Pain in the sciatic nerve

Author: K. Zbinden

Definition

What is pain in the sciatic nerve?

The sciatic nerve, medically known as the nervus ischiadicus, is the largest peripheral nerve in the body. It arises from several nerve roots in the lower back, passes through the pelvis and typically runs beneath or through parts of the gluteal muscles. From there, the sciatic nerve runs down the back of the thigh and branches further in the popliteal fossa into nerves that supply the lower leg, calf and foot. This explains why discomfort can be felt not only in the back or buttocks, but also further down the leg.

Pain in the sciatic nerve is spoken of when the nerve is irritated, compressed or inflamed along its course. These symptoms are often referred to as sciatica, sciatica pain or sciatic syndrome. Typical signs are a burning, stabbing or electric sciatic pain that radiates from the lower back via the buttocks into the thigh, lower leg or even the foot. Accompanying sensations such as tingling, numbness or a feeling of weakness may occur.
The sciatic nerve can be irritated in different ways. Often, the cause of sciatica lies in the spine. For example, irritation or pressure on a nerve root, such as with a herniated disc or wear-related changes that narrow the space for the nerves. The nerve can also be mechanically irritated along its course, for example by tense or shortened muscles in the buttock area. Inflammatory processes in the spine, pelvis or sacrum can also trigger sciatic nerve pain. It is important to note that back pain does not automatically originate from the sciatic nerve. Conversely, sciatic nerve pain can also occur when the main pain does not begin in the back, but is felt primarily in the buttocks or leg.

Causes of pain in the sciatic nerve

Pain in the sciatic nerve is one of the common forms of discomfort that can radiate from the lower back via the buttocks into the leg. The causes of sciatic pain, like many other back complaints, are closely linked to changed environmental conditions. These include in particular the widespread sedentary lifestyle and lack of exercise in everyday life. These factors interact on several levels and can contribute to irritation of the sciatic nerve or a nerve root in the lower back.
Today’s working and living environment differs fundamentally from that of earlier generations and from our ancestors, who as hunter-gatherers were much more varied in their movement. Technological progress has greatly reduced physically demanding work, but at the same time has also restricted natural movement variety. The use of computers, smartphones and automation means that many activities are carried out in static and often unphysiological positions. Many people spend a large part of the day sitting, in the office, on the way to work or in their leisure time. This persistently static posture can lead to incorrect loading in the lumbar spine, pelvis and surrounding muscles. As a result, structures that are closely related to the sciatic nerve can become overloaded. In addition, hard, flat floors and shoes with rigid soles have changed gait patterns and the load on the musculoskeletal system. This can also increase mechanical stress in the lower back and pelvis and thus promote irritation of the sciatic nerve. In addition to the changed environmental conditions, genetic predisposition, overweight, postural defects and misalignments, smoking and other stress factors are among the influences that can make sciatica more likely. The following describes the effects of the changed lifestyle on the development of pain in the sciatic nerve.

Lack of exercise and sedentary lifestyle

Due to the modern lifestyle, which is characterised by lack of exercise and a sedentary way of life, the musculoskeletal system is often subjected to incorrect loading. Lack of exercise and prolonged sitting lead to physical adaptations that can trigger or intensify pain in the sciatic nerve. The following changes play a major role:

• ◉ Weakened muscles and muscular imbalances

  Regular exercise is essential to strengthen the trunk and back muscles and thus keep the spine and pelvis stable. However, lack of exercise causes muscles to deteriorate and their supporting function to decline. If, for example, the deep trunk muscles are too weak, loads in the lower back are absorbed less evenly. As a result, nerve roots in the lumbar spine can be irritated more easily, which may be felt as radiating pain along the sciatic nerve.
  Lack of exercise and a sedentary lifestyle can also lead to muscular imbalances - that is, imbalances between different muscle groups - which favour irritation of the sciatic nerve. For example, if the back extensors are overactive while the gluteal and abdominal muscles are not contributing enough, unfavourable tension and pressure conditions arise in the lumbar spine and pelvis. This can cause the sciatic nerve to become trapped and lead to sciatic syndrome or chronic sciatic complaints.

