Yoga for Pain Relief – Managing and Preventing Sciatica
Doug Keller is a yoga therapist, author, and a lifelong yogi. He has spent most of his life studying in a wide range of yoga systems including Iyengar Yoga, Ashtanga Yoga, Anusara and many other systems. Doug combines his yoga background with extensive knowledge of Western anatomy. As a result, Doug is known for his brilliant teaching style, which offers one of the most insightful and comprehensive approaches to the practice of yoga.
In this interview with YogaUOnline, Doug discusses how yoga might help with some of the most common pain issues affecting a large percentage of people, i.e. sciatica and back pain.
YogaUOnline: Eight out of ten people are likely to experience back pain in their life. When it comes to sciatica, the number is equally high: one out of two people. Why are back pain and sciatica so common?
Doug Keller: It has to do with our structure and the challenges of standing on two legs instead of being quadrupeds. People have been dealing with it for a long time and doctors have tried everything from leeches to balms and injections. Even today, there are few good solutions.
Sciatica is complicated because it describes a pain pattern, but the pain pattern can have multiple causes at the same time. It can be related to low back and spine issues; it can be related to sacroiliac issues; it can be related to muscular tension, especially in the piriformis, but other muscles are involved, too.
Sciatica often arises when the sciatic nerve gets affected by the muscles around it. The sciatic nerve is the longest nerve in the body; it runs from your lower back all the way down to your feet and it can get stuck in the muscles or the fascia in different ways.
There are actually a number of approaches to working with sciatic pain and you’ll often find one approach works better than the others. If we get fixated on just one approach that doesn’t work for everybody, it’s harder to handle the problem.
But it is a pain that ranges from being simply annoying to debilitating. For some people it hurts so much in the hip, it radiates into the buttocks or down into the leg and for other people, they can’t function. It often gets worse from sitting for long periods of time, but things like how we stand can strain the muscles as well.
YogaUOnline: Yes. How would a person with back pain suspect it is sciatica and not just regular “back pain”?
Doug Keller: When it is sciatic pain, the pain might be felt in the back, but it also tends to radiate down into the buttocks or even down into the leg, sometimes all the way to the foot. If it’s localized to the low back or just the sacroiliac joint, it’s less likely to be a sciatic pain, because the pain is linked to the path of the sciatic nerve down to the buttock and the hip.
Sciatic pain is often characterized by a sharp electric or shocking shooting pain that both radiates and shoots down through the leg. There are also specific actions that tend to stimulate the pain. If it’s dull pain that’s persistent and it doesn’t radiate down through the limbs, then it’s a less likely that it’s sciatica. Though as always, things can come together. It’s often a combination of what’s going on in the back and what’s going on with the sciatic nerve.
YogaUOnline: There’s a great deal of interest in whether or not yoga can help with back pain either for people already suffering from back pain or wanting to prevent back pain. What’s the case with sciatica? Do we have any indications that yoga can help prevent it or relieve the condition?
Doug Keller: Well, there are many different factors involved in sciatica. When it has to do with the low back, it can be problems of infection, inflammation, cysts, in some cases, tumors. It can also be affected by pregnancy.
However, there are a number of things you can do to alleviate sciatic pain, including toning the core and working with stabilizing the sacrum. Though it’s not an overall cure, it can help prevent or relieve sciatic pain.
When the pain comes down to the hip and the legs, there’s a lot more that we can do for it in that case because it has to do with the fascia and the muscles. That is often linked to inaction, i.e. from not from using the muscles or sitting for long periods of time. There’s a lot we can do to relieve sciatic pain in that case.
Also, exercise caution during yoga poses. If done too strongly, some of the standard or old school adjustments can actually cause or aggravate sciatic pain.
There are also structural factors in the body, basic features about how we’re built that tend to aggravate sciatic pain in different ways. About seventy percent more women than men experience appendicular sciatica, going from the buttock down through the hip and into the leg.
