Pilates & Sciatica
What is sciatica?
Pilates & Sciatica. The term sciatica has commonly been used to describe a set of symptoms that may include pain traveling down the leg with possibly back pain, pins and needles and loss of limb power.
The term “sciatica” is however, misleading, unhelpful and arcane.
It comes from an era when the mechanisms of referred pain were not understood, and any referred pain was thought to be as a result of irritation of the peripheral nerve that passed through the region of pain.
There is no singular condition called ‘‘low back pain – sciatica”
This implies that the person has a single condition that causes both symptoms, which is not correct. Patients can have back pain; they can also have “sciatica”; but the two symptoms have separate mechanisms and causes. Features, causes, and mechanisms of one entity cannot be attributed to the other. Read more about Pilates & Sciatica
How can Pilates help you?
Pilates abdominal exercises can help by helping you strengthen your abdominal and back musculature, improve your core stability and spinal mobility and posture, which in turn can prevent (shear) compressive forces that could further degenerate your spine, which may cause any of the above symptoms.
Pilates exercises incorporate a variety of modalities to strengthen the abdominal and vertebral muscles which provide dynamic stabilisation for the spine during motion.
If you are experiencing back pain and discomfort going down your leg, speak to your GP, as you may greatly benefit from Pilates exercises and our technique. This would encourage prevention of further damage, rehabilitation and maintenance.
What is the sciatic nerve?
The sciatic nerve is a thick nerve that runs from the buttocks to the back of the knee. Anatomically, from the greater sciatic notch to the polpiteal fossa. Nowhere near the spine. If you have back pain it is not your sciatic nerve that is damaged.
Damage to the sciatic nerve itself (neuropraxia, neuromesis or axonpraxia) would result in peripheral nerve damage and the person would experience most neurological modalities (e.g. in pins and needles, reduced deep tendon reflexes, foot drop, loss of sensation and muscle wasting) all the way down to the foot.
What symptoms would spinal nerve root damage produce?
Damage to the spinal nerve, a nerve exiting the spine at any level, would result in the following types of pain and neurological symptoms. Read more about Pilates & Sciatica and how Pilates can help with Pilates rehabilitation.
The boring anatomical bits about the pathophysiology of referred pain, AKA “Sciatica”
The following are edited definitions from Bogdug, N (p 17-19).
1) Nociceptive back pain: By definition, nociceptive back pain must be pain that is evoked by noxious stimulation of structures in the lumbar spine. In simple terms it’s pain evoked by insults to any of the structures in the spinal segment, like micro tears to the discs, excessive deformation of the ligaments, irritation of the facets, etc. The posterior surface of the lumbar intervertebral discs are the
most potent source of experimentally-induced back pain.
2) Somatic referred pain: The pain spreads into the lower limbs, and is perceived in regions innervated by nerves other than those that innervate the site of noxious stimulation – the core of the definition of referred pain. Since the source of spinal referred pain lies in the somatic tissues of the lumbar spine it has been named somatic referred pain. Somatic referred pain does not involve stimulation of nerve roots. It is produced by noxious stimulation of nerve endings within spinal structures such as discs, zygapophysial joints, or sacroiliac joints.
3) Radicular pain: This is the term people often refer when they claim to experience sciatica. It has been described of a lancinating quality, traveling along the length of the lower limb, in a band no more than 2–3 inches wide. The evoked sensation is very unpleasant but is not exactly pain, in a classical, nociceptive sense. The qualities of lancinating, shocking, or electric are consonant with more than nociceptive afferents discharging. Since the English language lacks a more precise word, this sensation is, nevertheless, by default, called pain.
More importantly, radicular pain differs from somatic referred pain both in mechanism and clinical features. Physiologically, it is pain evoked by ectopic discharges emanating from a dorsal root or its ganglion.
Disc herniation is known to be the most common cause, and inflammation of the affected nerve seems to be the critical pathophysiological process. Only a very low percentage of people actually experience radicular pain.
Nerve compression away from the spine e.g. piriformis compressing the sciatic nerve is a peripheral nerve entrapment. This is distal to the spine, and has anything in common with radicular pain, other than being perceived in the lower limb.
4) Radiculopathy: is another distinct entity. It refers to the sensation of numbness or weakness in the limb. However radiculopathy is NOT defined by pain. It is a neurological state in which conduction is blocked along a spinal nerve or its roots. When sensory fibers are blocked, numbness is the symptom and sign. When motor fibers are blocked weakness ensues. Diminished reflexes occur as a result of either sensory or motor block.
Edited from: PAIN” 147 (2009) 17–19 “On the definitions and physiology of back pain, referred pain, and radicular pain” Nikolai Bogduk *