• ◉ Poor posture and overload of the spine

  When sitting for long periods, especially in a forward-bent posture or with a rounded back, the lumbar spine is subjected to one-sided stress over a prolonged period. This can increase pressure on the intervertebral discs and small vertebral joints and thus irritate the area around the nerve roots. At the same time, such a posture can place the pelvis in an unfavourable position, changing tension and pressure in the buttock area. This combination can contribute to the sciatic nerve reacting with pain or to radiating pain being felt.

• ◉ Restricted blood circulation and tissue supply

  Long periods of motionless sitting reduce muscle activity and metabolism in the pelvis and back area. Even though nerves are not trained like muscles, they depend on a well-supplied environment. If the surrounding tissues are less well perfused and less mobile, irritation can persist more easily. Movement acts here like a natural support because it promotes the alternation between tension and relaxation and thus improves tissue supply and the removal of metabolic products. Chronic sciatic complaints can be the result.

• ◉ Foot misalignments

  The connection between feet, legs, pelvis and back is crucial for the body’s overall statics. Foot misalignments such as flat feet, splayed feet, knock-knees or flat feet can change the gait pattern. This often results in compensatory movements in the knee, hip and pelvis. The pelvis often tilts forward or to the side, shifting the load in the lower back. Such changes can contribute to irritation of nerve roots in the lumbar region or to increased tension in the buttock area, which in turn can promote sciatica symptoms.

• ◉ Shortened and tense structures

  Lack of exercise and predominantly sedentary activities promote shortening and tension, especially in the hip flexors, hamstrings and gluteal muscles. Shortened muscles change pelvic position and restrict mobility. At the same time, tense structures in the buttock area can functionally narrow the space for the sciatic nerve or mechanically irritate it through increased tension. This makes symptoms more likely, described as pulling, burning or stabbing pain into the leg.

• ◉ Fascial dysfunction

  Fascia connect muscles and tissue and support the gliding ability between structures. If fascia are restricted in their gliding ability due to lack of exercise, chronic poor posture or one-sided loading, movement tends to become more sluggish. This can disrupt muscular coordination and lead to incorrect loading in the lower back and pelvis. Such tension patterns can promote irritation, causing inflammation of the sciatic nerve or generally leading to sciatica.

• ◉ Joint stiffness

  Lack of exercise and predominantly sedentary activities promote joint stiffness. Restricted mobility in the hip, pelvis or spine changes the natural dynamics of movement. If one area is stiff, compensation often occurs elsewhere, not infrequently in the lumbar spine. This can increase pressure and shear forces in the lower back. This additional load can irritate nerve roots and thus promote radiating pain along the sciatic nerve.

Hard, flat floors and immobile, supportive shoes

Hard, flat floors and immobile, supportive shoes can affect natural shock absorption and physiological gait. This changes force transmission and load distribution throughout the musculoskeletal system, which can also promote sciatica symptoms. The following factors are particularly relevant:

• ◉ Reduced shock absorption and increased force impact

  Normally, the arches of the foot, the muscles and the natural sequence of movement when walking on natural ground act like a buffer that absorbs shocks when walking or running. If this natural cushioning function is lost through constant walking on hard surfaces or by wearing rigid shoes, the impact forces are transmitted almost unfiltered to the knees, hips and back with every step. Impact forces are transmitted more strongly upwards and place strain on the knees, hips, pelvis and lumbar spine. This can increase mechanical stress in the lower back, which may cause the sciatic nerve to become trapped or typical sciatic pain symptoms to occur.
  Due to the earlier and increased force impact, the reaction time of the stabilising pelvic and back muscles is shortened. If the muscles do not become active in time to sufficiently stabilise the spine and pelvis, the sciatic nerve is incorrectly and excessively loaded. Typical sciatic pain or even chronic sciatic complaints can be the result.