Twice as many men as women get axial sciatica in the low back because of how the sacrum works. There are structural factors often connected to how we’re built according to our sex that can either aggravate one sciatic pain or the other.
YogaUOnline: Yes. Is this something that gets more common as we get older and our muscles get a little bit less flexible or dry out?
Doug Keller: I think likely so, especially if we move less as we age. The fascia gets sticky and the nerves are meant to be able to glide through the fascia. If there’s a lack of movement in an area of the body, the fascia gets a little bit gluey or sticky. When you stretch, it pulls on the nerve and causes the pain.
Actually, the sciatic nerve is so long that during normal leg movement, the sciatic nerve has to stretch up to three to five inches. It actually gets stretched and lengthened. That’s normal to the nerve. If the nerve gets stuck in the fascia and it gets stretched a little bit harder, it pulls on the branches and then that provokes the sciatic pain.
The goal is to restore that gliding action to the sciatic nerve, which is basically doing what I hesitate to call stretches because we think of a stretch as taking the leg up and pulling on it until you feel a stretch in the muscle. It’s more the smooth movement of bending and straightening the knee, getting the muscles to start to slide and glide and the nerves to slide within it.
YogaUOnline: The piriformis is often involved in triggering sciatic pain. Why does the piriformis muscle get so tense?
Doug Keller: The piriformis can get tense for a number of reasons. Women have more problems with the piriformis because the pelvis is built wider and the thighs angle inward. So posturally, that’s constantly pulling on the piriformis and stretching it in a way that presses on and aggravates the nerve.
Beyond that, the piriformis has a couple of functions. We use it to turn our legs out, so it’s an external rotator. The piriformis starts to get irritated when, for instance, you’re driving for a long period of time. As you work the gas pedal or just sit in the chair, the leg turns out and the piriformis gets locked into the shortened position, especially because of the pressure on the buttock from sitting.
But also, the piriformis acts in concert with other muscles as a stabilizer, especially for the sacrum. When we are walking, the piriformis tightens a little to help hold the sacroiliac joint together. If other muscles around it are weak, such as the abductors, it puts extra stress on the piriformis to try to perform that job. The piriformis is a small muscle, but it tightens to create that stability.
There are techniques to both strengthen and tone the piriformis in order to maintain its mobility and strengthen the abductors so they can assist the piriformis. But it is a problem that comes with standing up on two legs and how we’re built to be able to do that. The problem is as old as human history. It hasn’t gone away at any point.
YogaUOnline: So is the general approach to stretch, or do we follow the “strengthen before you lengthen” rule to work with the piriformis?
Doug Keller: A weak muscle complains more loudly. This is particularly true of the postural muscles, the muscles that work all day long to maintain our posture.
The principle is if a muscle is in a weakened position and it has a job to do, it tries to contract to do the job. For instance, the trapezius is not actually meant to hold our head up, but if we have forward head or computer posture, it starts to put a strain on the trapezius, and it contracts to try to help hold the head up. If it’s not strong enough to do it, it goes into spasm.
In the case of the piriformis, if you just stretch it when it’s pulled into a stretched and weakened position, it’s like pulling a rubber band across your sciatic nerve. That stretching is pressing upon and irritating the sciatic nerve.
If you try to take a weakened muscle and stretch it more, you’re just further pulling on it in a way that weakens it and it goes further into spasm or at least doesn’t relax. You haven’t solved the problem.
We want to bring the muscle back to its mid-range of motion, which means you strengthen it to bring it back to its normal position and then by maintaining that toning action, from there get the muscle to lengthen. That’s called eccentric stretching.
It’s like if you pick up a barbell, your bicep contracts. If you let the arm down really slowly, the bicep is still contracting, but it’s also lengthening. The effect of that is to make the bicep both stronger and longer instead of short and muscle bound.
We want the muscles of the body to be like that. We want them to have a nice length to them so they’re capable of free movement around the joint or through the body, but at the same time maintain their tone so they can return back to their natural position and not go into spasm, nor be too tight.
