Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their scope of practice, which means not attempting to diagnose, treat, or offer medical advice to students.
The sciatic nerve is the longest, largest nerve in the human body. It originates in the low back and travels through the buttocks and down the leg, where it divides above the knee before continuing into the foot. Sciatica is irritation of that nerve.
Sciatica generally occurs on just one side of the body, experienced as shooting or burning pain, tingling, numbness, or weakness anywhere along the route of the sciatic nerve. Somewhere between 13 and 40 percent of us may experience sciatica during our lifetime. In many cases, it resolves in just a few weeks, but for some people, it lasts a year or more.
Yoga practitioners with sciatica may find that certain yoga poses are helpful and others increase the irritation. Although this varies from person to person, there are some general “do’s and don’ts” that can be useful to consider when practicing with sciatica. But first, let’s take a close look at the source of the problem.
“Sciatica is not a cause but a symptom,” Bill Reif, physical therapist and author of The Back Pain Secret: The Real Cause of Women’s Back Pain and How to Treat It, explained to me in an interview. “The cause is often the pinching of one of five roots of the sciatic nerve in the lower back, usually around L4, L5, or S1. But compression can occur from L4 to S3.”
That pinching of the sciatic nerve, says Reif, “is often a result of excessive lumbar flexion [rounding of the lower back].” He points out that many activities of our daily lives—slumped sitting, forward bending, and lifting heavy objects—can cause disc problems, which in turn cause sciatic nerve problems.
In about 90 percent of cases, sciatica is caused by a herniated disc in the lower back compressing a nerve root. However, the problematic pressure on (or inflammation of) the sciatic nerve may also be caused by bone spurs, muscles, or other tissues. Spinal stenosis, a narrowing of the spinal canal through which the nerves run, can cause sciatica. A vertebra that has slipped out of place because of isthmic spondylolisthesis can place pressure on the roots of the sciatic nerve. Sciatic pain can also stem from problems with the sacroiliac (SI) joint.
According to Reif, “pseudo-sciatica” has symptoms similar to sciatica and can benefit from the same course of treatment. It occurs when there is pain along the sciatic nerve, but the origin of the compression is not in the lower back. This includes entrapment of the sciatic nerve in the gluteus (known as deep gluteal syndrome), and/or in the piriformis (called piriformis syndrome).
Prolonged sitting, larger body size, advancing age, and diabetes are among the factors associated with sciatica, as are anxiety, smoking, and certain jobs—such as those that require driving, heavy manual labor, or certain repetitive movements, like twisting. Reif points out that the wear and tear on the lower lumbar discs from movements like bending and lifting (to pick up heavy packages) or forward-folding and twisting (think snow shoveling) can often mean trouble for the sciatic nerve.
Diagnosing the exact source of the compression is difficult. “MRI and CT scans can help identify disc or stenosis involvement, and X-rays can show spondylolisthesis,” says Reif, “but sacroiliac joint dysfunction will not show on most diagnostic exams; often, examination by an experienced manual therapist is necessary. Soft tissue involvement, such as in piriformis syndrome, is difficult to identify precisely because soft tissue compression of nerves is not seen on diagnostic equipment. Manual PTs or massage therapists are usually the ones to identify the problem and provide relief when the piriformis is involved.”
According to Reif, the exact source of the compression may not be critical, because the course of treatment is often the same. Physical therapy with attention to posture and flexibility is often a recommended part of that treatment.
In many cases, exercise programs of various types can benefit those with or recovering from sciatica. A yoga practice that focuses on certain gentle movements, while avoiding other movements, may decrease sciatica symptoms.
According to Reif, rather than disappearing all at once, sciatic pain tends to first return to its point of origin. Symptoms tend to disappear only after this “centralization.” (The opposite, “peripheralization,” occurs when nerve compression worsens, sending pain farther afield.)
If sciatic pain peripheralizes, or simply does not improve after a few weeks, it is important to seek medical advice.
The suggestions below are meant to guide yoga students and their teachers in modifying practice in order to make it accessible, comfortable, and helpful for those with sciatic pain. “Those with active sciatica should always stop when a pose increases symptoms,” Reif cautions. For an example of a practice that puts all of the suggestions below into play, see A Yoga Practice for Sciatica.
1. Realign the spine.
Because a compressed or rounded lower back may contribute to pressure on the sciatic nerve, practice creating a neutral spine while lying on your back or standing with your back against a wall. Allow the lower back to curve in gently, while elongating from the tip of your tailbone to the crown of your head, inviting space between the lumbar vertebrae with every deep breath.