• ◉ Restricted foot function and muscle weakening

  Wearing shoes with rigid soles or supportive elements and walking on hard, flat floors prevents natural foot movement. In the long term, this can weaken the foot and lower leg muscles and impair the function of the arch of the foot. This worsens natural shock absorption and forces are increasingly transmitted via the knees and hips to the spine. The increased forces can cause inflammation of the sciatic nerve.
  Weakening of the foot muscles can also lead to compensatory postural adjustments in the pelvis, which in turn can promote unfavourable loads in the area of the sciatic nerve and sciatica symptoms.

• ◉ Changed gait and rolling movement

  Due to the lack of give in hard, flat floors and stiff shoes, the ground reaction force after heel strike is transmitted almost unfiltered through the feet and legs into the body. The muscles responsible are unable to react sufficiently due to the rapidly increasing force impact. As a result of the restricted muscular control, a functional flat foot often occurs, in which the foot drops down uncontrollably after heel strike. The forces generated are only inadequately cushioned and transmitted upwards. This creates incorrect loading and overload around the sciatic nerve, which favours irritation or compression.

• ◉ In addition, an unyielding surface prevents a natural rolling movement over the forefoot. The foot thus loses its elastic-spring function for the even absorption and transfer of force. The reduced rolling movement decreases the activation of the foot, leg, gluteal and trunk muscles, which are crucial for stabilising the pelvis and spine. Reduced muscular stability can further increase pressure on the sciatic nerve and trigger chronic sciatic complaints.

Symptoms of pain in the sciatic nerve

The symptoms of sciatic pain can vary in severity depending on the cause, the extent of irritation, individual pain perception and physical constitution. Often it is not clear whether it is actually pain in the sciatic nerve or another condition. For example, the symptoms of a herniated disc, spinal canal stenosis, piriformis syndrome or hip osteoarthritis can be similar. To obtain a clear diagnosis and rule out serious causes of sciatica, a doctor should be consulted if the symptoms are severe, newly occurring or persistent. Typical sciatica symptoms and sciatic nerve pain symptoms are listed below:

• ◉ Back pain: Pain in the lower back, often pulling or stabbing, which may worsen with movement, lifting or prolonged sitting.
• ◉ Radiating pain: Pain that pulls from the lower back or buttocks along the nerve path into the thigh, lower leg, calf or even the foot, typical of sciatic syndrome.
• ◉ One-sided buttock pain: One-sided discomfort in the buttock, sometimes deep-seated, which may become more noticeable when walking, standing or sitting.
• ◉ Tingling and numbness: Sensations such as tingling, pins and needles or numbness in the leg or foot are symptoms of sciatica.
• ◉ Burning or electric pain: Many describe sciatic pain as burning, sharp or like an electric shock, especially with certain movements.
• ◉ Sciatic calf pain / calf cramp: Pain, a feeling of pressure or a tendency to cramp in the calf, sometimes associated with a pull into the foot.
• ◉ Muscle weakness: Decreasing strength in the leg or foot, for example unsteady walking, stumbling or difficulty walking on tiptoes or heels.
• ◉ Restricted movement: Protective posture and reduced mobility in everyday life, for example when bending, turning or standing up.
• ◉ Pain worsens when coughing, sneezing or straining: A short-term increase in symptoms due to increased pressure in the trunk, especially if a nerve root is irritated.
• ◉ Pressure or stretching provokes symptoms: Pain increases when the nerve is stretched, for example when lifting the leg while lying down or bending forward with the knee extended.
• ◉ Symptoms of sciatic inflammation: In pronounced irritation, the pain can also be clearly noticeable at rest and worse at night, often associated with high sensitivity along the radiating path.
• ◉ Trapped sciatic nerve: In everyday language, a trapped sciatic nerve is spoken of when the symptoms suddenly shoot in, clearly radiate into one leg and are accompanied by tingling, numbness or loss of strength.

Important warning signs that must be clarified by a doctor immediately are increasing paralysis, numbness in the genital or anal area, and problems with bladder or bowel emptying. Medical assessment is also advisable in the event of severe pain after an accident, fever or a rapid worsening of symptoms.

