Knee & Ankle Lower back By Sophie Xie / October 10, 2016 Best 3 stretches and 4 strengthening exercises to improve chronic "sciatica" pain Quick Navigation Treatment for acute "sciatica" and chronic "sciatica" is DIFFERENTStretches for chronic "sciatica" painStretch 1: BKTC stretching (both knees to chest stretch)Stretch 2: Piriformis muscle stretchStretch 3: Prayer Stretch with an Exercise BallStrengthening exercises for Chronic "sciatica" painExercise 1: Clam ShellExercise 2: BridgingExercise 3: Cat-Camel to Bird-DogExercise 4: Side Planking So you are living with "sciatica"for months and years now. Sometimes it's not too bad, and you barely notice it. However, some days are dreadful. Your lower back pain flare-up, and your tender and sore hip is shooting pain all the way down to year ankles. You feel like moving around with a heavy, painful log (or two) attached to your weary body.Chronic "Sciatica"is nerve pain in the hip and leg caused by irritation to the sciatic nerve or nerve roots that have lasted for over 6 months. Your chronic "sciatica" may have started as part of an acute injury such as herniated disc, car accident or sports injury. "Sciatica" may become a chronic condition when the original injury has completed healing, but the hip and leg pain does not go away.Treatment for acute "sciatica" and chronic "sciatica" is DIFFERENT Since acute "sciatica" often occurs due to fresh injuries, we expect lots of active inflammation process: chemical warfare, swollen tissue, lots of sharp and aching painful sensation spreading across the entire lower back, hips and thighs.The best course of action for fresh injuries and symptoms are to rest, get comfortable with moderate ice and heat. Gentle treatment such as the McKenzie positional release protocol and sciatic nerve glide are good ways to help the nerve tissues to calm down.However, chronic "sciatica" happens when the chemical reactions died down, and mechanical problems continue to irritate the nerve roots and the sciatic nerve. For example, conditions such as the spinal stenosis(narrowing of spinal canal), degenerative disc disease, arthritis in the spine (spondylosis) can develop due to aging, repetitive lower back injuries, and more commonly, loss of core muscle strength. [Recommended Reading: 6 possible root causes of sciatica pain? Which one do you have?] For younger people, the piriformis syndrome can also keep you away from returning to an active lifestyle.So what do you do when the "sciatica" has gone "chronic"?The answer is: Save your nerves by stretching and strengthening until the mechanical problems improve and resolve. If you leave and ignore your "sciatica" condition for too long, you are risking surgeries and irreversible permanent nerve damages in your legs.Stretches for chronic "sciatica" painStretch 1: BKTC stretching (both knees to chest stretch)This stretch is simple and relaxing. It helps to stretch the lower back muscles and ligaments along the back of the spine. Note: Avoid this stretch if you suffered from herniated disc injury in the past 6-8 weeks. While Lying on your back, hold your knees and gently pull them up towards your chest.If you have a hard time holding your knees with your arms, you can lay down with your hips closely pressed against a wall, so that you can rest your feet on the wall.Hold this stretch for 30 seconds to 1 minStretch 2: Piriformis muscle stretchThis is a very essential stretching for people who have "sciatica" symptoms. Whether or not you suffer from the piriformis syndrome, the piriformis muscle is likely to be tender, tight and spasmic due to nerve irritation. Image via hep2go.com While lying on your back with both knee bent, cross your sciatica-side leg on the other knee.Next, hold your non-painful thigh and pull it up towards your chest until a stretch is felt in the buttock on the sciatica side.Hold this stretch for at least 30 seconds. You can switch to stretch the other side as well.This version of the piriformis stretch is not for everyone. If you find this position to be uncomfortable or difficult to maintain, try these other two stretches targeting this same muscles. All stretches are held for 30 seconds. Image via hep2go.com Piriformis stretch in sitting:While sitting in a chair, cross your sciatica-side leg on top of the other as shown.Next, straighten your back and gently lean your chest froward until a stretch is felt along the crossed leg. Piriformis stretch knee to shoulder:While lying on your back, hold your knee with your opposite hand and draw your knee up and over towards your opposite shoulder. Image via hep2go.com Stretch 3: Prayer Stretch with an Exercise BallI like to do the prayer stretch seating in a stool. This stretch may help to open up the tight fascia and muscles in the back that's over loading the spine. The muscles that we are hoping to stretch here are the latissimus dorsi muscles (the wing muscles) and the quadratus lumborum muscles on the side of your back. Begin seated in a chair, with good posture, core tight. Place a large exercise ball in between your legs. Place hands on the ball and slowly bend forward as far as you can, allowing the ball to roll forward with you. Hold for the 30 seconds and roll back up into starting position. Now, repeat, but instead of rolling forward, roll towards the left (about 45 degrees) so you feel a stretch on the RIGHT side of the back. Now, repeat, but instead of rolling forward, roll towards