2. Reset the sacrum (if you know or suspect that your sciatic pain stems from the sacroiliac joint).
“If you have sciatica, and the two sides of your pelvis don’t feel level—or if you’ve been told that one of your legs is shorter than the other—try sacral resets,” Reif suggests.
Because sciatica and other back pain can have their roots at the sacroiliac joint, certain “sacral resets” (i.e., low-risk movements borrowed from physical therapy that are designed to correct the pain-causing asymmetry and restore optimal alignment between the sacrum and ilia) may help to move the sacrum into a position that causes less pressure on the sciatic nerve. Please note that if you are not experiencing sacral dysfunction, “resets” will simply activate the muscles of your pelvis and lower back whose weakness can contribute to back pain.
This article explains resets in detail and offers several examples, such as simply hugging one knee in toward your chest while lying on your back, then pressing your shin against the resistance of your hands. Maintain this activation for a few breaths, allowing little or no actual movement; then switch sides, alternating between sides a few times.
3. Mobilize and extend the lower back.
Reif favors gentle poses that gradually improve the mobility of the lower back, the location of much sciatic nerve compression. Practicing pelvic tilts while lying on your back can increase the flexibility of the lower back, help you find a neutral position (where the lower back curves in gently), and warm you up for some gentle backbends.
In Reif’s experience, in cases where sciatica has derived from habitual flexion (rounding) of the back, mild extension (backbending) is part of the solution. In addition to practicing poses like baby cobra and sphinx, Reif suggests closing your practice with a few standing backbends after savasana, to leave you with a gentle inward curve of the lower back.
4. Stretch the gluteals and hamstrings.
According to Reif, not only can tightness in the gluteals and hamstrings restrict the sciatic nerve, but tightness in those muscles may also result from and contribute to poor posture. So stretch these areas, for example, by drawing one extended leg toward your chest while you lie on your back for reclining hand to big toe pose (supta padangusthasana). “But start with your knee bent, and straighten your leg only to the extent that causes no pain,” he says. Reif explains why a straighter leg causes a more intense sciatic nerve stretch: “The straight leg variation stretches the entire sciatic nerve and hamstrings, whereas the bent knee version stretches only the uppermost portion of the nerve within the buttocks.”
5. Internally rotate the hips.
“The piriformis”—a muscle whose tightness may be a factor in sciatic pain—“is a key external rotator, so internal rotation will stretch it,” Reif says. For example, lie on your back, place a strap around one foot, extend that leg toward the ceiling as much as you comfortably can, turn the toes in, and then draw that leg slightly toward the opposite shoulder.
6. Externally rotate the hips.
“Some of the gluteal muscles”—muscles in which the sciatic nerve can become entrapped—“are internal rotators,” says Reif, “so external rotation will help to stretch them.” Moving into poses like warrior II as well as all versions of pigeon that are accessible to you will stretch these muscles.
1. Don’t go so far into any pose that you feel an increase in symptoms.
It is important to note that “The exact same movements that are therapeutic for sciatica”—such as those mentioned in the “do’s” above—”can cause problems if taken to a degree for which your body is not ready,” says Reif. So, even while doing a stretch for the gluteals, hamstrings, or hips, never go so far that you feel an increase in pain, tingling, or numbness.
2. Avoid slouching.
Since rounding the lower back too much may lead to or exacerbate disc and nerve problems, when doing neutral spine poses like mountain, staff, and warrior poses, align and lengthen your spine. This includes lining up your ears, shoulders, and hips; curving your lower back in gently; and lengthening the crown of your head and the tip of your tailbone away from each other.
3. Don’t practice poses that require a strong contraction of the gluteals if it causes pain.
Contracting the gluteals can increase the pressure on the sciatic nerve and exacerbate pain, especially if your sciatic pain stems from piriformis syndrome. Poses that require a particularly strong contraction of these buttocks muscles include bridge and wheel, in which they contract to lift the body’s weight off the floor. Lifting one leg from tabletop or downward facing dog also contracts the gluteals on the side of the leg that is lifting. Those with severe sciatica may find that bow pose and dancer pose trigger their pain as well.
