Now, as we talked about in the last video (the link is above in the ‘links from the video section), sciatica is simply when your sciatic nerve is being irritated.

I talked about that and what that means in last week’s video. In today’s video, I want to share with you how we help sciatica at the clinic, which of course, includes things that you can do at home to help yourself. If you’d like some tips, have a look at this video. 

My name is Katherine. I’m the founder and principal therapist LSM Clinic in East London. In this channel, we share information about how the body works and simple things that you can do for yourself to live as close to pain free as possible.

Now, I really think it’s important for people to understand how their body works and what’s going on. I try to include a lot of background in the video, which I did a little bit more in last week’s video than today, but I’ll do a little bit of a recap here.

Oh, and before I forget, if you know someone with sciatica who could use some tips, please share this video. If you like this kind of content, please like and subscribe and leave a comment. All of that really helps get this in front of more people. We really want to help people with this so so that they can feel better in their bodies, right?

Sciatica is defined as where the sciatic nerve is being irritated or has been injured. Now, as I said in my last video, can be a bit ambiguous, because if your nerve is injured, then that is a very different treatment approach than it if it’s just having pressure put on it. Right now, when we see people the clinic, if they have sciatica, we are taking a muscle-based approach, because we work with soft tissue, there is a chance that it will be structural in the spine, or that it will have damage to the nerve, and we’ll be watching for those things while we’re working with people to try and see if maybe they need to get other investigations.

But we will generally take a muscle first approach, because assuming they don’t have any of the red flags, which I will link a link to what the red flags are for sciatica, nerve pain down the leg in the description box, assuming that you don’t have any of those red flags, even if there’s something else going on, most of the time, releasing the muscles that could be irritating the sciatic nerve will help, right?

They’re very rarely going to hurt. And also, we work very carefully with the body, so assuming you don’t have any of those red flags, we will do our normal assessment.

We look at the position of your pelvis.

Do you have an anterior tilt? Anterior tilt could indicate that the hip flexors are tight. It could indicate that you’ve got some pressure in your back from maybe excess lordosis or curb in your lumbar spine.

We look at the alignment of the spine like, is it scoliotic? Are you going side to side? Is it straight up and down? And basically look at like for the height of the hips.

The height of the hips can often tell us if the piriformis is tight on the side where you’re having the sciatic pain.

We also do movement tests.

We’ll do the knee lifts and the forward bend.

Those are mainly to assess your pain, but it also gives a sense of your balance or your glutes working the way they’re supposed to, etc.

When we’re thinking about the three main causes that we regularly see or hear about with sciatica, it’s very often:

• the piriformis irritating the sciatic nerve,
• muscles that are tight in the lower back, irritating a sciatic nerve, and
• something going on in the spine, like a disc issue, structural issue, irritating the sciatic nerve.

From a muscular perspective, obviously tighter back muscles and tight piriformis are things we can help with.

And then from the structural side, we try to just support the spine as much as we can. And if it’s really looking like it needs more investigation, we’ll recommend that, right?

In my mind, the piriformis complex and the lower back complex, while they are absolutely connected to each other and they can impact each other, are kind of two different things.

We’ll release the piriformis and then we will assess your glute activation.

Because, as you know, as we talk about a lot, most of the time, if a muscle is tight, it’s either a positional issue or it’s a compensating issue.

Often, if the piriformis is really tight, it’s because it’s compensating for the glutes, not stabilizing the pelvis, and sometimes the pelvic floor and sometimes lower abdominals as well.

All right, so we’ll release the piriformis and check how tight it is, and we will give you homework to do glute activation, which I’ll talk about the homework stuff in more detail in this video.

Now we test a lot during a session, so when you come in with sciatica, one of the things we want to try and assess is, is its piriformis? Is it muscles in the lower back? If it’s neither of those, it might be something else.

And then we can tell you, but this way, we can kind of pinpoint it. Very often, we will release the piriformis in isolation, and then retest it, and we see how much that changes symptoms, if you have any symptoms in that moment.

Because if you walk in with symptoms, and we release your piriformis, and then those symptoms decrease, that is a positive outcome, that your piriformis is probably at least part of what’s irritating your sciatic nerve, right? That is how we assess that with could it be lower back tension.

One of the things that we do, and this may seem a little bit counterintuitive, is we actually release your hip flexors first, specifically, usually the psoas and then also the iliacus as well.

