Sciatica

The Four Letter Word.

Sciatica

Chronic low back pain prevalence increases linearly in the adult population from the age of 30 on. At any given time, 20% of the over 30 crowd has low back pain. Sciatica is one type of low back pain that can be very painful, debilitating and difficult to live with. This is a condition that involves an impingement (compression) of the sciatic nerve due to either a vertebral disc anomaly, a spinal column anomaly, a muscle spasm or a combination of all three. While the causes of sciatic pain can sound scary and daunting, they are generally just a symptom of chronic and bad spinal mechanics. Thus, the underlying cause of sciatic pain is movement dysfunction. Acute injuries like fractures, and chronic degeneration based on predisposition are obvious exceptions to this hypothesis. That withstanding, even injuries or conditions that have persisted too long and require surgery and/or medication, often underscore an a priori movement dysfunction. That being said, after the short-term goal of pain reduction has been set in motion, restoring proper movement spine become the focus of treating sciatica.

The sciatic nerve is the longest nerve in the human body and is formed from 5 individual nerve roots that emerge from the 4th lumbar vertebrae down to the 3rd sacral segment. The nerve roots emerge from the spinal column, combine to form the sciatic nerve and descend through the pelvis emerging posterior to the thigh and traveling all the way to the foot. As the sciatic nerve emerges from the spinal column and course throughout the pelvis and lower body, it can become impinged by a herniated disc and/or the accompanying inflammation. Either of these conditions can cause pain or paresthesias locally at the point of insult or downstream anywhere from the posterior hip, the calf or the foot.

Certain muscles can indirectly cause sciatica as well. The psoas is a powerful hip flexor that originates at your lumbar spine(low back), passes through the pelvis and attaches to your femur (thigh). If the psoas gets too tight, and this happens quite frequently, it can begin to pull on the lumbar spine, altering spinal mechanics and ultimately irritating one of the nerve roots that feed into the sciatic nerve. Another muscle that can cause sciatic pain is the pirifomis. The piriformis is a deep hip stabilizer, whose path intersects with the sciatic nerve. In fact, a significant portion of the population has their piriformis bisected by the sciatic nerve. The piriformis, when tight and irritable, can impinge the sciatic nerve at the hip.

The literature says that most back pain SYMPTOMS begin to move in a positive direction, with decreased pain and disability within a month. For 3 months after that acute pain, chronic pain generally persists, but becomes less frequent and intense. Then sometime around the 1 year mark, give or take a few months, patients report their back is all better. Unfortunately most people will have a reoccurrence within one year. Either chronic back pain is an immutable characteristic of being human or we are just treating the symptoms not the underlying problem of movement dysfunction. In fact, restoring proper spinal mechanics is both a treatment and a prevention of future occurrence of back pain. The following exercises are your starting point when experiencing sciatic pain.

Down Regulation

Try this exercise if you are in acute 10/10 pain. This position and the associated breathwork will calm your nervous system and help to relax your back musculature. Begin on your back, with your calves resting on something like a couch or a bench, knees bent to 90 degrees or so. Gently push into the surface of the couch with your calves such that you are able to flatten your low back against the ground. Hold this position throughout. Now take a slow nasal inhale for 6 seconds, then a slow nasal exhale for 6 seconds. Perform this exercise for at least 5 minutes or up to 20 minutes. If your hamstrings get tired, either rest a bit and return to the exercise or lessen the amount of downward force you are applying.

These next two exercises are stretches that address the most common points of muscular impingement of the sciatic nerve.

Couch Stretch

Begin on your right knee with your right foot propped up on your couch and your left foot on the ground in front of you. Now engage your abdominals and tuck your pelvis underneath you. Hold this position for 1 minute. Then drop both hand down onto the ground, inside of your left foot, and drop your pelvis towards the ground. Hold this position for another minute. Then switch leg position and repeat.

Seated Pigeon

Sit on couch or bench such that both knees are bent to 90 degrees. Cross the right leg over the left , resting your right ankle on the left knee. If you feel a stretch in the outer part of the right hip, hold this position for 1-3 minutes. You don’t feel the stretch yet, lean forward until you do and then hold for 1-3 minutes.

These next two exercises are movements that improve and restore spinal mechanics. Generally speaking your back will prefer one of these positions over the other. When you are in a lot of pain, listen to your body and avoid the motion that produces pain. As you improve though, gradually incorporate the non-preferred movement.

Sphynx Pose

Lay on you stomach and gently prop yourself up by placing your elbows directly under your shoulders. Push you shoulder down and slightly back away from your ears. Now begin to gently inhale (6 seconds) and exhale (6 seconds) through your nose, allowing you stomach to sink into the floor. Slowly allow your upper and low back to arch into extension. Hold the position for at least a minute. If you low back starts to get sore in this position slowly back out of it and try again.

Jefferson Curl

Stand with your feet, hip width apart. Begin by nodding your chin down to your chest. Continue bending forward one vertebrae at a time, allowing your arms to hang freely forward. Continue bending forward until you have reached down as far as you can comfortably go. Then reverse your motion and slowly stand up, stacking one vertebrae at a time until your are standing up straight.