Sciatic pain is almost as ubiquitous as back pain in our culture. As with most chronic pain conditions, I’ve found sciatic pain to be a problem in people’s habits such as sitting or sleeping postures as well as anatomical issues such as tight muscles in the front of the pelvis or weak muscles in the back of the pelvis.

Let’s look at the anatomical players first. The sciatic nerve originates in the lumbar spine as nerve roots exiting the spine then coming together to form the sciatic nerve which passes through the back of the pelvis and continues down the leg. Often the pelvis can become tilted forward (anterior pelvic tilt), backward (posterior pelvic tilt), or rotated so that one of the pelvic bones is tilted forward while the other is not. The vast majority of sciatic pain I treat results from either an anteriorly tilted pelvis or one that is rotated.

This happens when the muscles in the front of the pelvis become symmetrically tight as with an anterior pelvic tilt or they can become asymmetrically tight creating a rotated pelvis. Correcting this tightness goes a long way toward correcting sciatic pain.

Pelvic Asymmetry Copyright Boone Publishing, LLC. 2009

Usually people with these issues also present with weakened or poorly performing gluteal muscles (the rear-end muscles). These usually turn off as a result of poor standing posture or walking mechanics. Turning these muscles on while walking or running, together with stretching the muscles in the front of the pelvis help restore normal pelvic mechanics which then restores normal spinal mechanics. The spine responds to the pelvis because both are linked so closely together. Fixing the pelvis will help fix the spine.

Let’s look at sitting and sleeping postures that relate to sciatic pain now. When sitting, most often I find the knees are resting too low in relationship to the hips or the legs are too close together. This creates an anterior pelvic tilt and consequent spinal extension (arching) which can create sciatic pain. Another problem would be sitting asymmetrically so one leg is loaded more than the other. This can create a rotated pelvis also contributing to asymmetrical stress to the spinal nerve roots.

Standing habits involve locking out the knees and allowing one or both leg bones (femurs) to rotate inward too much. Both of these habits also create varying degrees of anterior pelvic tilt either symmetrical or asymmetrical.

Typically people with sciatic pain sleep on their sides which allows spinal sidebending and rotation to occur. Sleeping presents one of the hardest stresses on the spine because you are in this position for 6-9 hours each night. This can cause damage if care isn’t taken to pay attention to your body. Often what I find helpful is folding a bath towel lengthwise and placing it under the waist. This removes sidebending and rotation stresses to the spine regardless of which side you are lying on. Consequently it helps sciatic pain.

These tips and others can be found in my book, Fixing You: Back Pain.

I recently saw a woman who had a history of sharp stabbing back pain for about 40 years. I performed my evaluation and gave her the exercises to correct the issues I found. She felt relief but still had occasional stabbing pain. I asked her when this happened and she told me it was after sitting in a chair or getting up from bed. So I evaluated her sitting and lying habits and made a few changes. Today she told me her pain was 98% gone–in one week.

To me this highlights the importance of addressing how you do things as much as what you do. She happened to have a hypermobile spine which made it difficult for her to stabilize well. She was out of touch with her body and couldn’t connect with her abdominals to stabilize the pelvis or spine. So focusing on habits such as how she stood up, sat down, slept, and worked at her desk was where we were really going to make a difference quickly. She was amazed.

This was deeply satisfying to me because she came to me a couple years ago with back pain and I wasn’t able to make a big difference in her pain. Now I know why. I didn’t focus on the things she did 99% of the day and instead focused on anatomical problems I found. This was a good lesson for both of us!

My first marathon is coming up in just over a month. I’m finding the most difficult part of the training is changing my lifestyle habits surrounding my training goals. In other words I’m having a hard time committing to the process of training.

Committing to the process is about identifying and altering the secondary aspects of meeting a goal in addition to meeting the primary requirements. Primary requirements in this case are completing the runs. The secondary aspects of the training are changing my diet to keep my glycogen levels adequate, hydrating more thoroughly throughout the week, getting more rest and staying on top of  minor aches and pains.

I must admit, I’ve been slacking on the fuel and hydrating parts of the goal. I haven’t taken it seriously enough and I’ve paid the price on a couple of longer runs where I’ve hit the wall way too soon. From now on, I’m embracing the process and changing my habits!

This closely parallels the process of injury recovery. Yes, you can perform the prescribed rehabilitative exercises x times a day but are you really embracing the secondary aspects of your healing? Have you taken the time to identify the habits, activities, and general attitudes that may be prolonging your recovery? If not, it’s time to begin! I’ll be doing it for my marathon and you should do it for your injuries (or whatever you are trying to achieve). Let’s commit to it for one month and see how it goes!