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.

A recent NY Times article discusses the alarming fact that hip injuries are on the rise. They point out that this may be due to changes in usage, early introduction into  sports causing bony changes in the hip socket, and better imaging detecting labral tears earlier.

All of these are feasable explanations but in my experience, hip pain and specifically labral tears are often caused by poor femoral head tracking in the hip socket due to poor strength of muscles responsible for the tracking as well as poor walking or running biomechanics. Labral tears are only one symptom of this problem. Others include hip bursitis (greater trochanteric bursits), ITB friction syndrome, chronic groin strain/pain, sciatic pain, and knee pain.

Poor tracking of the femoral head typically results in the head sliding forward. This impinges tissues in the front of the hip and can eventually break down the labrum causing tears. Especially in high level athletes, which the NY Times article is primarily concerned about, precise tracking becomes even more critical due to the extreme forces acting through the joint. Minor alterations in the quality of femoral tracking while walking or running become major problems for professional athletes due to the frequency and force they undergo. Others who don’t make a living playing sports typically don’t put their bodies through the same stresses and therefore can get away with minor tracking problems.

Very often these tracking problems can be resolved with proper diagnosis and training. Treatment centers around specific muscle testing combined with gait analysis to observe the person’s walking and running habits. Specific exercises to correct muscular weakness is only part of the answer. The real key is learning how to walk and run while activating the correct hip musculature.  This is simpler than it sounds. I just worked with a marathon runner with these tracking problems and consequent pain who resolved her issues within a week. Her leg would begin to drag after 15 miles of running and now she has just qualified for the Boston Marathon.