Sciatica will never completely go away unless you take care of two important foundational issues
that set up the root problem of sciatica. In this video, I'm going to go into a deep dive in how
these problems set up sciatica and how you can begin to fix them so that you can get long term
relief of sciatica, the two problems are glute activation, and lower abdominal muscle activation.
Now, I did not say strength on purpose, I said the word activation because many people actually have
decent glute strength and abdominal strength, but they're not activating the muscles properly at the
right times to get the stability and support they need for their low back and the pelvis
to take pressure off the sciatic nerve. And let me just explain to you a little
bit about the anatomy of these muscles where they attach so that you can see how
it influences the sciatic nerve, the glutes attached on the rim of this bone right here,
and it goes over onto the tailbone here. This is the sacrum and this is the ilium bone. S
o they attach all around this edge right here, the muscle comes down and attaches
to this part of the thigh bone. And part of the glutes role is to offer stability to the joint
between this bone right here the pelvis bone called the ilium and the sacrum, the tailbone.
So there's a joint right here you can see it better on the front looks like a crack, but it's
actually a joint that has a little bit of motion. And when that joint gets locked up, it can move
this pelvis bone or the tailbone out of its best position and begin to compress the sciatic nerve.
Now the sciatic nerve runs through right here, my fingers coming out,
there's this notch in the bone, it's actually called the greater sciatic notch. And what
isn't here on the skeleton is a big ligament that comes over right here and it closes the
notch to make a circle for that nerve to come out. So if the glute muscles are not doing their job,
because they're not activating properly, and it could be that they're not strong enough to that
happens frequently. But activation is even more foundational to getting strength. If the glutes
aren't doing their job, then this bone right here and even the tailbone can shift out of position.
And when it's just out of position at that nerves right here,
it can begin to pinch the nerve because of the bony knots around it, or the ligament
on this side of it. The ligaments are pretty hard structure has some flexibility and it's
not as hard as the bone, but it's also not soft. So it can compress the nerve and cause that deep
glute pain that even runs down the leg, usually the backside of the leg but it can go all the
way down to the calf, the heel, the foot, it can go to the toes and cause pain, of course numbness
tingling, a common symptom that's less talked about, it's cramping anywhere down the lead,
usually the hamstrings, a calf muscle, even the foot muscle, especially in the arch of the foot.
That's where people get cramping. That's caused by the sciatic nerve being pinched way up here.
Now I'm going to tell you how to activate the glutes. But before I do that, let me just explain
the abdominals and why they're important so that you can have an understanding of that.
So on the front side here, the abdominals fill this entire space, they attach to the ribs right
here, the bottom edges, they come in and attach to the floating ribs, 11 and 12. And then they have
tendons that go directly to the spine. And all along the rim of that same pelvis bone where the
glutes attach on the backside and the abdominals come down and attach on the bottom right here of
the abdominal area right above the pubic bone. And the same attachments are on the other side as
well, when the lower abdominals are not activating properly, so if you think of the lower abdominals,
the belly button is about right here, in the middle of both ends of the muscle,
the lower abdominals are below the belly button. So between the belly button in the pubic area down
here, those lower abdominal muscles send their muscle attachments to the pelvis bones on the
rim of the bone here and directly into the lowest part of the low back where the nerves
exit that eventually form the sciatic nerve. So those lower abdominals aren't doing their job,
they're not activating properly, then you're going to have less stability for these pelvis bones
and the lower back bones, the vertebrae of the lower back the lumbar vertebrae.
If these bones aren't stable, and moving properly with your normal everyday movements,
because lower abdominals aren't activating or they're weak, then you have a greater chance that
this bone can shift and cause that pinched sciatic nerve that I mentioned, or even pinched the nerve
in the lowest part of the low back right here. This is why these two muscle groups, the lower
abdominals and the glutes are so important. Now you might be asking what about the upper
abdominals or I've worked out my abs. But I feel it in the upper part isn't that helpful? Well,
the muscle fibers from the upper abdominals, they attached to the ribs, of course and
attached to the upper part of the low back. So it doesn't stabilize the lowest part of
the low back where the nerves exit that eventually come together to form the
sciatic nerve here that runs down the leg, all the way to the foot, the heel, the toes,
in our sciatica patients that we see here in the office, I consistently see poor activation of the
glutes and the lower abdominals. And that's one of the first thing that we're working on.
Because eventually, we need to get to strengthening those muscles because
they're typically weak too. But we can't jump directly into strengthening, I can't just give
people glute exercises and expect them to get stronger glutes can't give them ab exercises
and expect them to get stronger lower abs. Well, we always have to do first and this
is what I need you to learn from this video is how to even just activate the muscle. So let's
start with properly active in your glutes. And if you think that you have good glute activation,
run through this, and you'll be able to decide for yourself if your glutes are activating properly.
