Yoga, Injury and Safety Q+A / Survey Answer #2: “Five Things to Know about Sciatica and Yoga” or “Men can Kegel too”

The second question I received (from my survey of yoga students and teachers) comes from a friend and skilled vinyasa yoga teacher. This answer involves a little more anatomy.

What is the best plan for someone who comes to a vinyasa class and tells me they have some sciatica issues?

Sciatica, a term often used as a diagnosis, is actually a symptom.

The source of sciatic pain could be a few different body parts with a variety of mechanical dysfunctions.

In general terms, the low back, the sacroiliac (SI)  joints and the smaller internal and external rotator muscles around the hips are common culprits of sciatic pain (which implies radiating pain or abnormal sensation down a single leg in the path of the sciatic nerve).

How to treat sciatica with yoga:

1) Know the source

If a yoga student knows the source (there can be more than one) of her/his sciatica, an asana practice has great therapeutic and rehabilitative potential when the following guidance is applied.

2) Core Love

For sciatica originating from the low back (L4 or L5 nerve root compression via herniated disc, disc degeneration, stenosis, bone spurs, or joints that have slipped out of place as in spondylolisthesis), focus on mula (root) and uddiyana (upward lifting) bandhas as well as neutral core stabilization (think most pilates-style moves).

Mula Bandha, root lock, engages the sling of pelvic floor muscles. These are part of your “core” because intra-abdominal pressure is modulated from the diaphragm to the pelvic floor. That means the amount of pressure on your discs, therefore the very integrity of those discs, depends on your capacity to appropriately engage all of the muscles that form the capsule-like shape of the abdomen as you maneuver your body throughout your day and your practice.

Mula bandha is often described as an “energetic” action (more awareness, less muscle contraction), but in my humble opinion, it’s not unlike what modern medicine calls a Kegel. There are differing strengths and styles of Kegeling (a discussion for another post).

(So you know: men can Kegel.)

As you empty the air from your lungs, engaging the same muscles that help you hold onto your pee can help to stabilize your lumbar spine and decrease the pressure on the origins of the sciatic nerve.

Neutral core stabilization means perfecting the appropriate pelvic floor muscle and transverse abdominus action while in a neutral lumbar spine (which is actually a curve — the pretty and natural curvature of the low back.) Plank, GOOD chaturangas, side plank / vasistasana, table with opposite arms and legs, and tadasana are a few simple examples of appropriate postures in which to emphasize transverse abdominus, which is the muscle that creates the action of uddiyana bandha.

Crunches and the like are to be avoided! Pressure on the discs skyrockets during crunches, and abdominal crunching exercises are a frequent CAUSE of disc herniation. There is so much creative core work you can do without crunches, and I highly recommend alternatives.  In addition, lay off deep flexion poses, including plow, paschimottonasana / forward seated fold with legs straight, and anything nose-to-knee.

3) Symmetry is Beautiful

SI instability tugs on three of the five nerve roots of the sciatic nerve. It’s more common in women and in flexible women: a key consumer demographic of yoga.

For these students, mula bandha could help or hurt.

If the internal musculature of the pelvis has high tone or trigger points from irritated nerves (most people do not know whether they have this — see a pelvic floor physical therapist if you are unsure), Kegels and mula bandha might further aggravate the issue (in which case, pelvic floor relaxation techniques help).

SI joint instability originates in a sheering force from asymmetrical movements. Spinal twists can be a culprit (like using your arm as a lever without an equally powerful squeeze to the midline between your legs – aka “adduction”) as well as single leg standing poses.

To most yoga teachers, perhaps especially vinyasa teachers, eliminating sheer force on the SI joints during your students’ practice is a monumental challenge.

One prescription: Surya Namaskar A with a block between the thighs. Uktasanana / Chair pose with or without a block. Backbends emphasizing transverse abdominus / uddiyana bandha and zipping up the legs.

4) Appropriate stretching

Less prevalent than previously thought, if the source of sciatic pain is tight hip muscles, most famously the piriformis, conscious deep hip stretching can eliminate the cause.

A caution about stretching: do not bounce, do not force, and OMG-please-breathe.

Paradoxically, the most effective form of stretching requires muscle contraction.

Anusara yoga, R.I.P., had a solid principle to help make sense of this: “Muscular energy”. Having completed one of the last ever 108 hour Anusara Immersions, I’ll do my best to summarize. Hug into the core and midline of your body, suction your limbs into their sockets, and, like a tree drawing up water from roots, draw in energetically from your head, hands and feet.

Kapotasana

pigeon, amy ippoliti, kapotasana, eka pada, eka pada raja kapotasana, yoga, backbend, hip stretch

Boulder-based Yoga teacher Amy Ippoliti (who I get to study with next week…squeee!!!) in the full pose of Eka Pada Raja Kapotasana / One legged pigeon pose.

Take pigeon pose, which requires deep hip flexion and external rotation of the forward leg. Pigeon can be a profound stretch for piriformis and some of the the rotators of the hip. In fact, dropping the weight of your upper body on your hip is such a powerful pressure that you risk, guess what: sheer forces on the SI joint.

What’s a flexi-gal to do?

You pull in to the hip socket with your front leg. You press the outer edge of your front foot into the floor (“eversion”) and keep toes spread. You also draw in isometrically from your back thigh, as if you wanted to drag your yoga mat forward using your knee. The hips are even. It can help to curl the back toes under (if they are on the floor). The core is toned: mula, uddiyana and jalandhara bandhas applied for maximum safety.

Still in pigeon, your breath is your guide to soften the effort around the muscular foundation of the stretch. Your hips will likely be way farther from the floor than if this pose were performed passively, but your sciatic nerve will radiate dynamic goodness and peaceful soothing rainbows down your limb.*

Silliness aside, sometimes all three body parts contribute simultaneously to sciatica. This is more likely to be the case if the pain is chronic (more than 6 months).

Unfortunately, medical experts don’t always explain their expertise when diagnosing something like “sciatica” and often, they don’t take or maybe have the time to get to the source.

When in doubt of the actual source of sciatic pain, apply all three suggestions above to your practice or your teaching.

5) Mind Your Transitions

Mindfulness in transitions is king! Moving without mindfulness, usually too quickly, is The Likeliest Source of injury and the first place where we lose our bandhas or get sloppy on our non-dominant side.

Find the pose between the poses.

As always, avoid overdoing it. Group vinyasa classes, where it can be perceived as rude or disruptive to not follow the class, and more frankly, where humans (or rather our protective egos) inevitably want to fit in with everyone else, might not be appropriate until symptoms abate. Heated classes cause our bodies to think they can be pushed farther than they is safe. (We won’t get the physical message until later). Be kind to your one lovely body.

Bonus tip: hydrate

Intervertebral discs are 70% water.  Dehydration, especially coupled with physical activity, is a recipe for stress on the spine, as well as a muscle irritant since muscles rely on free fluid transport of electrolytes to stay happy. To keep your sciatic nerve happy, keep your muscles and discs plump and refreshed.

Much more can be written about yoga and sciatica, and I welcome further questions in the comments below or at my survey.

* oh Anusara, how I miss thee :)