The psoas is a muscle that goes from the front of the lumbar spine into the hip flexor sorry, into the inside of the thigh bone. And the iliacus is a muscle that’s like inside the ear bones (of the pelvis).

I’ll have a picture here, inside like the bones of the pelvis, and again, go into the inside of the thigh bone, so they both flex your hips.

Now, piriformis is often tight because it’s compensating for the glutes not doing their job.

Hip flexors are often tight because we are sitting down all day and they’re in a shortened position. That can often be a positional shortness. Sometimes when we’re doing a lot of lower ab work and our lower abs aren’t doing their job, we are using our hip flexors a lot, so that can also be a factor in it.

If the hip flexors are really tight, we find they tend to pull the spine forward, which then really compresses the back of the spine. Before we want to do anything on the lower back, we want to release what’s pulling on the spine, which is usually the hip flexors.

Now the lower back muscles will often be tight because of a combination of the piriformis – sorry, not the piriformis (although the piriformis can have an effect) – because the psoas, which is one of the hip flexors, is pulling the spine forward, and the body doesn’t want to be pulled forward. The lower back muscles try to tense to stop your back from going any further forward, can be one reason.

They can also be overcompensating because your abs aren’t doing their job, because your torso needs the support from all around back to front. All those muscles are supposed to be holding you up, but if your lower abdominals, or core in the front is not doing what it’s supposed to, then those lower back ones also have to work extra hard to keep you upright, right?

We’ll release the hip flexors and we’ll test and we’ll see what kind of change that makes. Is it that the spine is being pulled forward?

We’ll check and see are your abs actually able to activate?

A lot of times people’s upper abs activate, but the lower ones don’t. I do have a video about ab activation, I’ll link it below (see links above transcript), so we look at that, and then we’ll usually release the lower back muscles, assuming we feel it’s safe to do so.

Now, what do I mean by that? If there’s so much of an imbalance that everything is being pulled and we really think the back is compensating for that, it might not be safe to release the back muscles until the back has more support and isn’t being pulled on so much.

We might just do a small release to the back and really focus on the hip flexors and focus on getting your abs to be activated, to support your lower back, and getting your glutes to be activated, and getting your piriformis to be softer. Just just taking as much pressure off of your lower back as possible.

I do have some videos about lower back pain. I’ll link them.

Basically our back gets pulled in loads of different directions. If we’re not sure that we’ve addressed all the things that could be pulling the back in different directions, I don’t really want to loosen all the muscles in your back, because that’s going to be very destabilizing, right? And then that’s when we come to like this, this spine.

Now, obviously, if there is a significant disc issue or alignment issue, that’s not something that we really help with as massage therapists, as people who specialize in the muscles, right?

That may need a consultant, that may need an osteopath, that may need imaging. We do have to be careful with imaging, because most of us have some stuff going on in our back, so we don’t necessarily go, Okay, well, I can assess, like, whether or not your spine is like aligned or doesn’t have any problems.

But what I can do is we can look at the alignment of the spine and figure out what muscles might be pulling it out of alignment, what muscles might be tight, compensating, and talk to you about, like, stability, stuff that you can do to activate the lower abs, activate the pelvic floor, you know, keep yourself in a position so your back isn’t having to do all that work, and that can help support the spine in a better position.

That’s basically what we would do in a session when we’re working with someone who has sciatica or any kind of like lower back irritation that goes down the leg.

Now let’s talk about what you can do for yourself. So the home care that we give very much depends on what we find.

If we find that you respond better to your piriformis being released, we’re going to focus on the glute activation.

If we find that you respond better, or we get better improvement of symptoms from the hip flexor release, we’re going to focus on hip flexor stretch and activating the lower abdominals.

If we notice that you have a massive curve in your lumbar spine that your stomach looks like, it’s really not doing much activity-wise.

Side note: it has nothing to do with your weight or size. If your abs are working, okay, you can have extra layers on your abdomen and your abs are working, and you can have few layers and they’re not working, okay, so don’t this isn’t really like a size thing. It’s a function thing.

We look at all of those.

What can you do, right if you have all of these variables?

First of all, if you have sciatica-type pain, if you haven’t been to see someone who can just check that it’s not anything serious, it’s a good idea to check again.

