Exercises, exercise therapy and gymnastics for pinched sciatic nerve

The sciatic nerve (sacral plexus) is the largest and thickest nerve in the human body. It is localized in the lumbar spine and passes through the tailbone and lower limbs, reaching the very feet. In an adult, its diameter is 8-12 mm. It is formed by all the roots of the sacral nerve plexus, which is formed by two lumbar and three sacral segments of the spinal cord. This explains the fact that damage to the lower parts of the spinal column often causes pain along the sciatic nerve.

The main functions of the sciatic nerve are to provide sensitive (afferent) and motor (efferent) innervation of the lower extremities. Pinching of the sciatic nerve (sciatica) occurs due to compression of its trunk or root, which is accompanied by severe pain. This is a common occurrence. According to statistics, it can occur in 30% of people who suffer from disorders of the musculoskeletal system.

Signs of a pinched sciatic nerve

The sciatic nerve is one of the largest in the human body. It is formed from six nerve roots, originates in the region of the 4th and 5th lumbar vertebrae and, passing through the greater sciatic foramen, stretches to the popliteal fossa. The main sign of a pinched sciatic nerve is pain. In this case, it is the intensity of this pain that matters in order to determine how much the sciatic nerve suffers.

Anyone can do a simple test at home to see if they have signs of a pinched sciatic nerve. You need to bend forward and then straighten your back. If, at the moment of bending the torso, pain occurs in the back, which goes through the buttock and back of the thigh to the bottom of the leg, then there are definitely problems with the sciatic nerve. Neurologists and neuropathologists use several other tests. For example, the patient lies on his back on the couch and straightens his legs. Then the doctor begins to lift his leg and brings it to a 90-degree angle. If the sciatic nerve is inflamed or pinched, pain will certainly appear in the leg when lifting. The earlier the pain appears when lifting, the more complex the problem. In addition to pain, other signs indicate a pinched sciatic nerve:

• motor dysfunction;
• dysfunction of the pelvic organs;
• loss of sensation in the buttocks and back of the legs.

Surgery

The operation is indicated if conservative therapy is ineffective and severe pain that cannot be eliminated by conservative methods persists for more than 6 weeks, as well as in the presence of:

• large intervertebral hernias;
• spondylolisthesis;
• spinal deformities;
• hemangiomas, chondromas and other spinal tumors;
• severe dysfunction of the pelvic organs, leading to urinary or fecal incontinence.

In such situations, conservative therapy will, at best, slow down the development of these pathologies, but not eliminate them completely. But if in the isolated existence of, for example, an intervertebral hernia, this is enough to improve the patient’s condition, then in cases where the presence of spinal pathology provokes the addition of sciatica, such measures will not be enough.

After all, the cause of the pinched sciatic nerve remains, it continues to suffer and cause the corresponding clinical picture. Therefore, in such cases, surgery is the only way to achieve a lasting improvement in the condition, restore a normal quality of life and eliminate the risk of loss of ability to work.

But even if there are indications, surgical intervention cannot always be performed. It is contraindicated for:

• pregnancy;
• infectious and inflammatory diseases;
• decompensated diabetes mellitus;
• serious respiratory or heart failure.

A timely operation can completely eliminate the causes of sciatica.

Surgical treatment of sciatica for intervertebral hernias

Herniated discs are a common cause of sciatica. Moreover, the severity of symptoms of nerve entrapment does not always depend on the size of the protrusion. Sometimes even small hernias can cause serious pain, limited mobility and neurological disorders.

Today, the problem of intervertebral hernia can be completely solved only by surgery, but the type of operation directly depends on the size, location and other features of the hernia. For small protrusions, preference is given to percutaneous surgical methods: nucleoplasty and hydroplasty.

In both cases, the essence of the operation is to destroy part of the nucleus pulposus of the disc, which leads to a reduction in the size of the hernia or even its retraction due to the creation of reduced pressure inside the disc. Percutaneous surgery techniques involve the use of thin cannulas, the diameter of which does not exceed several millimeters.

Operations of this type can be performed under general or local anesthesia. The instruments are inserted into the disc under the control of the image intensifier, which allows the neurosurgeon to precisely control the direction and depth of needle insertion, and also practically reduces the likelihood of injury to nerves or large blood vessels to 0.

Using cold plasma, radio waves, thermal laser energy or liquid pressure (during hydroplasty), part of the nucleus pulposus is destroyed. The volume of intervention is clearly controlled by the surgeon. Once the desired effect is achieved, the cannula is removed, and the remaining postoperative wound does not even require sutures. It is covered with a sterile bandage, and within a few hours the patient can leave the clinic and return to daily activities.