It’s generally true that if you want to stretch the muscles or lengthen them properly, you don’t just pull on it because that provokes a stretch response where the muscle shortens up to protect itself. If you get the muscle to engage and then lengthen it, then the nervous system allows the muscle to lengthen because it feels, in a sense, safe.
The nervous system is set up to sense instability. If one particular area of the spine moves more than the other parts, it sends sensations to the brain, alerting to that movement. The reaction of the nervous system overall on the unconscious level is often to make the muscle tight and to stabilize the mobility in that place. Then that tightening is felt as a spasm, and once really strong, then the nervous system interprets that as pain, which causes you to pay attention to what’s going on there.
In yoga, we’re paying attention to the smaller muscles close to the core of the body and the joints that maintain the stability of the body. That’s how yoga helps reduce the kind of pain that comes from the body sensing instability.
YogaUOnline: Right, yes. I think that’s an element of how yoga can help with issues like back pain and sciatica. It’s the interoceptive awareness that we build where we start being more aware of signals from the body and even the intuitive sense of what we can do to help. But that’s a dimension that you can’t really measure in a study.
Doug Keller: Yes. Well actually what they have seen in studies of pain is when a person understands the pain or understands why they’re having the pain, it almost immediately reduces the experience of pain, even though you haven’t changed the condition. It also raises your pain threshold, which means you may still be experiencing the pain, but it’s no longer experienced as suffering. The mere fact of understanding it helps to make that shift.
And like you’re saying with the interoception that comes with yoga, you’re working with the body to understand why this pain is coming up.
That’s something different from just going to a doctor and the doctor saying, well, I’ll give you this shot or this pill. All of which can help sometimes. But if you don’t understand why you’re having the pain, then that shot or pill is less effective than if you do.
YogaUOnline: Yes. Can you tell the difference between sciatic pain and piriformis pain?
Doug Keller: Sciatic pain refers to irritation of the sciatic nerve, which is usually from pressure on the nerve. They call it mechanical pressure. One of the causes of that pressure is the piriformis muscle. The nerve can get squeezed between the gluteal muscle and the lateral rotators underneath the quadratus femoris. If you do a stretch, this specifically activates and pulls on the piriformis muscle.
If that caused the sciatic pain, then you can say, my sciatic pain is due to the piriformis. If that particular stretch doesn’t provoke sciatic pain, but you’re still experiencing the pain, especially in other physical postures or just during the day, then you can say, it may not be the piriformis, but there is something else going on with the muscles or something is pressing on the nerve to irritate it. So yes, you can get a sense if it’s specifically the piriformis, but there are other causes and all of that is sciatic.
YogaUOnline: Yes. Excellent. Doug, you also have a course on YogaU on this subject, which we’re really excited about, where you go deeply into this vast topic. Tell us about the course and what you are covering?
Doug Keller: The course looks at the different factors that cause sciatica and how to recognize it.
The main focus is on the areas where yoga can help sciatic pain. We go through a series or spectrum of stretches from the simplest and the least provocative to the stronger stretches that you might encounter in a yoga class. It’s important to be aware of the kinds of actions that are good to perform and the ones to be cautious of if sciatic pain is acute.
The problem with sciatic work, especially with stretching muscles like the piriformis, is that the very action that provokes the sciatic pain is the action that we’re practicing in the stretch with extra elements added in to create a kind of release. And so, if you overdo it, you make the sciatic pain worse. If you’re experiencing an episode of acute sciatic pain, and you try to do something according to these stretches, you’re more likely to provoke it further and make it worse. In some cases it does require a referral to a professional to look more closely.
YogaUOnline: Yes. Given that almost one out of two people will suffer from sciatica at one point in their life, it’s essential self-care information that we should be learning in grade school.
Doug Keller: Yes. It’s too bad we don’t get handed an owners’ manual when we’re born as far as how to take care of the body because we don’t think about it until much later in life.