I’ll put the link for the red flags. Just check to make sure you don’t have any of those.

It’s a good idea to just go to your doctor when you have nerve stuff and just be like, ‘Hey, I’m having, like, a nerve sensation. Can we just make sure it’s not anything serious?’

If you’ve been told that you have sciatica, then you want to go, ‘Okay, do I think, have I had, you know, a sciatic nerve injury?’ which that’s like a whole other kettle of fish we won’t get into right now, but assuming that you don’t think you’ve injured your sciatic nerve, like in a boating accident or something. I don’t know.

The things that are really easy to do is that you can do glute activation. We have a whole playlist about glute activation here.

It’s very easy to start just doing the glute activation into extra time that we have.

You can do very basic abdominal activation.

Those two things will start to give you more support in your torso, right? So those are the first two things.

Make sure your glutes are supporting you.

Make sure your lower abs are supporting you.

Then you want to be looking at tension.

Your piriformis might be tight. I have a muscle of the month on the piriformis. So I’ll share that there’s some very gentle ways that you can release it with the piriformis.

You don’t want to stretch it too hard, because it will actually tighten against what you’re doing very easily. So you do need to be careful with that. Again, that’s something we can help you with in a session if you want to be shown how to stretch gently on the piriformis.

And then hip flexor stretches. I did a video about why your back hurts when you walk for a long time, and it kind of describes the hip flexor stretch that I recommend.

Basically you stretch your hip flexors and you activate your abdominals, which means that your lower back is going to be upright.

I do have tips for lower back pain that I’ll include as well, because there’s some overlap here, right?

That’s really the basic things that you need to focus on

• glute activation,
• ab activation,
• piriformis release,
• potentially hip flexor release.

I know that if you watch my videos, you probably like, oh my gosh, this is so repetitive, and it is, but it’s because a lot of the stuff that’s going on in our body muscularly have, like, similar ‘centers of the onions’ that you’re going down to. So you can actually get a lot of improvement from like, focusing on these things.

There’s one more thing, okay,so you’re gonna have to delete that section where I completely forgot what I was talking about. A lot of things, all get down to the same thing.

One thing I do want to let you know about with nerves, and I’ve seen this, is that I have had clients where they’ve had impingement on nerves, not always sciatic nerves, sometimes other nerves that go down the leg, where they’d had tingling and numbness and like, a bit of loss of sensation, which I guess is numbness.

We released the tissue that was irritating them, and then the nerve started to burn a little bit, not in like, a scary way, not in a, like, it felt bad kind of way, like, not in a you need to go see a doctor kind of way.

There was just, like, a bit of a heat feeling. And that lasted for a few weeks, while the sensation came back.

It was because with that client, with those clients, they all had such long impingement that the nerve had been a bit damaged, and then that was the nerve recovering. I’m saying this to say nerves are the slowes – are some of the slowest healing cells in our body. If you notice that it’s numb or like it feels like the nerve’s irritated and it’s taking a while for it to feel better, as long as it’s not getting worse, and you have no red flags and doesn’t feel like there’s anything wrong, sometimes nerves just take a while.

Actually, maybe just delete that whole part about the nerves. Just pretend I didn’t see it. Just take that part out of the video. So there’s too many caveats I need for that one.

Okay, okay, so final recap, sciatica can be caused by the piriformis, irritating the sciatic nerve, lower back pain, irritating the sciatic nerve and stuff going on in the spine. In a session, we will help by assessing what’s going on in the back of the hip, what’s going on around the spine, and then giving you the tools that you need to address it based on what we find in our testing. What you can do at home is release the piriformis, gently work on glute activation and or work on lower abdominal activation and release your hip flexors. If you come see us in a session, we can do the testing and help kind of guide you which direction to focus. But you can also play around with these yourself. Maybe do the glute activation and piriformis for a week and see how that feels, and then swap to the AB stuff, although really you can do you know it’s all good for you, right? If you have any questions about this, please feel free to leave a comment below, and I’ll share as much as I can. If you are in East London and you’d like to see us for a session, I’ll put our online booking link below so you can come and see us for an appointment. And if you have any other things that you’d like me to talk about in a video? Please let me know, because I’m always open to ideas. And thank you so much for watching. I really appreciate your time, and I’ll see you in the next video. Okay, bye. Bye.