Sciatica Pain During Pregnancy: Causes and How to Find Relief
Many women think that aches and pains are just a part of the pregnancy journey. But at Expecting and Empowered, we want to make pregnancy as comfortable and healthy as possible for each and every pregnant mama.
One of the aches and pains we see a lot in women is sciatica, which is a complex condition that can be caused by many different issues. That is often why women don’t get the proper treatment they need. Below we’ll try to simplify the potential causes and possible treatments to help you start finding relief as soon as possible.
Keep these two things in mind as you navigate life with sciatica:
Pain does not necessarily mean damage! Try not to be fearful of movement. As physical therapists, we often say, “Motion is lotion.” The more often we move, the more the joints get lubricated.
You want the symptoms to centralize. In other words, we want the symptoms to move away from the leg and up towards the buttox or spine before fully going away. This is how you address sciatica from the root cause.
Symptoms of 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.
Causes of sciatica
Sciatic pain during pregnancy is caused by excess pressure on the sciatic nerve. It is more common during pregnancy, but it can happen to anyone.
The sciatic nerve is a large nerve that runs from the spine through the back of the hip, down the back of the leg, and all the way to the foot. Our body is connected from head to toe, which means this is a whole body issue. Everything works together as one kinetic chain.
Sciatica is often thought to be a problem just at the pelvis or low back, but the root cause can actually stem from many different areas in the body. Generally these whole body problems are caused by asymmetry or a lack of mobility and/or strength in different areas in the body.
Below are some different causes of sciatic nerve pain throughout the body. It can be caused by one or a combination of these.
Lack of core strength. Your pelvic floor, lumbar spine, and abdominal muscles all impact sciatica. The weight of the baby places excessive constant pressure on the pelvic floor — and an overstretched pelvic floor is a weaker pelvic floor. Our back muscles are also doing a lot more work because of the weight pregnancy places on our front side. Additionally, that extra weight causes our abdominal muscles to become extremely stretched toward the later stages of pregnancy, 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 your 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 (including your piriformis) become shortened. This can cause your piriformis to become irritated and possibly inflamed, which can press directly on the sciatic nerve. This causes irritation of the nerve, thus resulting in pain traveling along the sciatic nerve pathway.
Forward head position. As the center of gravity continues to shift forward due to the extra weight in front, so will your head posture. Without conscious awareness and effort to reduce this, your head starts to jut out forward like a turtle. Forward head posture is like carrying a bowling ball straight out in front of you instead of right at your chest (aka it’s HEAVY!). This head position change puts more weight in front, which further impacts the muscle balance at the hips, causing even more irritation at the piriformis and stress on the low back.
Opposite shoulder problem. Our body works in diagonals and spirals. We are 3-dimensional beings, making our issues more complex than simply treating where the issue is. All day long, we walk and move in a reciprocal pattern (opposite foot and arm move together to walk or run). If we have a mobility restriction or weakness in one shoulder, it can lay a foundation for additional pressure placed on the opposite hip and low back where the sciatic nerve runs through. We see this a lot in our runners and racquet sport players.
Excessive foot arch or flattening. When the foot hits the ground, it will impact everything up the chain. Excessive foot arch or flattening (which is usually a strength issue for flat feet and a mobility issue for high arches) will impact the way the knee tracks and the stability at the hip in single leg activities such as putting on your clothes, climbing stairs or running.
Knee tracking problem. I always say the knee is a “dumb joint.” The ability for the kneecap (patella) to track properly relies on both foot stabilization and hip strength/mobility from above and below. If the hip lacks mobility or strength, the knee is unable to glide properly in the groove. If the foot excessively pronates inward due to flat feet or excessively supinates due to a high arch, the patella won’t be able to move correctly within the groove. When the knee doesn’t track properly, our gait will be altered. When this happens, it will place additional pressure at the back, hip and leg, which can lead to sciatica symptoms and pressure on the nerve.
Pelvic shifting problem. You can get something called a “lateral shift” due to a herniated disc or sitting leaning to one side for a long period of time. When a lateral shift occurs, the shoulders are shifted to the left (or right) of the pelvis causing additional pressure at the sciatic nerve.
Adhesions in the abdominal viscera, internal organs, coccyx or sphenoid deviation. Adhesions can be caused by repetitive poor postures, the inflammatory food we eat, trauma (falling on your bottom, hitting your head, blow to the stomach in sports).
We know the origin of your symptoms can be hard to pinpoint. Like we said, sciatica is complex. We want to give you some tangible tips for relief!
Self treatment for sciatica in pregnancy
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.
Exercises
Neck and shoulders:
SNAGS on opposite side of neck (right)
Set your arm back on the opposite side (right).
Think of putting your shoulder blade down and back.
External shoulder rotation (right)
Resistance band pull aparts (right only)
Hips:
Side lying lateral leg raise (left)
Lateral band walks (left)
Ankles:
Posterior tibias ankle exercises
Stretches
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). 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.
Seated piriformis stretch (left)
Triangle and side angle pose (left leg in back)
Seated side stretch (left)
Hamstring foam roller (left)
Supine hamstring stretch (left)
Quadruped tail wag (left)
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 out 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.
Partner Assisted Massage
It’s a bonus if you can find someone to help you massage the areas seen in this video.
Activity Modification for Sciatica in Pregnancy
Reduce 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 it more bearable:
Sitting
Keep your feet flat on the ground, with your knees and hips level.
Use support:
Try placing a rolled up towel 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 from your spinal cord. It also changes the pressure on your sitting bones and may reduce pressure and stretch on your piriformis.
Use that same rolled towel (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 each arm, cross them over and tuck them under each leg.
Find an appropriate chair:
No hard chairs.
If you don’t have a soft chair, try a seat cushion.
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 and walking
Use a standing desk or take standing breaks:
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.
Minimizing pelvic shifting when walking:
Keep your toes forward, take longer steps, and do not shift hips side to side.
Think about your posture (applies to sitting too!):
Push your head back over your shoulders. Think about getting tall and pulling your head back.
Set your arm back on the opposite side of your symptoms. Squeeze your shoulder blade down and back towards the opposite butt cheek and pull your elbow in toward your side and rotate your upper arm like a screw driver outward.
Form while exercising — especially while squatting
When you’re working out, it’s super important that you have the right form or else you’ll be strengthening bad movement patterns.
Make sure that your knee is coming forward like headlights of a car.
Wear shoes
Fake it until you make it!
If you don’t have great strength in your feet, putting shoes on in the house and wearing them most of the day will help that arch from falling.
Avoid wearing heels/wedges.
Other treatment options for sciatica in pregnancy
Physical therapy: During the evaluation, your PT can target what is causing the sciatica 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. Dry needling is really helpful for this condition. When you are postpartum, try to find an IPA therapist to release visceral adhesions.
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).
I know it can be a very painful condition. I would suggest using the Expecting and Empowered App to help with common pregnancy aches and pains. Again, moving and strengthening will help, not make it worse. I would highly suggest using the guide in conjunction with these tips. Any alignment issues you have will make an appearance during pregnancy.
-Krystle Howald, PT, DPT and Molly Shea, PT, DPT, RYT (Yogi)
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