What Sciatica Really Means (and How to Fix it)

fix sciatica
Treat sciatica to relieve low back and leg pain. Maridav / Alamy

You've probably heard of sciatica in reference to mysterious leg pain. Technically speaking, sciatica is just a term used to describe any type of irritation of the sciatic nerve. The sciatic nerve is the longest and widest nerve in the human body, and is responsible for the activation of several leg muscles as well as sensation to the back of the leg. Based on the size and functions of the sciatic nerve, sciatica can end up looking like a lot of different things. More importantly, its causes can also be varied.

To treat sciatica, you need to correctly diagnose the underlying condition causing the irritation. The causes can range from a herniated disc to arthritis in your spine, but one of the most common culprits, and the one I would like to focus on here, is piriformis syndrome.

First, let’s get a clear picture. The sciatic nerve looks like a thick rope, and it runs through the middle of your deep hip rotators, one of which is your piriformis. In some people, the sciatic nerve actually pierces straight through the middle of the piriformis. When the deep hip rotators become tight, they basically compress this nerve like a bandage, irritating and decreasing the function of the nerve. This is when sciatica symptoms — tingling, numbness, and pain — can kick in.

The deep hip external rotators, like the piriformis, get tight for a variety of reasons, one of which is overuse. This happens when big muscles, namely the glutes, aren’t engaging when you run or lift, and the smaller deep hip rotators have to help out.

To treat piriformis syndrome, you need to take the pressure off the sciatic nerve by activating the glutes. Step one is releasing the hip flexors (which are often tight in men, and prevent the glutes from engaging) and putting the pelvis in the optimal position. Next, you want to stretch them. And finally, activate the pelvic floor and hip adductors, which ensures proper pelvic stability and allows the glutes to engage properly. This three-step process will put you on the road to sciatica relief.

Hip Flexor Release

  • Lay facedown and place a double lacrosse ball just below the hip bone.
  • Lean a tolerable amount of weight onto lacrosse balls.
  • Bend the knee on the side of the release back to a 90-degree angle.
  • Swing leg side to side in a tolerable range of motion.
  • Repeat for 1 minute on each side.

Piriformis Release

  • Sit on floor, legs extended, with a lacrosse ball centered under one glute muscle. Lean weight onto ball to target piriformis.
  • Bend the corresponding leg so knee points up with foot flat on floor.
  • Fan leg back and forth from one side to the other.
  • Repeat in 30-second to two-minute intervals, then switch sides.

Hip Flexor Stretch

  • Begin in split kneeling position (back knee down, front knee up) with the back knee on a soft pad. Forward knee should be directly above ankle with a 90-degree bend in knee.
  • To begin stretch, press hips forward while keeping torso tall and pelvis tucked under. You should feel the stretch in the front of the hip.
  • To get a deeper stretch, bring the arm on the same side as your back leg up over your head, then side bend and twist torso away from the leg being stretched.
  • Hold 30 seconds; repeat three times on each side.

Piriformis Stretch

  • Stand in front of a cushioned tabletop or bed and place the outside of one shin on table or bed in front of your body with the knee bent out and shin as close to parallel to the edge as you can. Keep the foot flexed.
  • Position one: Twist torso toward raised foot and fold forward over raised leg, bringing right shoulder over right shin. Return to standing.
  • Position two: Keeping torso squared straight, fold forward toward raised leg, extending arms above head and resting them on the tabletop or bed. Return to standing.
  • Position three: Twist torso toward raised knee (opposite position one) and fold forward. Return to a standing position.

Activate: Glute Step-Backs

  • Stand with feet shoulder-width apart and lunge one leg backward, keeping knees at 90-degree angles. Perform 15 reps of each side of each of the three variations:
  • Straight: Keep shoulders square facing forward.
  • Twist: Rotate upper body toward front leg.
  • Side Bend: Facing forward, bend to the side opposite the front leg.

Activate: Hip Thrust

  • Rest upper back against a bench with feet planted shoulder-width apart in front of you, and holding a dumbbell over hips. 
  • Press through feet to raise hips up so torso is parallel to floor.
  • Lower hips, then thrust back up, squeezing glutes throughout the movement. Repeat for three sets of 15 reps.

David Reavy, founder of Chicago-based React Physical Therapy, is the creator of the Reavy Method, a whole body approach to physical therapy and exercise. Reavy works with numerous pro athletes from the NFL, NBA, MLS, and the WNBA.