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.

Search any health or fitness magazine and you’ll see how important core strength is for back pain by virtue of the number of articles devoted to the subject. In fact, there are over 30,000 search hits each month about core strength on Google. Fitness instructors and medical professionals all espouse the benefits of core strength for chronic pain. Then why do we still have back pain? After all, many of you have been subjecting yourselves to endless abdominal exercises for years and still have that nagging pain. So, if it were a matter of just strengthening the core, we really shouldn’t be reading another word about back pain–but we do.

So, obviously core strengthening is not the key to fixing back pain–or at least how it is traditionally taught. Back pain stems from a functional problem with the pelvis and spine. Most back pain can be categorized into three root causes. All of these causes take into account the pelvis’s relationship to the spine.

What I mean by this is that, for various reasons, often the pelvis is tilted either forward, backward, or sideways. The spine then adjusts for these pelvic positions compensating in the opposite direction. For instance with an anterior pelvic tilt (where the pelvis is tilted forward), the spine will then compensate by bending backward or extending more to maintain an upright position. This increases lumbar lordosis (the inward curve of the lower spine) creating a spine that, more or less, becomes stuck in this position. During normal daily activities the spine moves maintaining this new posture.

This is the essence of why core strengthening doesn’t work, in and of itself, to fix back pain. Because the core is strengthened in a position that reinforces the original pelvic and spinal alignment causing pain. Don’t get me wrong, it’s possible to stumble upon the right way to strengthen the core and help relieve back pain. That is why you’ll read of so many people who were helped by one particular method or another. But remember, at least as many people have not been helped by it or have been made worse. You never read about those people.

When I look at yoga or Pilates exercises for back pain, they are usually taught in a series. If you look closely, half of the exercises in the series does one thing to the spine and half does the opposite. That is why they can sometimes be beneficial, because half the time you’ve happened to do the right thing for your spine. But that’s also why they don’t really help the spine, because half the time you’ve happened to do the wrong thing for your spine.

Probably more important than core strength is understanding how your daily activities are contributing to your back pain. After all, you spend far more time at your job than you do strengthening your core don’t you?

Now, I know a lot of you will think I’m just plugging my book here and I am–for the purpose of helping you understand exactly why you have back pain and what to do about it. The key to developing a core strengthening program that helps your back pain is to first understand why you have back pain. Sounds pretty obvious doesn’t it?