Sciatica pain is a rather common occurrence and as yoga teachers you might often have students in your class that are recovering from a case of sciatica.
Sciatica is radiating pain in the buttock and leg that occurs due to the irritation or compression of the root of the largest nerve in the body called sciatic nerve. The sciatic nerve starts its journey from the lower back and moves down the legs providing sensation to them.
When the sciatic nerve root is compressed due to changes in the lower back like a slipped disc, herniated disc, or other weaknesses of the back, it results in severe pain in the buttock and legs. Pain in many cases is so severe that a person cannot even walk. Mostly the pain is on the one side, though bilateral sciatica is also possible. Treatment of sciatica will depend on its causes.
The most common cause for sciatica is the herniation of lumbar discs (disc-shaped cartridges in the lower spine). These discs get herniated due to stress, trauma, or disease. 85% of cases of sciatica are due to spinal disc disorders.
A less common cause of sciatica is the piriformis syndrome, a condition characterized by the spasm of small muscles below the larger muscles of the buttock called piriformis muscle. Spasms of the piriformis muscle can irritate or compress the sciatic nerve; it is the second most common cause of sciatica. Piriformis syndrome is often the cause behind difficult-to-diagnose lower back pain. 
In most cases, a medical history of radiating pain is enough for a doctor to come to the diagnosis. A physical examination along with certain maneuvers may help confirm the condition. Nonetheless, the doctor may ask for imaging tests like X-rays, CT scan, or MRI to confirm the diagnosis and understand its causes.
Fortunately, most sciatica pains will subside within two to 12 weeks, though in smaller number it may continue for longer. Rest is recommended in the initial period only. For most people treatment will include pain management with the help of medications and physiotherapy. Few cases with severe spinal deformation may require surgical correction.
Important here is to know that physiotherapy is an essential part of the treatment, which includes massage, manual therapy and exercise therapy. Physiotherapy tries to correct the spinal alignment, strengthen the local muscles and release excessive tension in the piriformis muscle.
Without exercise therapy, sciatica may repeat itself as the local issues in the lower back or the piriformis continue to exist. Choice of physical therapy in sciatica is critical as physical training with brisk movements, or high impact may do more harm than good.
Yoga is ideally suited for those with chronic low back issues and sciatica. It does not involve brisk movements, nor are there any high impact motions. It primarily consists of stretching and strengthening of muscles progressively.
Yoga poses that involve stretching of the hip flexors, hamstrings and glutes are regarded especially useful for lower back pain and sciatica. However, in the later stages when the pain has subsided, strengthening of other supportive muscles like those of the pelvis, abdomen, and back muscles is also necessary.
Before starting yoga, it is essential to consult a physician. During the acute phase or in case of severe herniation, it may be better to have rest. Generally, rest is recommended in the acute phase as it helps to reduce inflammation and minimize any further damage. However, once the acute phase is over yoga can help accelerate the healing process and prevent future sciatica pain, by correcting the spinal alignment, strengthening the local muscles and releasing excessive tension in the piriformis muscle.
Yes, absolutely so. There are thousands of clinical trials and research articles to support the use of yoga in lower back conditions. In modern medicine, systematic reviews are regarded as a higher level of evidence in support of any therapy. The systemic reviews are studies that pool the data from numerous studies, carry out statistical analysis and then conclude the efficacy of any intervention.
Cramer et al. carried out one of the most well-planned systematic reviews and meta-analysis regarding the benefits of yoga for lower back pain . In the study, they included data from several clinical trials with a total of 967 chronic low back patients. The study concluded that there is strong evidence in support of doing yoga to relieve lower back pain.
The above named systematic review was focused on all-cause lower back pain, and not just sciatica. However, will yoga work in patients diagnosed with herniated disc and resulting sciatica? In the random clinical trial, sixty participants were divided into two groups. Out of them, sixty-two percent had sciatica. At the end of the trial, those who did yoga along with conventional treatment had a much better score and a reduced disability. Thus, the study concluded that yoga is a safe and effective way to overcome sciatica caused by a bulging disc.
A second most common cause of sciatica, though underrated is piriformis syndrome. There are no conclusive studies yet, that show that yoga might have a positive effect on sciatica caused by the piriformis syndrome. However, a very common treatment in these cases are stretching exercises of the buttocks with external rotation, that target exactly the piriformis and the other lateral rotator muscles below the glutes. Yoga has a great repertoire of asanas that stretch these muscles.
When teaching yoga to students with sciatica, make sure that the student is out of the acute phase of pain and has been cleared by the physician or physiotherapy to practice yoga. Also request the student to inform you what general movement and exercise advise was given to them, so which movements and stretches to do and which better to avoid.
The wrong alignment of the lumbar spine that causes the pressure on the sciatica nerve is very often caused by wrong postural habits over a prolonged time. A lot of sitting and slouching results in tight hip flexors, tight glutes and hamstrings as well as a muscular imbalance between the abdominal and lower-back muscles. Restoring a healthy and natural lumbar curve is essential, as this will reduce the pressure on the inter-vertebral discs.
Below you will find 9 yoga poses that can help to release tension in the muscles that often cause the sciatica pain and also help to re-balance and strengthen the appropriate muscle groups. Make sure to apply these postures within a balanced practice and ask your students to give you feedback if they feel that a certain posture or exercises increases their pain during or after the practice.
1. Dragon Pose (Yin Yoga)
2. Sphinx Pose (Yin Yoga)
7. Eye of the Needle Pose (Yin Yoga)
8. Shoelace Pose (Yin Yoga)
Kalyani Hauswirth-Jain is a senior teacher & the Creative Director at the Arhanta Yoga Ashrams since 2013. She is a lead trainer for the 200 hour Yoga Teacher Training, 300 hour Yoga Teacher Training as well as a variety of 50 hour courses like Yin Yoga and Vinyasa Yoga, for more than eight years now.
She has also co-authored the book Hatha Yoga for Teachers & Practitioners: A Comprehensive Guide to Holistic Sequencing.