Physical Therapy Stretches

Mechanisms. Targeted movement reduces sensitivity and mechanical loading on the irritated nerve root, eases muscle spasm (e.g., piriformis/hamstrings), improves blood flow, and supports graded return to activity—key elements recommended in major guidelines for sciatica and low-back pain. National recommendations (NICE, ACP) emphasize self-management, staying active, and exercise as first-line care for most people with sciatica. NICE

Guideline backing. The UK NICE guideline for “Low back pain and sciatica in over-16s” recommends advice to remain active and use non-invasive approaches such as exercise; it discourages bed rest. The document consolidates the evidence base and is updated to reflect newer reviews. NICE

Clinical trajectory. Many disc herniations regress with time; movement programs help function during recovery and may reduce pain flares. (North American Spine Society guideline on lumbar disc herniation with radiculopathy.) thespinejournalonline.com

Below are commonly used, low-risk options a physio may prescribe. Start gently; mild stretch is fine, sharp or spreading leg pain is a stop sign.

1) Sciatic nerve “slider” (neural glide) – helps the nerve move without much tension

• Lie on your back. Bring your hip to ~90° with hands behind the thigh. Slowly extend the knee as you flex the ankle (toes up), then bend the knee as you point the ankle (toes down)—a smooth, rocking motion.
• 10 slow reps × 2–3 sets, 1–2× daily if symptoms allow.
• Background on neural mobilization for lumbar radiculopathy and dosing examples: RCTs and meta-analysis below; practical how-tos are often included in NHS/physio handouts. ScienceDirect

2) Piriformis stretch (Figure-4) – helpful if buttock tightness reproduces symptoms

• Lying on your back, cross the symptomatic ankle over the opposite knee (figure-4). Pull the uncrossed thigh toward your chest until you feel a buttock stretch (not sharp leg pain).
• Hold 20–30 s; 3–5 reps, 1–2× daily.
• Video/steps: NHS piriformis/sciatica exercise page; Cleveland Clinic has a practical sequence. nhs.uk

3) Hamstring stretch (gentle) – reduces posterior-chain tension that can aggravate symptoms

• Place the heel on a low stool, knee slightly bent. Hinge forward at the hips until a comfortable stretch behind the thigh. Keep the back long.
• Hold 20–30 s; 3–5 reps, 1–2× daily.
• See NHS and Harvard Health stretch guides. nhs.uk

4) Knee-to-chest (single or double) – mobility for lumbar segments

• On your back, bring one knee toward the chest with hands around the shin. Gentle pull to a stretch in the low back/buttock (not into leg pain).
• Hold 10–20 s; 5–10 reps each side.
• Illustrated patient sheet (Mayo Clinic Health System). Mayo Clinic Health System

5) Repeated extension in lying (“press-ups,” McKenzie-style) – symptom-guided

• Lie prone (on your stomach). Prop on forearms; if tolerated, press up through hands to extend your back while hips stay on the mat. Only proceed if leg pain centralizes (moves out of the leg toward the back) or remains no worse.
• 10 reps, up to 5–6 times/day if helpful.
• Rationale and trial comparisons vs. advice appear in the studies below; many hospital/physio leaflets include step-by-steps. SAGE Journals

6) Gentle lumbar mobility (knee rolls, side bends) – for stiffness

• Supine knee rolls: knees bent, roll both knees side-to-side to a comfortable range.
• 10–15 reps, 1–2× daily.
• NHS community physiotherapy example program. Sussex Community NHS Trust

Practical cadence: 10–15 minutes, 1–2 times daily on days you’re symptomatic; gradually blend in walking and light strengthening as pain allows (bridges, hip abduction), per guideline advice to stay active. NICE

NICE evidence synthesis for sciatica (NG59). Supports advice to keep active and consider exercise-based management in primary care; provides the evidentiary basis and update notes. NICE

ACP Clinical Practice Guideline (2017) for noninvasive treatment of low back pain (covers radicular presentations). Recommends nonpharmacologic therapies (including exercise) as first-line, reserving invasive options for persistent/severe cases. American College of Physicians

Neural mobilization (nerve gliding) for lumbar radiculopathy:

• Meta-analysis of RCTs (2023): neural mobilization reduced pain and disability vs. comparison care in lumbar radiculopathy populations. MDPI
• Individual RCTs show short-term improvements in pain, straight-leg-raise range, and function with slider/tensioner techniques. ScienceDirect

McKenzie-style repeated movements for MRI-confirmed disc herniation sciatica:

• Randomized clinical trial (multicenter): McKenzie program (7 visits + book) vs. guideline-based single-session education; reports on 24-month outcomes (pain/disability, surgery rates). SAGE Journals

Broader low-back pain exercise evidence: Cochrane reviews and major guidelines consistently find exercise helps with pain and function across stages of low-back pain (though effect sizes vary; sciatica-specific data are more limited but supportive for active management). Cochrane

Natural history and conservative care context: NASS guideline on lumbar disc herniation with radiculopathy notes many patients improve over weeks to months as herniations regress—supporting initial conservative pathways that emphasize movement and exercise. thespinejournalonline.com