But nucleoplasty and hydroplasty are effective only for hernia sizes up to 0.7 cm. In other cases, other methods are used:

• Microdiscectomy – involves removing the hernia through an incision of about 3 cm in the projection of the affected disc. Special miniature instruments are used to perform the operation. Microdiscectomy allows you to remove a hernia of almost any size and location, while the small size of the incision ensures ease of rehabilitation and speed of recovery.
• Endoscopic surgery is a gentle method of surgical treatment of intervertebral hernia, which involves removing it with special instruments that are inserted into the patient’s body through punctures up to 1 cm in diameter. Through endoscopic surgery it is also possible to remove almost any hernia, but if its location is complex, the technique is powerless.

Surgery for sciatica caused by spondylolisthesis

Surgical treatment is indicated for spondylolisthesis, accompanied by a displacement of the vertebra by more than 50% relative to the normal axis. It can be carried out in two ways, and the choice of a particular one is based on the results of the MRI. But with sciatica, stabilization of a displaced vertebra in a normal position is permissible only after removal of the anatomical formation that provokes compression of the nerve and the development of neurological symptoms of sciatica.

In almost all cases, stabilization of a displaced vertebra is carried out using a special plate, which is fixed to a healthy and slipping vertebra using screws. This eliminates the possibility of it being re-displaced from its anatomically correct position. But first it is necessary to carry out:

• Discectomy – removal of the intervertebral disc is indicated if, against the background of spondylolisthesis, an intervertebral hernia forms and impinges on the spinal root. If complete removal of the disc is required, it is replaced with an endoprosthesis or a graft of the patient's own bone. The first option is preferable, since modern endoprostheses are in no way inferior in functionality to natural intervertebral discs.
• Foraminotomy - is performed when a nerve is pinched in the foraminal openings of the spine as a result of a decrease in their size due to the proliferation of bone tissue or other reasons.
• Laminectomy is a radical operation used only in extreme cases when spondylolisthesis has led to stenosis of the spinal canal. During a laminectomy, both individual anatomical structures and entire vertebrae can be removed. In the latter case, the removed vertebra is replaced with appropriate implants.

Surgery for sciatica caused by scoliosis

Scoliotic deformity of the spine often provokes pinching of various nerves and the development of sciatica in particular. Therefore, if the deformity cannot be corrected conservatively, surgical intervention is resorted to.

There are several types of operations performed for scoliosis. The specific tactics for restoring the correct axis of the spine are determined individually, but in all cases special metal structures are used that fix the vertebrae in the correct position. Sometimes they involve correcting the position of the vertebrae after surgery with gradual tightening of the screws to form a more correct axis of the spine.

But if previously all operations to correct scoliosis involved long incisions along almost the entire length of the spine, today this is possible even in a minimally invasive way. As a result of eliminating spinal deformity, the nerves are freed, which helps eliminate the causes of sciatica and progressively improve the patient’s condition.

Do exercise therapy and gymnastics help with a pinched sciatic nerve?

If you ignore the first signs of a pinched sciatic nerve, then in the future the situation may become more serious - the nerve will become inflamed, and further treatment will be more difficult and longer. Therefore, in order to avoid complications, and even better, this disease altogether, you should use the recommendations of doctors and perform a special course of physical exercises. Exercise therapy and gymnastics for pinched sciatic nerves generally improve blood circulation in the vessels, increase muscle tone, and activate metabolism. As a result of daily exercise, compression and compression of the sciatic nerve will decrease, inflammation will decrease, and therefore the pain will appear much less. The main thing to remember is that you can perform gymnastics and special physical exercises when the sciatic nerve is pinched only when there are no severe attacks of pain. Otherwise, first you need to take pain relief medications. Also, you should not choose the types of exercises on your own - the complex must be agreed upon with your doctor.

What can't you do?

To prevent exercise from doing more harm than good, there are several tips on what not to do:

• It is not recommended to carry out exercises before consulting with a specialist and making an accurate diagnosis;
• When doing exercises, you need to take into account your own feelings, and not just follow the instructions;
• exercises are contraindicated in advanced forms of osteochondrosis and intervertebral hernia;
• Do not perform exercises with severe pain;
• It is not recommended to overexert yourself.

If physical therapy is approved by a specialist, it will only bring benefits and quickly eliminate discomfort. Otherwise, it can only aggravate the condition and increase pain.

When is the best time to see a doctor and which one?

When talking about any disease, even the simplest one, doctors advise us to make an appointment and undergo examination as soon as possible. In the case of a pinched sciatic nerve, the situation is absolutely the same. As soon as the first pain appears in the back, buttocks, or leg, you should definitely consult a doctor. To begin with, you can visit a therapist or immediately make an appointment with a neurologist or neurologist.