Conventional therapies - What helps with pain in the sciatic nerve

There are several approaches to treating pain in the sciatic nerve. Which measures are useful depends, among other things, on the cause of the sciatica, the severity of the pain, the duration of the symptoms and possible neurological deficits. Below are some options for conventional sciatica treatment or sciatica therapy. The list is not exhaustive. Often several measures are combined to relieve sciatic nerve pain and improve everyday function. Medical consultation is recommended to determine the appropriate therapy and rule out serious causes of sciatica.

• ◉ Pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can be used as sciatica medication to reduce pain and dampen inflammatory irritation. For more severe symptoms, muscle relaxants or short-term cortisone may also be used depending on the situation.
• ◉ Stay active and provide targeted relief: Short relief phases can be helpful in the acute phase, but complete bed rest is usually not recommended. A sensible approach is dosed activity with frequent changes of position to reduce irritation without further stiffening the musculoskeletal system.
• ◉ Physiotherapy: Targeted exercises improve mobility and stability, reduce muscular protective tension and support better load distribution in the back and pelvis. Depending on the findings, the focus is on mobilisation of the spine and hips, stabilisation of the trunk muscles and a controlled return to everyday movements.
• ◉ Medical training therapy (MTT): Under guidance, strength, endurance and mobility are systematically built up. A stable trunk and gluteal musculature can relieve the lumbar spine and prevent relapses.
• ◉ Manual therapy: Targeted mobilisation of the spine, pelvis and hip joints as well as treatment of soft tissues can reduce restrictions in movement and muscular tension. This can have a favourable effect on mechanical irritation of nerve structures.
• ◉ Nerve mobilisation: So-called neurodynamic techniques are useful for many sufferers. These involve gently moving nerve structures to improve their gliding ability and reduce hypersensitivity. This is dosed individually so that the symptoms of sciatic nerve pain are not worsened.
• ◉ Infiltrations and injections: In the case of severe, persistent pain, targeted injections, for example with cortisone and local anaesthetic, may be considered near an irritated nerve root. The aim is to reduce inflammation and provide short-term pain relief so that active therapy becomes possible.
• ◉ Heat or cold: Heat can promote blood circulation and relieve muscle tension in the back and buttocks. Cold can be pain-relieving in the acute phase if the irritation appears clearly inflammatory. Which application helps better is individual.
• ◉ Ergonomics and posture training: Adjustments in everyday life, for example at work, when lifting or when sitting, can reduce irritation. This also includes recognising unfavourable movement patterns and replacing them with relieving strategies.
• ◉ Orthopaedic aids: Depending on the findings, insoles for foot misalignments, temporary bandages or other aids may be useful to improve loading.
• ◉ Multimodal pain therapy: For chronic sciatic complaints or long-standing sciatica, a combination of medical, physiotherapeutic and psychosocial support can be helpful.
• ◉ Surgery: Surgery is usually not the first choice for sciatic syndrome. It may become necessary if pronounced or increasing paralysis occurs or if bladder or bowel emptying disorders are added. Surgery may also be considered in the case of persistently severe, therapy-resistant pain and a suitable cause of sciatica.

It is important to note that many measures primarily relieve sciatica symptoms. In order for symptoms not to recur regularly, treatment of sciatic pain should always also be aimed at long-term influencing factors and functional causes. The next section therefore describes the kybun mode of action as a complementary approach.

kybun mode of action - What helps with pain in the sciatic nerve

The kybun products aim to reduce the health-damaging effects of hard, flat floors and immobile, supportive shoes, and to actively address lack of exercise and a sedentary lifestyle. Thanks to the elastic-springy properties of kybun products, the musculoskeletal system is relieved on the one hand and activated on the other. The relief ensures that, in a first step, the force impact on the back, pelvis and surrounding structures decreases, which often allows sciatic nerve pain to calm down. The activation is intended to support a natural, joint-friendly gait and strengthen the muscles throughout the musculoskeletal system. This can help reduce irritation around the sciatic nerve in the long term. kybun shoes and mats are therefore suitable as a complementary approach for sciatica, as they can support sciatica treatment through the following effects:

