Pain in the Butt (or Back or Leg ...)

Baxter Bell explains what "sciatica" actually is, and suggest some strategies and poses that may help.
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Baxter Bell explains what "sciatica" actually is, and suggest some strategies and poses that may help.

Most everyone who strolls into my class seems to know someone who has “sciatica,” usually associated with low-back pain of some sort. Problem is, the term as it is commonly used seems to mean different things to different people.

parsvottanasana

According to PubMed, the National Institutes of Health's online resource: “Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.”

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Illustrations from A.D.A.M. courtesy of National Institutes of Health

But what causes the injury to or pressure on the sciatic nerve? And before answering that question, it's good to understand the function of the nerve and its location. The sciatic nerve is the longest and widest nerve in the body, starting in the lumber spine and running down the back of each leg, controlling the muscles of the back of the knee and lower leg, and involved with function and sensation all the way down the leg to the sole of the foot.

When there is pressure or injury to the nerve, the path of pain can take a few different routes, which is why it can be a bit confusing as to its source. Pain that radiates from your lumbar spine to your buttock and down the back of your leg is the hallmark of sciatica. However, it sometimes sciatic pain will sweep more to the out-seam of the leg and travel down the side of the leg to the foot, or maybe only travel part way down the buttock and back leg.

The most common causes of sciatica are slipped or herniated disk, Piriformis syndrome, pelvic injury or fracture (uncommon), and tumors (again, uncommon). The first two causes show up in my students more often than I wish. And the first one is partially due to the aging changes that take place in the intervertebral discs in the low back, which makes the discs more prone to injury over time. Sudden onset of sciatic pain is often precipitated by an acute change, such as lifting something heavy or twisting and bending forward simultaneously.

Piriformis syndrome, which can mimic disc rupture, involves a small deep muscle in the buttock region that happens to come into close contact with the sciatic nerve on its path from the lumbo-sacral region toward the back of the leg. Because the nerve and the muscle abut one another, if the Piriformis is tight enough, it can put pressure on the nerve and cause the same sort of symptoms as the discs that are located higher up. However, in Piriformis syndrome, the pain often starts in the deep buttock area, not the lower back, which can help to differentiate how to approach sciatica with yoga.

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So if you are thinking you may have “sciatica,” I’d recommend you start by getting checked out by your doctor. And once you are clearer on the underlying cause (your diagnosis, that is), and your doc doesn’t see any contraindications to you trying some yoga as part of your healing plan, start working one-on-one with an experienced teacher or look for a dedicated yoga class for students with back pain and its many varieties.

Here are a few general ideas and suggestions for working with sciatica from ruptured discs and Piriformis syndrome. For a ruptured disc, since it is a potentially more serious situation, you need to seek out a teacher who has worked with this condition and can provide you with appropriate, gentle, gradual re-entry into asana practice. For example, most forward bends will need to dramatically modified or temporarily removed from your practice, at least until the sciatica begins to resolve. Forward bends can push the ruptured disk further into the sensitive spinal cord or nerve roots and cause more problems. Focus instead on tipping forward from the hip joint, as in modified Downward-Facing Dog at the wall, with the hands up at shoulder level. This might be a way to experience safe opening and stretching of the spine and hamstrings. Relieving muscular and fascial tension around the area of disc injury through other yoga asana could promote resolution of your symptoms, addressing not only the muscles of the back of the legs, buttock and spine, but also anterior hip muscles, such as the quads and psoas. High Lunges, Drop Knee Lunges, and variations of Warrior 1 Pose all address this area of the body.

With Piriformis syndrome, if the disks are healthy, usually determined via MRI, you can target stretching the Piriformis muscle directly, which could bring surprising relief from sciatica. A yoga asana warm up, sometimes called figure 4 or Thread the Needle, borrowed from the world of physical therapy, is a great one to practice regularly. In addition, Half King of the Fishes Pose, Ardha Matsyendrasana, done without the twist, as well as Marichyasana III variations tend to lengthen the Piriformis as well. Because each of us in unique in our structure and function, your practice will need to be tailored to your special needs. Dare I say it again: Find a teacher experienced in working with sciatica to help you on your way.

Happy healing through yoga!