bend your right knee over the right ankle so that the shin is perpendicular to the floor. Exhale and lower the right side of your torso as close as possible to the right thigh. Place your right hand on the block. Extend your left arm up toward the ceiling, turn the left palm toward your head, then reach the arm over your left ear, palm facing the floor. Stretch the entire left side of your body from your heel through your fingertips. Hold for 30 seconds, then push the back foot against the wall to come back to standing. Repeat twice on each side. Then repeat Ardha Uttanasana.
6. Bharadvajasana I (Bharadvaja's Twist), with a chair
If the previous poses bring relief after two to four weeks, add this seated twist. Sit sideways in a chair with your buttocks lined up with the right edge of the chair and your left side perpendicular to the chair back. Twist to the left and grasp the sides of the chair back with your hands. As you do this, wedge a bolster or rolled-up blanket between your waist and the chair back. It will feel like a tight fit. The bolster forces you to twist upward instead of downward, which is the usual tendency in twists, and provides space between the vertebrae. The emphasis in the pose should be on lifting, not twisting. Just placing your hands on the chair back provides enough of a twist, so don't pull to create more of a twist. Hold for 30 seconds. Release, move your legs to the other side of the chair, and repeat. Repeat two to four times in each direction.