4. Don’t forward-fold past your limit.
While “Any pose performed too quickly or too deeply can overstress the sciatic nerve and increase symptoms,” according to Reif, this is especially true of forward folds. “This flexion or bend at the waist can be especially bad for sciatica,” he says. “Shortened, tight lumbar, gluteal, and hamstring muscles can act like a brake and stop any more forward movement of the pelvis. If your pelvis stops tilting anteriorly, in order to fold more deeply, you might bend from your lower back. This could potentially overstretch the lumbar muscles and cause the discs to bulge backward, placing more pressure on the sciatic nerve in the spinal canal.”
To gradually move the back toward flexion without the stress of a forward fold, Reif suggests gently hugging one knee to the chest, then the other, while lying supine. (If or when this movement causes no pain, you can try drawing both knees toward the chest.)
If a stretch for the hamstrings and gluteals is desired—and often, stretching these areas is a key to relieving sciatic pain—to prevent straining the lumbar discs, Reif usually advises those with sciatica to maintain a neutral spine rather than folding to a degree that rounds the back. For example, lying down in hand to big toe pose using a strap around the foot, and choosing half standing forward fold (ardha uttanasana) over standing forward fold (uttanasana) and staff pose (dandasana) over seated forward bend (paschimottanasana).
5. Avoid twisting (especially while folding) if it causes discomfort.
Any twist can be tricky when sciatica is flaring because of the pressure twisting places on the outermost parts of the intervertebral discs in the lumbar spine. Twisting combined with forward-folding can be especially problematic. “There are several yoga poses that encourage a twist while bringing the torso close to the thighs,” Reif says, referring to twisting versions of triangle (parivrtta trikonasana), chair pose (parivrtta utkatasana), and head to knee pose (parivrtta janu sirsasana). “Those who have active symptoms should avoid these.”
Once pain has centralized, in addition to focusing on posture and on stretches for the hamstrings, gluteals, and hips, Reif recommends adding core-strengthening movements.
“The priority for the yogi then becomes building core strength through poses like plank in order to help keep the pressure off the L5 nerve root. Improvements to posture, and consistently performing the most effective exercises, can keep the entire pathway free of compression,” he says.
Once your pain is gone, you can experiment with re-introducing the movements on the “don’t” list, keeping them gentle at first. Naturally, back off if any pain recurs.
“The point is not to avoid these movements forever,” says Reif. “In fact, many of them are important for daily life. Eventually, you want to do spinal twists, which will free up the lumbar rotation so necessary for daily activities (like getting out of the car). And sometimes, the same pose that causes problems when your symptoms are acute may be therapeutic once symptoms have abated.” For instance, while contraction of the gluteals as required by bird dog may be painful for those with active sciatica, strengthening the core and gluteals with this pose—once sciatica has abated—may build the strength that helps to prevent future sciatica.
In addition to practicing yoga regularly and carefully, make a practice of noticing which movements or positions of daily life provoke your sciatica symptoms. According to Reif, “Symptoms often disappear for a while, then return when you do the same activity that produced the symptoms initially.” Be aware that those symptoms may not occur immediately: “There is often a delay after the sitting, standing, or lifting that commonly causes sciatic problems, with pain coming on only hours later.”
If sitting triggers your pain, Reif recommends that you “Choose a chair with lumbar support, or place a pillow or rolled towel in the small of your back to help you maintain your lumbar curve. A chair with a swivel base would be helpful so you can get out of your chair without any twisting.” The height of that chair matters, too. “Keep your knees and hips level by lowering the chair seat or lifting your feet,” says Reif, “since knees above hips encourages the lower back to round, and knees below hips encourages too much lumbar arching.” Pay attention to how you sit, rooting down with your sitting bones and lifting up through the crown of your head, curving your lower back in gently, and keeping your ears over your shoulders to minimize compression to the intervertebral discs.
Since standing can put pressure on the lower back, which may aggravate sciatica, Reif suggests: “When standing, try from time to time resting one foot”—the foot on the side of your body where you experience sciatic pain—“on a yoga block, book, or small box. This can take the load off the symptomatic side and return a slight curve to the lumbar spine, which will then take pressure off all lumbar nerve roots.”
Because lifting can contribute to sciatica and other kinds of lower back pain, when picking up something heavy, Reif suggests to “Distribute the effort more into the legs and away from the lower back, bend your knees and keep your back straight with a gentle curve in the lower back, and hold the load close to your body. If the object is too heavy for you to do this, find a friend to help you lift. Always avoid lifting and twisting simultaneously.”
Along with a mindful yoga practice, making these everyday actions central to your self-treatment protocal may help to alleviate sciatica symptoms.