Spinal Series

Spinal Series

I’ve been asked a lot recently to write about common spine conditions that Pilates teachers are faced with on a daily basis. So I decided that a good place to start would be Sciatica – what it is, what causes it and how Pilates can help. This sets up the ‘Spinal Series’ well for looking at the causes of Sciatica individually in more detail.

Spinal Series - Part 1

Sciatica  

What is Sciatica?

Sciatica is the term given to any kind of irritation or compression of the sciatic nerve causing pain. The sciatic nerve begins bilaterally in the lumbar spine and derived from the anterior and posterior divisions of the lumbar plexus at L4 all the way to the sacral plexus at S3, travelling through the buttock down the entire length of the leg forming the tibial nerve and the common peroneal nerve.

In combination with its distal divisions, the sciatic nerve innervates the majority of the skin in the lower leg and the skin in the posterior aspect of the thigh and the gluteals. It also forms 2 branches – the articular and the muscular branches. The articular branch comes from the upper section of the sciatic nerve and helps to control the hip joint. The lower section forms the muscular branch which serves the biceps femoris, semitendinosus, semimembranosus and the adductor magnus.

What can cause Sciatica?

IMPORTANT – Sciatica is essentially a symptom of an underlying cause in the spine / leg. Make sure that the cause of your client’s Sciatica has been established BEFORE you begin work with them. Movement patterns will help one cause but irritate another. If your client attends having been simply told they have Sciatica without knowing the cause of it, make sure to refer them back to their GP or a suitably qualified healthcare professional like a Physiotherapist.

Sciatica is usually caused by compression or irritation of the Sciatic nerve in the lumbar spine or through the hip. The most common causes of Sciatica are:

·       Degenerative Disc Disease

·       Spinal Stenosis

·       Spondylolisthesis

·       Piriformis Syndrome

·       Disc pathology (bulges, herniation, slipped)

As part of the Spinal Series, I will be exploring each of the above in more detail, adding to the article ‘Piriformis Syndrome’ published previously.

How to treat Sciatica?

The priority in treating Sciatica is to first identify the cause. Once the cause is known, Sciatica is most commonly treated non-surgically with the use of manual therapy (Physiotherapy, Osteopathy, etc), anti-inflammatory and analgesic medication and specific back exercises. Rarely, clients will undergo surgery but on the identified ‘cause’ of the symptom, not the sciatic nerve itself.

Pilates and Sciatica

IF the cause of your client’s Sciatica has been identified then the direction you choose with Pilates can ultimately be the perfect treatment for them!

Some causes of Sciatica will benefit from lumbar flexion and rotation based Pilates exercises whilst other pathologies will respond better to lumbar extension work. The correct exercises for each Sciatica-causing pathology will be explained in more detail throughout the forthcoming Spinal Series.

In the majority of cases, clients will report that there symptoms are reduced when they are on the move and aggravated when static in prolonged positions. Therefore, aim to keep their repertoire flowing, changing posture frequently and encouraging good breath control and stabilisation. The client will also benefit from exercises that are more functional but incorporate the basic Pilates principles, thereby allowing them to continue the self-management of their symptoms.

Look out for the next article in the Spinal Series including tips on suitable Pilates exercises, which will help reduce the symptoms of Sciatica caused by Degenerative Disc Disease.