• ◉ Promoting movement and reducing sedentary behaviour

  Regular exercise and reducing sedentary behaviour play a central role in positively influencing complaints in the lower back and in the area of the sciatic nerve. It is generally known that exercise has positive effects on many back complaints and that inactivity can worsen symptoms in many cases. The elastic-springy kybun products encourage enjoyment of movement because walking and standing on the unique material can feel more relieving. This makes it easier for many sufferers to stand up more often in everyday life, walk short distances and interrupt sitting time. In this way, the negative side effects of a sedentary lifestyle can be gradually minimised.

• ◉ Activation and strengthening of the muscles through elastic-springy properties

  An elastic-springy surface can specifically promote muscle activation and strengthening and thus help relieve the lower back and pelvis. When walking and standing on a slightly yielding surface, the muscles, especially in the foot, leg, pelvis and trunk, must continuously perform small compensatory movements to maintain balance. This constant, reflex-like activation trains the deep muscles in particular, which are crucial for good stabilisation of the spine and pelvis. At the same time, the interaction of the muscle groups is improved, which supports movement control. Better stability in the trunk and pelvis can reduce mechanical irritation of nerve structures and thus positively influence sciatic nerve pain.
  Activation of the feet also has a direct effect on statics and load distribution. The feet form the basis of posture and are essential for force transmission and shock absorption. If the foot muscles become more active, the overall body statics can improve. This leads to more stable guidance of the knees, hips, pelvis and spine. In addition, the slow and controlled sinking of the heel into the elastic-springy material creates myofascial pre-tension in the structures involved. This pre-tension can help stabilise movements earlier and reduce load peaks in the lower back.

Balance and EMG

Balance ability was measured with a force plate by tracking the movement of the body’s centre of mass from front to back (ant-post) and side to side (med-lat) while standing. An electromyography (EMG) simultaneously recorded muscle activity.

• ◉ Reduction of the force impact of hard, flat floors through a cushioning effect

  Hard, flat floors transmit impact forces with every step via the feet, knees and hips into the pelvis and spine. These repeated micro-loads can overtax the lower back and surrounding structures and promote irritation. When the heel strikes in kybun shoes, the elastic-springy material is compressed. Thanks to this cushioning effect, the forces acting on the body are reduced and the body is therefore relieved.
  Furthermore, the so-called rebound effect means that part of the forces generated can be absorbed and released again for the rolling phase. This additionally reduces peak loads and distributes the load more evenly. This can relieve the lower back and thus indirectly reduce the irritation that leads to sciatic nerve pain.
  In addition, the slower sinking of the heel gives the body more time to tense the relevant muscle groups. Better basic tension can guide the spine more stably, reducing sudden load peaks.

• ◉ Natural foot rolling thanks to muscle activation and rolling function

  Due to the slower sinking into the elastic-springy material, the time of maximum force impact is delayed. This time gain helps the muscles to react in time in order to place the foot more controlled after heel strike. On the one hand, activation of the foot muscles supports the stabilisation of the arch of the foot and promotes natural shock absorption. As a result, forces are transmitted upwards less unbuffered when walking and standing. On the other hand, active rolling over the forefoot is facilitated. Better rolling supports a more harmonious movement sequence via the knees, hips and pelvis up into the upper body. If movement becomes more even, this can reduce the load in the lower back and thus create conditions under which sciatic complaints are more likely to calm down.

• ◉ Care and protection of the fascia

  Walking on an elastic-springy surface can contribute to fascia care. Fascia react sensitively to movement, especially to gentle, rhythmic and springy impulses. These promote fluid exchange in the tissue layers and can help prevent or release adhesions and hardening. If fascia are loaded too little or unevenly, for example through prolonged sitting or rigid movement patterns, they lose elasticity and gliding ability. This can lead to restricted movement, muscular tension and unfavourable tension relationships in the pelvis and lower back. Smoother fascial mobility can counteract this and thus indirectly also positively influence irritation in the area of the sciatic nerve.

