Which poses are best to avoid for an aggravated sciatic nerve? Are there any poses that are restorative or healing for sciatica?
—Anastasia Coon, San Luis Obispo
Sarah Powers' reply:
Many people have experienced or at least heard of sciatica. This is the condition whereby either compression of the L4-S1 nerve roots affects the sciatic distribution or the sciatic nerve is injured as it exits the buttocks. It can also be influenced by the piriformis muscle, which originates on the anterior of the sacrum and passes under the sciatic notch, inserting on the top of the greater trochanter. The piriformis functions in lateral rotation of the thigh.
Many practitioners with tight hips and/or weak and tight lower-back muscles will find that straight-leg forward bends aggravate or even create sciatica. If the pelvis is unable to rotate forward (flexion of the hip) by the psoas and iliacus muscles, quadratus lumborum, and rectus abdominis, then ante-version or rotation of the pelvis forward will be limited, resulting in the pelvis rotating back (retroversion).
Translation: Instead of bending forward from the hips, the lower spine rounds and bends forward while the pelvis tugs back. This is why you often hear the instruction to "bend from the hip creases" to lift the sitting bones. The action of lifting and separating the sitting bones results in the pelvis tilting forward. If the pelvis does not tilt forward in a forward bend, the result can be either a strain or pull of the sacroiliac (SI) ligaments or sciatica. This happens more often in seated forward bends, where the pelvis is fixed to the floor.
It is therefore important to avoid these poses, as well as any pose where shooting pain develops. Sciatica is often felt on one side only, so instead of taking Paschimottanasana (Seated Forward Bend), try Janu Sirsasana (Head-to-Knee Forward Bend). If the pain shoots from the lower back, bring the leg in toward the groin on the side you are not experiencing sciatica. If it is located more in your buttocks, bring in the leg in which you experience the pain. If bringing one leg in still makes you suffer from the shooting nerve pain, avoid seated forward bends altogether.
Using your practice to heal the condition is possible with patience and specific sequencing. It is important to strengthen the muscles around the sciatic nerve and bring circulation to this region. First, I suggest you bend the knees when in standing forward bends and Downward-Facing Dog to assist in the forward pelvic rotation. Also, moving in and out of poses increases the circulation to the area.
Salabhasana (Locust Pose) is the best backbend for healing, because it strengthens the lower-back muscles while bringing circulation to the hip muscles. The best variation is to inhale; lift the chest and legs; exhale there. Then inhale and bring the legs apart (which affects the piriformis also); exhale and bring the legs back together. If lifting the feet aggravates it, then do this with the feet moving along the floor. Repeat this five times before lowering down. This sequence could be inserted within the sun salutations and/or between other backbends like Bhujangasana (Cobra Pose) and Dhanurasana (Bow Pose).
Doing Setu Bandha (Bridge Pose) is also helpful. I prefer to alternate the distance between the feet to isolate different muscle groups first with the feet together, then hip distance apart, and lastly with the feet and knees quite wide, keeping the inner thighs (adductors) engaged. For increased circulation, move up and down in the pose before staying stationary for a number of breaths. Stretching the area by folding forward in Pigeon Pose or twisting in Ardha Matseyendrasana (Half Lord of the Fishes Pose) may also be helpful.
Finally, remember to continue with these poses long after the symptoms have disappeared, while still avoiding seated forward bends because re-injury is very common the first few months after sciatica has healed.
Sarah Powers blends the insights of yoga and Buddhism in her practice and teaching. She incorporates both a Yin style of holding poses and a Vinyasa style of moving with the breath, blending essential aspects of the Iyengar, Ashtanga, and Viniyoga traditions. Pranayama and meditation are always included in her practice and classes. Sarah has been a student of Buddhism in both Asia and the U.S. and draws inspiration from teachers such as Jack Kornfield, Toni Packer, and Tsoknyi Rinpoche. Sarah also draws inspiration from the Self Inquiry (Atma Vichara) of the Advaita Vedanta philosophy. She lives in Marin, California where she home schools her daughter and teaches classes. For more information go to www.sarahpowers.com.