Exercise for Sciatica from Spinal Stenosis

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Sciatic pain from nerve root irritation or impingement can be caused by spinal stenosis, a condition that causes the nerve’s passageway to narrow or constrict. A typical symptom of spinal stenosis is pain that radiates along the sciatic nerve down the leg while walking, and to feel relief of the pain after sitting down. The study of this leg pain (sciatica) is referred to as radiculopathy. For more information on spinal stenosis, please see Definitive Guide to Lumbar Spinal Stenosis and Living with spinal stenosis.

Spinal stenosis exercises

When treating sciatica from spinal stenosis, the spine specialist may encourage flexion exercises (forward bending). Flexing the lower spine (bending forward) increases the size of these passageways and allows the irritation or impingement to resolve. This is why people with spinal stenosis often feel better when bending forward (such as leaning on a cane, walker or shopping cart) than when standing up straight.

Exercise targeted at alleviating the sciatica pain caused by spinal stenosis typically includes a combination of specific stretching and strengthening exercises that focuses on:

1. Stretching the muscles of the back that hold the spine in extension (backwards bending) and;
2. Strengthening the muscles that bring the spine into flexion (forward bending)

Stretching exercises for sciatica from spinal stenosis

The stretches for the muscles of the low back that hold the spine in a backward bending position (the low back extensors) are typically held lightly for 30 seconds. These exercises include the following:

• Back flexion: Lie on the back and gently pull the knees to the chest until a comfortable stretch is felt (). After 30 seconds, slowly return to starting position. Aim to complete four to six repetitions of this flex.
• Get down on the hands and knees, then sit back on the heels with the chest down and arms outstretched (). After 30 seconds, slowly return to starting position. Aim to complete four to six repetitions of this stretch. Do not bounce on heels.

Strengthening exercises for sciatic pain from spinal stenosis

Strengthening exercises for spinal stenosis focus on strengthening the lower abdominal muscles and include:

• Lie on the back and press the low back into the floor by tightening the lower stomach muscles, pulling the navel (or belly button) in and up (), hold for 10 seconds. Aim to complete eight to ten repetitions of this press.
• Hook-lying march. For a more advanced exercise, this position may be held while marching in place in the hook-lying position, slowly raising alternate legs 3 to 4 inches from the floor (). Aim to ‘march’ for 30 seconds, two to three repetitions, with 30-second breaks in between repetitions.
• Curl-ups. Another strengthening exercise that may be recommended by spine specialists to strengthen the lower abs is called a curl-up (). These are done by folding arms across chest, flattening the back by tightening lower abs, then raising the head and shoulders from the floor. Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls.

These exercises alone will not necessarily make the patient with sciatica from spinal stenosis “better”, but they will allow the patient to more easily hold a posterior pelvic tilt during activities, especially standing and walking. This posture will allow the patient to perform more activities with less pain. The pelvic tilt is often very difficult for patients to learn and can take a good deal of practice with the guidance of a physical therapist before it is used effectively to treat sciatica resulting from spinal stenosis.

• Article written By:
• Ron S. Miller, PT

January 3, 2007

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