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.