Sciatica in pregnancy - Don’t put up with it
Tommy Conway, Director and Lead Physiotherapist at OneHEALTH
Sciatica is a diagnosis that many people receive but they don’t know how they got it and what caused it. Everybody knows it is a severe painful condition and everybody knows at least one person that suffered from it. If you have pain running from your back, into your buttocks, down your leg and struggle to drive, sit and walk then you could have sciatica.
When I see pregnant clients with sciatica, they think it is just part of the pregnancy, they are told ‘you just have to live with it for the duration of the pregnancy and there is nothing you can do.’ This is not the case, it is common to get sciatica during pregnancy but it is not normal and should not be accepted as normal. There are warning signs at the start of your pregnancy if you are going to avoid sciatica and you need to incorporate the right stretching and strengthening regime to prevent it. If you are reading this and have sciatica, you can get rid of it and enjoy the term of your pregnancy.
What is Sciatica?
Before we get into helping it, let's explain Sciatica. Your sciatic nerve is a nerve that goes from your Spine and down your leg and branches off into smaller nerves. Think of your Spine as a tree trunk, your sciatic nerve as a branch and the smaller nerves down your leg are like the twigs off the branch.
So, why am I having sciatica?
There can be two main reasons why you are having Sciatica;
Nerves are very sensitive and don’t like being irritated, that is why it causes pain and irritation down your leg. Understanding where your sciatic nerve is irritated and why will allow you to become pain free. In pregnancy you will be unable to take pain relief so for both reasons you have to work at it yourself, I will guide you through it.
Why does it happen in pregnancy?
You are born with a lot of movement in the upper back and hips. When you start to lose mobility your body has to compensate for this loss of movement. Your lower back is stuck in the middle of these two moving pieces and when the movement above the lower back (Upper back) decreases the lower back will get compressed and take the load. The same thing happens when you lose movement below the lower back (Hips) the lower back will again get overloaded and start to make changes to your discs in your lower back.
When you are pregnant you grow the bump at the front of your body, this will make you push forward. As you push forward your hips will tip forward, this is called an anterior pelvic tilt. In the picture attached you can see the hips tip forward to accommodate the developing bump(Pic )1. This will lengthen the muscle at the back of your legs (hamstring) and shorten the muscles at the front of your legs (Quads) (Pic 2). This is why you need hamstring strength throughout your pregnancy, at the same time you need quad muscle lengthening to fight against the tip forward.This tipping forward of the hips will cause you to lose movement at the hips putting pressure on the sciatic nerve. Furthermore, this tipping forward of the hips will cause your back to arch more, losing your mobility at the upper back. You are left with very little range of motion in your body for your nerves to move freely, especially your sciatic nerve. You are in a fight, you are being pushed forward by the growing baby and you need to build the strength to push back.
What can you do?
The sciatic nerve is encased by muscles and when you lose range of motion in the muscles of your hips and back, these muscles get compressed. The muscles then compress the sciatic nerve and that starts the saga of pain running down your leg, unable to walk and the torture of 9 months of pregnancy to come. To explain it better: Did you ever hear of a “crick in the neck”? Well that can happen at the lower back as well. The muscles of the hip and leg surround the sciatic nerve, picture 1 shows the sciatic nerve and the route it travels down the back of your body. In picture 2 you can see the nerve is not as visible now as the muscles of the hips and hamstrings start to cover it. In the third picture you cannot see the nerve at all because the muscles of the glute max which are closest to the skin fully cover the nerve.
You can now clearly see how if one of the muscles identified in picture 2 and 3 gets shortened and loses their ability to move freely it can cause a compression on the sciatic nerve. What I want people to take from this article is there is a reason for everything, there are clues throughout and starting at the warning shot. How you move now determines the potential damage in the future. You are in a fight and you simply need to do pilates to maintain strength in your legs and hips but you also need yoga to maintain your flexibility throughout the pregnancy.
One without the other is a waste of time for me, Yoga is brilliant for stretching, relaxing and unwinding the body, but on it’s own can cause a person to become more pushed forward. The growing baby has allowed your loosening of pelvic ligaments, your stomach is being stretched and your hamstrings have been stretched, now more than ever you need strength. This is where pilates comes in, you need to put the body under pressure and get the burn. You need to fight back, maintain your strength and prevent the pelvis from tipping too far forward. Yoga and pilates for me are the perfect yin and yang, you will probably enjoy one more than the other but believe me you need both throughout your pregnancy.