Physical therapy (PT) can help relieve sciatica pain by reducing nerve compression, improving flexibility, and strengthening muscles. Physical therapists use various techniques to treat sciatica pain, such as manual therapy, pain-relieving modalities (e.g., ultrasound, heat, ice, and electrical stimulation), exercises, and lifestyle modifications.

Exercises for sciatica pain focus on improving the flexibility and strength of muscles in your spine, hips, and buttocks to support your spine and decrease pressure on your sciatic nerve. Exercise also increases blood flow, which promotes healing.

1. Glute Bridge

Glute bridges strengthen muscles in your buttocks:

1. Lie on your back on the floor.
2. Bend both knees and rest your feet on the floor.
3. Rest your arms at your sides, palms on the floor.
4. Squeeze your buttock muscles and lift your hips off the floor.
5. Hold for five seconds, then lower down.
6. Repeat 10 to 15 times.

2. Lying Knee-to-Chest Stretch

The lying knee-to-chest stretch improves flexibility in the muscles of the lower back:

1. Like on your back with your legs straight.
2. Bend one knee and bring it in toward your chest.
3. Use your hands to gently pull your knee closer to your chest until you feel a stretch along your lower back.
4. Hold for five seconds, then straighten your leg back out.
5. Repeat five times on each leg.

3. Clamshell

The clamshell exercise strengthens muscles on the outer hips:

1. Lie on your left side with your knees bent and legs stacked on each other.
2. Rest your right hand on your right hip.
3. Keep your heels together, and lift your right knee to mimic an opening clamshell.
4. Hold for a few seconds, then lower your knee down.
5. Do eight to 10 repetitions, then switch sides.

4. Bird-Dog

The bird-dog exercise strengthens muscles in the buttocks and along the spine:

1. Start on your hands and knees, with your hands in line with your shoulders and knees in line with your hips. Keep your neck straight and look at the ground between your hands.
2. Lift your right arm straight out in front of you. At the same time, lift your left leg out straight behind you. Keep your back flat, with your core engaged (think about pulling your navel toward your spine).
3. Hold for five seconds, then lower back down.
4. Lift the opposite arm and leg.
5. Continue to alternate sides for 10 repetitions on each side.

5. Cobra Stretch

The cobra stretch improves flexibility in the lower back:

1. Lie on your stomach.
2. Bend your elbows and rest your forearms on the ground with your hands beneath your shoulders.
3. Keep your hips on the ground and press down through your hands to raise your chest off the ground until your elbows are straight.
4. Hold this stretch for 15 to 30 seconds and repeat three times.

6. Child’s Pose Stretch

Child’s pose (also known as kneeling back extension) stretches muscles at the top of the pelvis and along the spine:

1. Begin on your hands and knees.
2. With your elbows straight, sit back until your buttocks are resting on your heels. Keep your neck straight, with your ears between your shoulders.
3. Hold for 15 to 30 seconds and repeat three times.

7. Standing Hamstring Stretch

The standing hamstring stretch improves the flexibility of the muscles along the back of your thighs:

1. Stand facing a step, stool, or another sturdy surface.
2. Prop the heel of your painful leg on the step.
3. Keeping your knee straight, slowly hinge forward at your hips until you feel a stretch along the back of your thigh.
4. Hold for 15 to 30 seconds.
5. Repeat three times.

8. Pelvic Tilts

Pelvic tilts (also known as abdominal bracing) help strengthen muscles in your core that support your spine:

1. Lie on your back on a firm surface.
2. Bend your knees and rest your feet on the floor.
3. Place your hands on your hips with your fingers resting inside your hip bones.
4. Tighten your lower abdominals as if pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten.
5. Hold for three seconds, then relax.
6. Repeat 10 times.

9. Lying Gluteal Stretch

The lying gluteal stretch (also known as a piriformis stretch or figure-4 stretch) improves flexibility in muscles that cover the sciatic nerve in your buttocks:

1. Lie on your back with your knees bent and feet resting on the floor.
2. Cross the ankle of your painful leg over your opposite thigh, making a “figure-4.”
3. Gently press your knee away from your body until you feel a stretch in your buttocks.
4. Hold for 15 to 30 seconds, then relax.
5. Repeat three times.

Safety Considerations

Sciatica pain can be caused by underlying spinal conditions, such as a herniated disc (when the soft, jellylike center of a disc between the bones of the spine pushes out through the tough, rubbery outer layer and presses on nearby nerves), which can get worse with the wrong kind of exercise.

It can also be a symptom of a serious health condition, such as spinal cord compression (due to a medical condition or injury that puts pressure on the spinal cord), cauda equina syndrome (a rare condition affecting the nerves in the spinal cord, leading to motor function and sensory disruptions), or infection that can lead to serious consequences if left untreated.

Seek immediate medical attention if you have any of the additional signs or symptoms:

• Decreased coordination
• Difficulty walking
• Fever
• Loss of bowel or bladder control
• Loss of sensation in your feet
• Numbness in the genital region
• Sexual dysfunction
• Weakness in your legs or feet

Does Sciatica Go Away With Exercise?

Sciatica often goes away without treatment within four to six weeks. Depending on the underlying cause, exercise can help improve strength and flexibility and relieve pressure on the sciatic nerve.

Other conservative treatments for sciatica can include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen) or Aleve (naproxen), oral corticosteroid medications, and spinal injections.

If sciatica pain continues to be severe after several months of conservative treatment, a healthcare provider may recommend surgery to relieve pressure on your sciatic nerve.

Should You Do Sciatica Exercises If You Have Pain?

Sciatica exercises are meant to help relieve pain associated with the condition and should be done under the supervision of a physical therapist. Stop doing physical therapy exercises for sciatica if your pain increases.

Consult a healthcare provider if you have other symptoms of nerve compression, such as numbness, tingling, or muscle weakness.

Exercises to Avoid

When performing physical therapy exercises for pain from sciatica, avoid overdoing it.

Specific exercises or movements can worsen sciatica pain. Avoid activities that involve:

• Heavy lifting
• Overstretching your muscles (stretching should not be painful)
• Twisting your spine

Consult a physical therapist for individualized recommendations.

Summary

Physical therapy exercises can help relieve sciatica pain by strengthening muscles in your hips and spine and improving flexibility to relieve pressure on your spinal nerves. Exercise also increases blood flow which promotes healing. Sciatica often improves with conservative treatment, but if you continue to experience pain or would like individualized exercise recommendations, see a physical therapist.