Clinic "Energo" in St. Petersburg offers you a wide range of medical services. Including from us you will receive qualified assistance from a neurologist.

and other specialists who deal with the problem of pinched sciatic nerve, as well as other pathologies associated with the central and peripheral nervous system. Our clinic is equipped with modern diagnostic equipment. X-ray, CT, MRI - you can undergo all these and other examinations at Energo. In this case, you will not have to wait long in line. You can make an appointment at a time convenient for you by phone. Doctors at the Energo clinic will be able to select for you the optimal set of exercise therapy and gymnastics to relieve pinched sciatic nerves, which you can perform at home.

Rules for performing exercises

In order for exercises for the treatment of the sciatic nerve to bring only benefits, it is necessary to follow the basic rules for their implementation. These include:

• You should start doing any exercises with 7-15 repetitions, gradually increasing their number as you feel better;
• a set of exercises must be performed several times a day;
• the duration of treatment of sciatica with therapeutic exercises should be determined by the attending physician;
• If you experience pain, deterioration in well-being or other symptoms, you should immediately stop gymnastics.

If you follow the rules of therapeutic exercises, sciatica will quickly go away and will not bother you for a long time. You can perform the exercises at home and in specialized groups.

It should be understood that in addition to therapeutic exercises, drug therapy may also be required to eliminate inflammation of the sciatic nerve.

A set of useful activities

A complex of exercise therapy and therapeutic exercises for pinched sciatic nerves can consist of various types of exercises.

Sitting position

• Sit on the floor, straighten your legs. Move your buttocks forward.
• Sit on a chair, back straight and relaxed, legs crossed at the knees. Place your hands behind your head and turn your body left and right.
• While standing on all fours, you need to arch your back and return to the starting position.

Lying position

• Lie on your back and straighten up as much as possible. Raise your leg, bend it at the knee and bring it as close to your chest as possible. You need to maintain this position for 7-10 seconds. Next, do the same with the other leg.
• Lie on your back, place your hands under your buttocks and spin your legs like a bicycle.
• Lie on your back, arms to the sides, legs raised. It is necessary to make smooth bends with your legs in different directions.
• Lie on your stomach, stretch your arms forward. You need to smoothly lift your body up and fixate in this position for 5-6 seconds.

Standing position

• Starting position – standing, feet shoulder-width apart. As you exhale, you need to “stick out” your lower back, and as you inhale, return to the starting position. Repeat 3-5 times.
• Starting position – standing, feet shoulder-width apart. Raise your left arm above your head and make a smooth tilt to the right side. Then change your hand and lean in the other direction.
• Stand up straight. Using smooth, circular movements of your hands, you need to rub your lower back.

Swimming

Swimming will help enhance the effect of treating a pinched sciatic nerve. Exercising in water helps to relax muscles as much as possible, as well as strengthen them. After just a few swimming sessions, you will notice that the pain has decreased and it has become much easier to move. You can also perform special exercises in water:

• vigorous walking in water (the water level should be waist-deep or higher);
• swing your legs while also standing waist-deep in water;
• swing your legs with the knee bent, while you can hold on to the side of the pool or the buoys.

How is diagnostics carried out?

Typical patient complaints of pain and its return, paresthesia and associated symptoms usually facilitate the diagnosis of a pinched nerve in the hip area. The doctor collects anamnesis and prescribes visual and laboratory diagnostic methods to confirm the diagnosis and select subsequent treatment:

• CT, MRI of the spine and soft tissues;
• radiography of the pelvic bones and spine;
• Ultrasound of the hip joint;
• electromyography;
• general and biochemical blood tests, general urine analysis.

Contraindications for exercise therapy

There are a number of contraindications for gymnastics when the sciatic nerve is pinched:

• mental disorders;
• frequent attacks of epilepsy;
• complex spinal injuries;
• oncological diseases;
• heart failure and other heart pathologies;
• viral infections that are accompanied by fever.

It is necessary to perform exercise therapy with a preliminary warm-up. Also, do not immediately perform many repetitions of the same exercise. To begin with, 2-3 repetitions are enough, then you can increase them (the exact load should be calculated by the doctor).

Causes of inflammation

Let us dwell on the basic prerequisites that can lead to inflammatory processes of the sciatic nerve.

Among the reasons that can provoke the problem, we note:

• complete or partial displacement of the intervertebral disc;
• the appearance of osteochondrosis;
• infections (sepsis, typhus, syphilis, influenza, tuberculosis);
• intervertebral hernia;
• hypothermia

Sciatica can be caused by malignant or benign tumors of the vertebrae, poisoning (arsenic, mercury, lead), internal bleeding, arthritis.