• ◉ Promotion of blood circulation through increased movement activity

  Walking and standing on an elastic-springy surface often naturally increases movement activity. More movement improves blood circulation throughout the musculoskeletal system, including the muscles close to the spine and the tissue around the pelvis and buttocks. Better blood circulation means more oxygen and nutrients for muscles and fascia and supports the removal of metabolic products. This can promote regeneration and help reduce muscular protective tension. Less protective tension and better tissue quality can improve the conditions for sciatic nerve pain to calm down.

• ◉ Optimised pressure distribution

  The sole of the foot is surrounded by the elastic-springy material. This can lead to optimised pressure distribution and reduce peak loads. As a result, impact forces are distributed more evenly across the feet, legs and trunk. More even force transmission can relieve the lower back and thus alleviate complaints of sciatica. In addition, the constant, slight compensatory movement increases the load-bearing area, which can further reduce individual pressure points.

Application tips for pain in the sciatic nerve

Before using kybun shoes or the kybun mat for the first time, you should consider a few application tips. Correct use can help calm sciatic pain and better control the load in the lower back, buttocks and along the leg. You can additionally treat pain in the sciatic nerve with targeted exercises, which are explained in the next section.

• ◉ At the beginning, use the kybun products only for as long as your body allows. Take breaks if the sciatic pain increases or if there is noticeable fatigue in the musculoskeletal system. The changeover takes time. Due to the activating properties of the kybun products, the muscles are trained, which can lead to so-called initial reactions, especially at the beginning.
• ◉ Reduce prolonged sitting, especially when you have sciatic nerve pain, and regularly interrupt sitting phases with short walks or standing. Prolonged sitting can increase pressure and tension in the lumbar spine, pelvis and buttocks and thus worsen symptoms. Also avoid movements or postures that clearly provoke pain, such as deep forward bending with a rounded back or jerky twisting movements. Perform movements slowly and in a controlled manner.
• ◉ Actively press the heel into the elastic-springy material during heel strike in kybun shoes and feel the cushioning effect. This is intended to reduce impact forces. Many sufferers find this pleasant because it can reduce the load in the lower back and pelvis, which can have a favourable effect on radiating pain.
• ◉ Try to roll over the forefoot as actively as possible without hurrying. A calm, complete rolling movement promotes a harmonious gait. This can help activate the muscles in the foot, leg, pelvis and trunk more evenly and reduce tension peaks.
• ◉ Change walking speed only cautiously and in a dosed manner. Short sections of slightly faster walking can promote natural trunk rotation. It is important that this does not lead to a stabbing or shooting sciatic pain. If symptoms increase, stay at a calmer pace.

Helpful exercises for pain in the sciatic nerve

To enhance the effectiveness of kybun shoes and the kybun mat and positively influence sciatic pain, we recommend performing the following exercises regularly. The selection of exercises is not exhaustive and can be supplemented by further measures of sciatica treatment. As a general rule for all exercises: the sciatic pain must not increase, especially not in the form of stabbing or burning pain radiating into the leg. If an exercise worsens the symptoms, it must be stopped or adapted. Beneficial, relieving stretching sensations in the muscle are desired, but not an electric sciatic pain.
The exercises are divided into the following areas: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia roller” and “Strengthening”. Ideally, the different areas are used as a complementary exercise routine in order to combine exercises against sciatic pain sensibly.

Correct walking in kybun shoes
The quality of each individual step is crucial for pain in the sciatic nerve in order to reduce incorrect and excessive loading and to distribute the load on the musculoskeletal system more evenly again. kybun shoes support this because the elastic-springy material can reduce load peaks while also activating the muscles.

Active heel strike

• ◉ Press the heel consciously and in a controlled manner deep into the elastic-springy material to feel the cushioning.
• ◉ Guide the foot stably so that it does not tilt strongly inwards or outwards.
• ◉ Place the midfoot and forefoot down in a controlled manner so that the force impact on the back, pelvis and legs becomes more even.
• ◉ Adjust stride length: rather shorter and calmer if the sciatic pain is acute.

