“My pregnancy was progressing smoothly until the 4th month, when I began experiencing intermittent, debilitating nerve pain in my left hip when out for a stroll. The pain was so intense that I didn’t know how I would make it to the store, let alone to the end of my pregnancy. This type of incident happened several times over a few weeks but, after about a month, I never had any problems again. So mysterious. I suspect my son had found a cozy place, nestled just in front on my lumbar spine, and took a very long nap.”
– Carolyn Appel, Director of Education, ProNatal Fitness.
While there are many aches and pains that your pregnant body might experience as a result of weight gain, alignment shifts, and other physiological changes, sciatica may be one of the most intense.
Sciatica is not a medical diagnosis. Instead, it is the term used to describe irritation to the sciatic nerve. It can be experienced as numbness, pain, or tingling in the back of your hips and buttocks, and down each leg. The pain is typically felt on one side and can vary from dull and mild, to sharp and shooting.
Sciatica is sometimes confused with SI Joint Pain (another common pregnancy “pain in the butt”), but if you feel numbness and pain radiating all the way down your leg, it is likely sciatica.
The good news is that, like the example above, the pain may be transient and only disturb you for a limited duration during pregnancy.
More good news: there are definitely things you can do to minimize pain. This will be the focus of this post. First, let’s begin with a brief look at what causes sciatica so that you can better understand some of the strategies we recommend to address it.
What Causes Sciatica
In this diagram, you can see that the sciatic nerve (in blue) exits the lumbar spine and travels down the back of the leg. Therefore, any “entrapment” along its path can cause irritation. Some examples of things that could cause this entrapment, or irritation, to the sciatic nerve are:
- Misalignment of the spine (such as with a herniated disc in the lumbar spine)
- Another potential cause is due to an imbalance in the hip musculature. The muscles can become too tight from excessive use and compress the nerve, which runs through it. Conversely, if the glute muscles are weak from underuse, the piriformis — a deep hip rotator — may overcompensate and compress the sciatica nerve. This latter cause is often referred to as piriformis syndrome.
The most common cause during pregnancy is the anterior pelvic tilt from the growing belly. When the pelvis tips forward, it pulls the lumbar spine forward into an excessive low back arch, as you can see in the image below. This can put pressure on the sciatic nerve.
Exercises to Focus On
To alleviate sciatic nerve pain, you want to focus on the following two goals:
- Alleviate pressure on the structures that are compressing the nerve
- Strengthening the surrounding structures to increase pelvic stability.
Here are some beneficial exercises to focus on.
1. Focus on Neutral Alignment: OK, so this first one is not technically an “exercise,” but it is the most important tip to focus on to minimize sciatic nerve pain. Poor spinal alignment plays a big role in the potential for nerve irritation. Therefore, you want to focus on “getting in neutral” to bring back better balance to the curves of your spine. Pay special attention to getting your body in pelvic neutral, as explained in the video.
2. 360° Breathing: We refer to this one as the #1 most effective core exercise. 360° Breathing has numerous benefits, but specifically as it relates to sciatica, it helps to strengthen your core from the inside-out, which helps stabilize your hips and pelvis. While this demonstration is shown seated, this position may not feel good to your hip, so adjust as necessary. You could try standing, side-lying, on hands and knees, or what ever position reduces your symptoms.
3. Cat Stretch: Posterior pelvic tilting (or tucking your pelvis under, as in the “cat” portion of cat-cow) can provide some temporary relief by taking pressure off the sciatic nerve. This stretch is a variation on the “cat-cow” stretch where you only perform the cat portion (tucking your pelvis under), then come back to a neutral spine instead of going into “cow” (arching).
4. Seated Cradle Stretch: This is another feel-good stretch to take pressure off the sciatic nerve. Lift your leg only as far as you can maintaining neutral alignment (sitting tall).
5. Windshield Wiper with Fold: This is another good one to alleviate pressure from the sciatic nerve. Hold one side for a few breath cycles.
6. Back-Lying Sciatic Nerve Floss: This technique is similar to stretching, but it helps to gently mobilize the nerve and get it “unstuck.” Try this for several repetitions. You do not have to fully straighten your leg. Just reach your foot up to the point where you feel gentle tension on the back of your leg.
7. Bridge (with optional knee squeeze): Remember the second goal of our sciatica exercises is to strengthen the surrounding muscles to increase pelvic stability. Your glutes help to stabilize your pelvis, and this bridge exercise is a great way to target your glutes. For an added bonus, place a rolled up towel, partially deflated ball, or yoga block between your knees and actively squeeze it while performing your bridges — on the way up and down. This helps to strengthen your inner thighs (adductors), which can also reduce stress on your outer hips (recall overactive hips are sometimes a contributor to sciatica).
8. Incline Plank: Strengthening the front of your core can help lengthen your lumbar spine (key to alleviating pressure on the sciatic nerve) while also helping you establish and reinforce the neutral pelvic position that we discussed in #1. A plank can be a great exercise for this. Of course, depending on where you are at in your pregnancy, you may need to modify full planks. The incline plank can be a great option. The key to figuring out the right plank variation (and degree of incline) for you is that you should be able to perform your plank 1) maintaining neutral alignment, and 2) with no coning in your belly.
9. Bird Dog: Like the incline plank, this is another great pregnancy-safe core exercise that targets the muscles in the front of your core.
10. Sleep on “uninjured side:” Well, like #1, our last point isn’t really an “exercise” either, but it’s important to note that you might find it more comfortable to sleep on your “good” side. When sleeping on your side, place a pillow between your knees to keep your pelvis in a more neutral alignment. You could also try a warm compress or warm bath for some temporary relief.
Exercises to Avoid
The exercises to avoid are very similar to if you are experiencing SI Joint Pain. These include:
- Lower Body Single-Leg Moves: Weight-bearing single-leg moves like lunges of any kind or step-ups/downs place your pelvis in a less stable position. In general, you want to keep your weight evenly distributed over two feet (think squats and bridges).
- Traditional cardio machines: Machines like the elliptical, Stairmaster, and treadmill all promote single-leg activities, so it is best to avoid these.
- (Use caution with) single-leg daily activities: Activities like walking, stair climbing, and getting up and down from the ground are also single-leg activities. Of course, it’s not possible to completely avoid these activities, and we wouldn’t want you to either. It’s important to keep moving. You may just want to limit extended periods of walking or stair climbing when pain is severe. Also, when getting up off the ground, step up on the side that does not hurt.
- Impact: When performing any sort of impact activity (running, plyometrics, etc.), the impact forces travel up the body and can spur more pain. It’s best to focus on non-impact moves while you are symptomatic.
- Any move that triggers pain: This should be an obvious one, but worth mentioning. Sometimes the pain triggers are different for every individual, so try to pay attention to the activities that trigger pain for you, and avoid those.
- If you have painful symptoms, consider wearing a compression garment. We love the range from SRC Health, which offers high-quality garments to wear under and over your bump (use code PRONATAL10 for 10% off).
- For programs and services to help you exercise safely and effectively during pregnancy, check out our training programs & services.
- If you are a health & fitness pro interested in coaching pre & postnatal clients, explore our ProNatal Education & Certification.
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