Now you need to be able to isolate out contractions in these muscles. So right now
sit down if you're not already sitting down like I am right here. And what you need to do is think
about clenching the glute muscles. So think about squeezing or tightening, or flexing those glute
muscles, and only the glute muscles, see if you can do it without your thigh muscles. Also kicking
in, try it out, hold it for five or 10 seconds. And I'm willing to bet money that if you've got
a sciatica problem, your thigh muscles probably kicked into. That's proof right there that you're
not activating your glute muscles properly. It should not make everything in your thighs also
tighten up and flex, you should ideally be able to tighten up your glutes with
minimal to nothing happening in your thighs. If you can't do that, then here's what's going
to happen. If you go to any exercise, whether it's something you learned off YouTube here,
or you're given an exercise by a therapist or a doctor or a friend or whoever.
If you're not properly isolating your glute muscles when an intended glute exercise is given,
then you're not going to work them out, you're going to work
out the other muscles that primarily activate. So oftentimes, people will do a bridge exercise,
I recommend bridges often but I don't just jump into the bridges without first making sure that
the patient can truly activate their glutes and they're conscious of it, they can feel it.
Only after they can do that successfully can we begin to go into glute exercises and have
confidence that they're going to work out their glutes and not their thighs, not their quads,
or their hamstrings because if you start to work out your quads and hamstrings, what's interesting
about that is the hamstrings attach to the butt bone right here like your sit bone where you're
when you sit down the bone that makes direct contact with the C hamstrings attach right there.
And if those muscles are pulling a lot, they can pull this bone out of position and feed into the
sciatica problem. And then the quad muscles, most of them attached to the thigh bone right here on
the back. But one of them in particular called the rectus femoris muscle attaches right here to
the front most part of the ilium bone and if that muscle is pulling right there, it can also pull
this bone in a way that makes the joint gets stuck and aggravates by pinching the sciatic nerve here.
So you don't want a ton of muscle activity in your thighs when you're trying to get your
glutes active glutes are in the best position because they go right over that joint to give
this joint stability and prevent a sciatica problem from recurring over and over again.
So now back to tightening up your glutes. If you need to get better at tightening
up your glutes, here's what you need to do. Focus really hard on flexing your glutes in
a seated position you might need to close your eyes just to focus in, open up your knees. So
that you can put your glutes in a better position to fire and then lightly engage
your glutes because if you try to go 100% Everything's going to go find the percentage
that works best for you try just 10% 20% See if you can climb up by 10s or even fives,
whatever's best for you. And just hold it there for a good 10 seconds. The 10 second
hold is important because neurologically the way the nerves connect to the muscles.
You're getting more of those dormant less active muscle cells in your glutes to wake up and
give you a better contraction every time you do this, which you might need to do
if you have very poor glute activation is tighten up your glutes like this for 10
seconds and do anywhere from 10 to 20 reps. Our leave for the next week or two or three,
or as long as it takes for you to confidently say, I can flex my glutes without my thigh muscles,
just taking over everything. And now just to give you clarity, it doesn't
need to be the extreme of where there's absolutely nothing working in your thighs.
It's okay if your thighs work. So, but it needs to be a significant majority of a glute
contraction whenever you intend to contract your glutes. If you're trying to contract your glutes
and your thighs are doing about 50% of the work, that's too much, you need to get it to about 70,
80 or beyond, more glutes need to activate that. You can do this in different positions, you can
lie down on your back and just squeeze your glutes from right here, just tensioning up your glutes
will help and you can hold your glutes contracted for 10 seconds, you can repeat this, you can do
this in bed, you can do this in the morning, in the evening, anytime you want during the day.
Of course, we talked about seated. But you can also do this in standing,
which is really nice. And it might be a bit of a progression for you to do it in standing. So just
make sure that you can do it. Otherwise, you're going to be activating your thighs and training
your muscles and appropriately. But when you stand up,
just think just think about clenching from back here at the right percentage so that your thigh
muscles aren't also engaging and still do the 10. Second holds 10 reps is what I
usually recommend, because it's easy to remember. But really, you want to get to where the muscles
get a little bit fatigued, where your glutes get slightly tired. And if you could repeat that,
that means that you activated the muscle cells enough to push them to make them wake up and work.
Now it's a similar concept with the abdominals except I like to start people lying down on their
back with their knees bent with the abdominals. So let me show you what that looks like.