Active foot rolling

• ◉ Actively roll over the forefoot and use the maximum comfortable range of motion.
• ◉ Perform the rolling movement consciously and slowly, without jerky acceleration.
• ◉ Make sure you maintain an upright posture with relaxed shoulders so that the movement can flow through the hips and pelvis.

Muscle length training
Muscle length training is often very helpful for sciatic pain because irritation in the buttocks, hips and thighs can be intensified by shortened or tense myofascial structures. The aim is to reduce tension and improve mobility without provoking the nerve.

Hip opener

• ◉ Start position on all fours.
• ◉ Place the left foot forward next to the arms.
• ◉ Stretch the right leg backwards and place the foot flat on the floor. Make sure that the hips and spine are in one line.
• ◉ To intensify the stretch, press the hips forwards and down. Depending on individual mobility.
• ◉ Perform 1–2 times daily.
• ◉ Hold the exercise for 3 x 30 seconds.

Buttocks

• ◉ Start position lying on your back.
• ◉ Stretch both arms out to the sides at a 90-degree angle and place the left leg bent over to the right side.
• ◉ Use the right hand to press the bent knee down.
• ◉ Make sure both shoulder blades remain on the floor.
• ◉ Perform 1–2 times daily.
• ◉ Hold the exercise for 3 x 30 seconds.

Fascia roller
Fascia training can be useful for sciatic pain if shortened or tense structures in the buttocks and thigh intensify the symptoms. Roll slowly and in a controlled manner, applying pressure according to personal tolerance.

Front thigh muscles

• ◉ Start position lying on your stomach.
• ◉ Place the large roller under the thigh of the extended leg. Place the other leg bent down to control movement.
• ◉ Actively roll out the front thigh from the hip to above the knee joint.
• ◉ Perform the exercises slowly and in a controlled manner. Adjust pressure to your personal perception, but go to the tolerable pain threshold.
• ◉ Roll out local adhesions more intensively or hold the position at this point.
• ◉ 3 minutes per side.
• ◉ Perform 1–2 times daily.

Gluteal muscles

• ◉ Bend both legs and use the fascia ball to roll out the corresponding half of the buttock. Increase pressure by placing one leg on top of the other. If pain occurs in the wrist, the exercise can also be performed on the forearms.
• ◉ Perform the exercise slowly and in a controlled manner.
• ◉ Adjust pressure to your personal perception, but go to the tolerable pain threshold. Important: if the pain increases massively at the pressure point, avoid this area or reduce pressure significantly.
• ◉ Roll out local adhesions more intensively or hold the position at this point.
• ◉ 3 minutes per side.
• ◉ Perform 1–2 times daily.

Strengthening

Targeted strength training helps stabilise the trunk, pelvis and buttocks. Better stability reduces load peaks in the lower back and can thus have a favourable long-term effect on pain in the sciatic nerve. Strengthening exercises should be performed in a controlled manner, without breath-holding and without jerky movements.

All fours

• ◉ Start position on all fours.
• ◉ Place your hands shoulder-width apart below the shoulders, the knees hip-width apart below the pelvis.
• ◉ Stretch the right leg backwards and the left arm forwards.
• ◉ Keep the back straight and stable.
• ◉ Then bring the right leg and left arm together and extend them again.
• ◉ 3 sets of 8–12 repetitions.
• ◉ Perform 2–3 times per week.

Bridge

• ◉ Start position: lying on your back with bent legs (hip-width apart). Arms are stretched shoulder-width apart towards the feet.
• ◉ Lift the hips actively off the floor and move them towards the ceiling (the hips should be fully extended at the highest point of the exercise).
• ◉ Hold the position at the highest point for 4 seconds.
• ◉ Make sure the force comes from the buttocks (not from the heels or the back of the thighs).
• ◉ Lower the hips slowly again without the buttocks touching the floor.
• ◉ 3 sets of 8–12 repetitions.
• ◉ Perform 2–3 times per week.