Sciatica Pain During Pregnancy and What YOU Can Do
Many women think aches and pains are just part of the pregnancy journey. Here at Expecting and Empowered we want to make pregnancy as comfortable and healthy as possible for each and every pregnant mama.
Today we’re covering one of the most common offenders: sciatica.
Sciatica is characterized by leg pain, numbness, tingling and possible weakness that starts in your lower back and radiates down your leg. The pain can be occasional or constant in one side of your buttocks or leg. Symptoms are often worse with sitting, forward bending, going up stairs, walking or running.
Sciatic pain during pregnancy is caused by excess pressure on the sciatic nerve. It is more common during pregnancy due to a number of reasons:
Lacking core strength. Pelvic floor, lumbar, and abdominal muscles all impact sciatica. The weight of the baby places excessive constant pressure on the pelvic floor. An overstretched pelvic floor makes it weaker. Our back muscles are doing a lot more work because of the weight pregnancy places on the front side. Toward the later stages of pregnancy the abdominal muscles are extremely stretched out making some of them useless.
Tightness of the hip muscles that compress the nerve. As pregnancy progresses, your center of gravity shifts due to the extra weight in the front. To accommodate for this change, your feet will typically rotate outward to increase your base of support. When this happens, your muscles that rotate the hip become shortened including the pirifiromis, quadratus femoris, obturatus externus, obturatus internus, superior gemelli and inferior gemelli muscles. The shortening of these muscles places pressure on the sciatic nerve. When the piriformis becomes irritated and possibly inflamed, it can press directly on the sciatic nerve. This causes irritation of the nerve, thus resulting in pain traveling along the sciatic nerve pathway. Typically with piriformis syndrome, the pain is mainly in the buttocks or back of thigh. Often the piriformis is getting overworked and the neighboring hip muscles are recruited to assist the piriformis. As a result, those helper muscles can get overworked and irritated too. Sounds like a complicated mess, doesn’t it?
Sacroiliac joint pain can be mistaken for sciatica. This pain usually creates numbness and tingling in the butt but does not go past the knee and often causes lower back pain as well. SI joint pain will hurt more when you sit for a while and then try to stand up. Contrast that with sciatica, in which it is more of a bother to sit or stand for prolonged periods.
The key is to first get the muscles in the pelvis and hips moving, followed by strengthening. By getting the muscles moving you are pumping oxygen and blood flow to the area. Lack of strength of the muscles in this area can actually cause impingement of the sciatic nerve, which is why strengthening is so important. Download our FREEBIE below for a step by step print out of these exercises.
Stretching: Stretching the piriformis and surrounding musculature relieves pressure on the sciatic nerve and helps the muscle gain blood flow and relax. Be cautious with stretching because if the piriformis and sciatic nerve are VERY irritated stretching could make it worse. Try these stretches, but if you immediately have increased leg pain, numbness or tingling, stretching is not for you (yet). Give each of these stretches a try and see what works for you. Some positions may be difficult to get into and others easier, so only do what is comfortable. There is no benefit to forcing it. If you can, heat up this tissue with a hot pack for ten minutes prior to stretching. You can put the hot pack on your butt or hamstring.
Trigger Point Release: Be cautious with this! If the piriformis and sciatic nerve are VERY irritated, trigger point release can make it worse. You can use a foam roller or lacrosse ball to apply pressure to tight areas.
Nerve Glides: Your sciatic nerve branches as it travels down the back of your leg and eventually feeds the muscles in your calf and foot (this is why an issue in your buttocks can radiate all the way down to your toes!). Due to the length of this nerve and all of the work it performs, your sciatic nerve can become even more sensitive and cause further muscle tightness. You can desensitize your sciatic nerve and improve flexibility with this mobilization.
Strength: Lateral band walks and side lying leg raises.
Partner Assisted Massage: It’s a bonus if you can find someone to help you massage these areas seen in this video. See video at the bottom of the page if you have a sweetheart willing to help.
Physical Therapy: During the evaluation, your PT can target what is causing the sciatic pain and work specifically on that area. The hip muscles are very deep and hard to get loosened up on your own. Prior to choosing a PT there are some skills that would be helpful to treat this condition, such as dry needling, an understanding of the sacroiliac joint, and nerve mobilization. I’d suggest asking the clinic you call for someone that has worked with sciatica patients before.
Massage: In my physical therapy clinic, we often work in conjunction with massage therapists. For this condition, I would tell the massage therapist to work on these muscles on the symptomatic side: quadratus lumborum, lumbar multifidus, piriformis, quadratus femoris, biceps femoris, gluteus medius, gluteus minimus. On the opposite side: gluteus medius, gluteus minimus, lumbar multifidus, latissimus dorsi.
Non-weight Bearing Cardio: Motion is lotion. It is advantageous to do the RIGHT kind of cardio. Keep the area moving but do not put excessive pressure on just one side of the body. A couple of options for cardio would be swimming, stationary bike or elliptical (with minimal resistance if you start to feel any symptoms).
Sciatica symptoms are easy to re-irritate. You can help reduce the symptoms if you identify and then modify your aggravating factors. Sometimes symptoms can be worse at your workplace, sitting in the car, or watching TV. Here are some quick tips to make work more bearable:
Sitting: Keep your feet flat on the ground, with your knees and hips level.
Use of support:
Try placing a towel roll behind the small of your back. This puts your back in a better position to open up the roots where your sciatic nerve branches off your spinal cord. It also changes the pressure on your sitting bones and may reduce pressure and stretch on your piriformis.
Use that same towel roll (or grab another one if it is more comfortable with both) and place it against the outside of your entire leg.
Tie a hooded sweatshirt around your hips like you are tying it around your waist. Then take one arm, cross it over and tuck it in under your other leg.
Finding an appropriate chair:
No hard chairs.
The chair should support the entire leg. There should only be a gap of two inches between the back of your knee and the edge of the chair.
Other sitting considerations:
Do not cross your legs.
Do not slouch or bend forward.
Scoot your butt all the way to the back of the chair.
Take rests from sitting, every 30 minutes if you can.
If the pain is more one-sided, try to shift your hips more toward the non-painful side (temporarily).
Standing: Try to stand as much as possible since sitting is what generally makes your symptoms worse.
If you have a standing desk, use it!
If you do not have a standing desk, set a timer so you are getting up every 30 minutes to give your piriformis and sciatic nerve a break from sitting on them. Seriously set a timer, you will get too involved in your work to keep a reliable eye on the time!
When standing, try resting one foot on a stool or box. If you are at home cooking or washing dishes, open the cabinet under you and place your foot inside the cabinet to elevate.
Try creating some space in your lower back. Nerves like a decrease in pressure. Push your weight through your arms on a countertop with your legs dead weight and your bottom half limp. Once your body relaxes into this you can do some gentle rocking of your pelvis.
I hope a tip of 10 help your sciatica pain! I KNOW It can be a very painful condition. As always, I would suggest doing the Expecting and Empowered: The Complete Guide to help with common pregnancy aches and pains like this. -Krystle Howald, DPT