Sciatica – it’s not as scary as you think.

As a Certified Pilates Instructor and Health Coach, with a focus on back pain and injury recovery, I often hear people talk about sciatica as if there is nothing they can do except suffer. Nothing could be further from the truth.

Sciatica is super common, super treatable, and yes, at times, super painful. I know how painful sciatica can be from personal experience, as I have had several bouts of it myself over the years. Conflicting information from medical doctors and other professionals — or even your next-door neighbor — often leads to confusion about the best way to treat sciatica.

Don’t hit the panic button

If you have been told you have sciatica, don’t panic. Sciatica is a common health issue. Except in rare cases such as severe physical trauma, sciatica can be resolved by a consistent mix of small, specific movement exercises, gentle bodywork to release tension, and moderate strengthening.

Sciatica can present itself in the body in so many different ways, and can be affected by so many different factors, that it’s important for a practitioner to tailor an exercise and movement plan based on each client and their pain pattern. The approach that has been most effective with my clients is teaching them very subtle, gentle movements, along with de-stressing techniques. Also, very gentle, targeted bodywork to specific muscles groups is essential to a quick recovery.

What is Sciatica?

The sciatic nerve is the largest and longest spinal nerve in the body. The sciatic nerve descends to the base of the spine and passes through a very narrow gap in a bony plate called the sacrum. From this narrow gap, called the sciatic notch, the sciatic nerve descends into the buttocks, down both legs and into the feet.

Ideally, the spine, pelvis and sacrum are in balanced, functional alignment. If that alignment is thrown off by injury, postural habits, inactivity, or over-training, the sciatic nerve can become pinched. The result can be pain, numbness or tingling affecting some or all of the area between the lower back and the feet. Depending on the severity, the pain ranges from a mild, dull ache to excruciating, shooting pain.

When working in my studio, I like to get out a skeleton and show people what goes on with their vertebrae, sacrum and pelvis to cause the pain. Sciatica can be a difficult concept to grasp, but if you can see visually how the skeletal muscles work, most people quickly grasp the basic concepts.

Why is Sciatica so confusing?

Here is the frustrating part! Sciatica --and back pain in general -- often follow no predictable rules and can change hour-by-hour and day-to-day. Sciatica and back pain

can vary widely in each individual. Every situation is slightly different and can be affected by many factors not related to just the structures of the body. Often stress, lack of sleep, or other emotional issues play a big role. Negative emotions can affect the spinal area and nervous system so much that in some cases sciatica and back pain are literally caused by the stress of the negative emotions. For all these reasons, sciatica and back pain often require a lot of patience, creative thinking and trial and error.

What Causes Sciatica?

An episode of sciatica can be brought on by lifting heavy objects without correct alignment, bending or turning the wrong way, over-training — particularly with running or jogging or lifting weights — or by jobs that require a lot of standing. Another cause of sciatica and other back injuries is fitness classes like large group Pilates or Yoga classes in which the instructor does not emphasize correct alignment or the repertoire is too advanced for the participants. Sciatica can also be caused by a number of different situations like pregnancy, or having a large belly, which puts extra stress on the back.

Doctors often tell people that Sciatica can be caused by spinal stenosis (a narrowing of the spinal canal), spinal disc degeneration, herniated disc, and bulging disc. MRI’s are often used to identify these and other disc issues, and their specific location.

Should I see my doctor first?

A good medical doctor can diagnose sciatica. But beyond diagnosis, a medical doctor will typically limit treatment advise to anti-inflammatories (such as Advil) or other pain medicine. While this can be essential in the beginning to get people out of excruciating pain, over-the-counter pharmaceuticals and narcotic painkillers or muscle relaxants are not long-term solutions because they do not address underlying alignment, movement and lifestyle issues.

On a special note – please take care with narcotic pharmaceuticals, as they can be highly addictive. If you pick up a newspaper these days, there is almost always some tragic story of someone who died of a pharmaceutical overdose, often being first prescribed by a doctor to treat back pain, as with the recent death of Prince. And now there is more and more evidence that opioid use actually increases pain, rather than decreases pain.

Advil and other anti-inflammatories are safe when used as prescribed for limited periods of time. Extensive use of Advil and other OTC anti-inflammatories can sometimes cause internal bleeding and kidney damage, so long-term use is not advised.

The goal is to use pharmaceutical therapy for only a brief period of time, if you use it at all.

Should Surgery Be Considered?

I have worked with some clients who are in so much pain, they think surgery might be a good option. Surgery should never be a first option. In addition to the inherent risks of any surgery, surgery for sciatica has a high risk of making the situation worse over time by creating scar tissue and inducing permanent changes to natural movement patterns in the body. I have never had a trouble treating anyone for sciatica in my 15 years of working with injured clients. But I have had trouble treating clients who have had back surgery. Once someone undergoes back surgery, it changes the natural rhythms, patterns and flow of the spinal muscles and nerve signals.

Combined Movement Therapy and Gentle Bodywork

I find that the key benefit in using movement routines is that through movement, a person can actively stimulate small, deeper muscles often ignored in our daily routines or through bodywork alone. Over time the atrophy of those small muscles can lead to misalignment, back pain and sciatica. Another benefit to prescribed movement routines is that they put you in the driver’s seat and offer a more long-term solution. If the symptoms kick up again you will know the movements to relieve the pain, and you can do them yourself on your living room floor. Gentle, targeted bodywork will encourage muscles to relax, and allow realignment in the body to occur.

What role does stress play?

Stress is always a piece of the puzzle because anyone who is in pain is also stressed out, which increases body tension, which makes the pain worse. Getting to the root cause of someone’s stress is essential, which is where the coaching skills I have learned come in handy. If you are seeing a good physical therapist who isn’t trained to work with lifestyle issues, you may ask to be referred to a somatic therapist or a similar professional to help you sort through lifestyle issues or stress. After studying healing for 20 years, I believe that stress is at the root of all illness as the main contributing factor.

If you have questions or want to come for a session, I can be reached by email at laura@joyfulmovement.com or by phone/text at 415.309.3357.

Laura Marquit is a Certified Pilates Instructor and Certified Life Coach with a private practice located in Fairfax, CA, right across from Good Earth grocery store. The majority of her work is focused on recovery from injuries, but she also teaches fitness and a focused, objectives-setting approach to reaching professional or personal goals.