Just like this. And you if you think about tightening up your abs, immediately, you're
going to think to tighten up the upper abs above the belly button, my belly buttons right here. So
if I want to target lower abs, what you actually need to do is flatten out your lower back,
that's a cue I give all my patients, it's not flex your abs, it's flattened out your lower back.
So what that looks like is that right there, because a posterior pelvic tilt in the physical
therapy world, what I'll have patients do all the time, you might try this, put your hand under your
low back, like right above your belt, line your waistline, and push your back down against your
hand like you're smashing it and hold it there. And you'll notice as you hold 5-10,
maybe more seconds, your lower abs start to work. Now the goal is to get those lower abs
to work slightly more than the upper abs, it's not going to be as dramatic as like with the
glutes and the thighs like I do want you to get to 70 80% plus glute activation force versus thigh
force. But with the lower abs, if you can get to at least 50 60%. Using your lower abs, that's
pretty good, your upper abs will still work. But if you can at least get your lower abs to
activate, and then get up to 50%. That's pretty darn good. But what tends to happen with most
people is they'll try to get the lower abs to work and upper abs or just dominating and lower abs or
doing nothing. If that's the case for you, then you probably need to be on your back right here.
Just trying to connect your brain and what you're feeling to the right muscle
contraction. And I literally will spend a week or two with a patient just trying to get them
to do this motion, focusing use the right muscles, get them tired, get them to burn.
Doing this on an hourly basis, well tell them to 10 second holds 10 reps every hour while
they're awake. And they're just practicing over and over and over again. And what I
want to tell you that I tell my patients is if you don't master this, if you don't get your
glutes to work, if you don't get your abdominals to work, then you're not going to resolve your
sciatica problem for the long term. Because these are at the very root of the problem.
You can do all the glute exercises you want and you can do all the ab exercises you want. But if
you're not actually activating the glute muscles right away and you're dominating with your thigh
muscles, or you're dominating with your upper abs, when you're trying to get your lower abs to work,
then you're feeding the problem, you're actually going to make it worse over time.
Now for the lower abs. You can also fire them and seated you can just think about driving
you have to do is that similar posterior pelvic tilt to like you're flattening out
your back. And when people do it and seated and standing, they start to do a little bit worried
because they feel like they're slouching. And you technically are but it's okay,
because you're actually gaining more stability for your lower back. And oftentimes people get
relief from doing this, even though they're slouching into a bad position. Who cares? If
you're feeling better from it? It doesn't matter. or go against traditional medicine to traditional
conventional thinking. You're not slouching all out where you're coming over and putting
a big giant, bad stress to your back. In fact, you're taking pressure off
your lower back by subtly slouching, watch my chest and my shoulders here.
When I suck in my lower abs, I just suddenly come down right here. And it feels good. It
actually feels nice, my back, my lower abs are working right here. Nobody needs to know that
I'm doing it, it doesn't look like a terrible slouch. It's just a very mild, subtle slouch,
you might feel like it's a big start, especially if you're used to try to keep your posture up.
But that might be why you have your sciatica problem, because when you do that,
you kind of turn off your abs, they have to stretch out and not activate. But you need
more stability from your lower abs in order to get this sciatica problem result. And then you can do
this in standing too. And it's a similar thing. When you stand up and you suck in those abs,
you're going to slouch just solely from the top. So right there I did. It's just a subtle slouch.
But it's not an all out terrible posture, slouch. It's just an AB activation. But
because your abs pull this way, it pulls the bottom of the ribcage suddenly down,
which pulls everything else down and makes you feel like you're doing a little baby slouch,
but it's okay, it's good for your low back. Now long term, this needs to transfer into
your everyday activities. You need to be able to on command, use your glutes and
your lower abdominals, activate them while you're walking while you're exercising. If
there's an exercise out there, that's supposed to be using your glutes, you need to make sure
you use them and you should get feedback from the muscles from your abdominals too.
By getting tired there. If you got tired in that muscle, you used it. If you went
for a walk and you felt your thighs, get tired, your quads right here on the front or maybe your
hamstrings or maybe even your calf muscles right here, then that's what you use more.
And if you didn't feel anything happening in your glutes, your lower abdominals,
you missed the boat and you did not get those muscles stronger. In fact,
you got more strength in the muscles that are going to pull the joints into a bad position and
possibly compress your sciatic nerves even more. Now we've got a lot of videos to help you with
sciatica problems, get a lot of other exercises that you can do things that you shouldn't do.
We've got a playlist here, it's linked in the description below. If you want to learn
more about that, go check out that playlist and start watching our help for sciatica problems.
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