the right (about 45 degrees) so you feel a stretch on the LEFT side of the back.Each time stretching hold for 30 seconds Strengthening exercises for Chronic "sciatica" painExercise 1: Clam ShellWe introduced the clamshell exercise before as a gentle core strengthening for lower back pain. Clamshell training is also crucial to relieve piriformis spasm and pain. Image via hep2go.com Lay on your side (choose one, you will need to do it on both sides anyway). Ideally, you want to press your back and heel against a wall or furniture to prevent compensation.Bend your knees 90 deg and place your foot so that they form a line with your trunk.Then, without moving your trunk, lift your top knee off the bottom knee, while keeping your feet together.Once you cannot move your knees further, slowly place it back on top of the bottom knee.Repeat this exercise anywhere from 10 to 50 repetitions until you are tired and start feeling the burn in your hip. Switch and do the same on the opposite side.Frequency: My personal preference is to encourage patients to slowly increase their clam shell exercise repetition over time, until they are able to perform 50 on each side. At that time, they will be able to progress to more advanced exercises in this category. So for starters, do clamshell at 1-2 times per day with repetition at your comfort level.Note: if you have pain with this exercise, especially when the knee is lifted at its highest, you may try to decrease the magnitude of your movement by keeping your knee lifted (hip rotation) in the PAIN-FREE ZONE. You do not need your knee all the way up to get good strengthening results with this exercise.Exercise 2: BridgingBridging is a very popular exercise to regain strength in the gluteus max muscles. This exercise will help to regain strength in the lower back without aggravating the piriformis muscles. Image via hep2go.com Lie down facing the ceiling with your knees bent and feet supported on the surface comfortably.Before you move, pull in your belly button, and squeeze your buttocks together.Then, lift your bottoms up towards the ceiling until you trunk and knees are in a straight line.Then slowly lower your bottom down until it is placed back onto the surface. Relax TA and un-squeeze buttocks.Repeat after brief rest as needed.Frequency: 10 – 30 repetition as tolerated, 1-3 times per day for 3-4 weeks.Exercise 3: Cat-Camel to Bird-DogThere is a lot of animals in the name. Cat-camel and bird-dog are two different exercises. I highly recommend familiarizing with the cat-camel exercise first to learn to activate abdominal muscles correctly. Then as you grow confident, you can progress to the bird-dog exercise.Cat-Camel Image via hep2go.com Start on your hands and kneesArch your back slowly by dropping your stomach towards the floorThen start to suck in your belly button and round your back towards the ceilingRepeat this movement slowly for 7-10 repeatitionBird Dog image from hep2go.com Begin on your hands and knees, with your knees directly under your hips and your hands directly under your shoulders. Back Flat and Relaxed.Tighten your core and back while extending your leg straight behind you and extending the opposite arm in front of your body. Hold for 5 seconds. Slowly lower both and return to the start position. Repeat the exercise with the opposite leg and arm.Make sure you do not arch your lower back or tilt your body. Prevent there is a cup of water sitting on your back and you need to keep it balanced while performing this exercise.Repeat 7-10 repeatitions per setIf you find it challenging to move both arms and legs, you can start off by only alternating between legs. After a while, you can add on the arms part.Exercise 4: Side PlankingSide planking is a great way to train abdominal muscles, gluteus muscles and hip muscles to work together. If you are less confident about your ability to perform a complete side plank, you can definitely start with a half side plank.Half side plank image via hep2go.com Begin lying on your side with legs stacked one on top of the other and knees bent. Bring your forearm to the mat and elbow directly under your shoulder. Raise your hips up off the ground so that your should to knees forms a straight line.You can start by hold only 3-5 seconds, and progress to 10 seconds. Repeat 10 times.Full side plank image via hep2go.com Begin lying on your side with legs stacked one on top of the other. Bring your forearm to the mat as pictured with your elbow directly under your shoulder. Raise your hips up into the air so that your shoulder to ankle forms a straight line. You can start by holding 3-5 seconds and progress to 10 seconds holding. Repeat 10 times. Thank you for reading, and I hope you find this post helpful.Recommended readings:How to use TENS therapy to relieve lower back painWill traction help with herniated disc pain or sciaticaSciatica nerve flossing? How does it help to relieve your sciatica painWhat's the cause of sudden stabbing pain in my lower backLooking for stretches for lower back pain? Hip flexor stretch is the place to startBest 4 gentle yet effective core exercises for lower back painWhy your chronic lower back pain has nothing to do with a herniating discLike what you just read? Share this post via our social media buttons! They are everywhere on this page!Want to know more about treating your own pain with techniques from a physical therapist? Please subscribe to our newsletter!