Revolution Athletics

My wife has sciatic nerve pain (sciatica). If you know anything about relationships you know that when she has pain, I have pain. Therefore when she first starting having pain I was quick to offer advice on how to treat this painful condition and return her to an active state. As I have also had sciatica from time to time (from an old sprinting injury while training a group of hockey players), and some of my clients have mentioned this as well I decided to write about the various ways to treat and recover from sciatica.

The cause of sciatica occurs when a nerve root in the lower spine (that forms the sciatic nerve bundle) is pinched or irritated. The most likely culprits are a herniated disk (where the fluid sack between the vertebrae bones leaks or bulges into other areas), muscle imbalances (which may cause over-use injuries of one particular area), or inflammation of a specific area that pinches the nerve. The result is an irritating and often severe pain (that usually only affects one side of the body). Depending on where the pain originates it will often radiate (or shoot) down the back side of the leg (generally the left leg), and can travel down to the foot or toes. Usually most patients complain of a dull ache in the buttocks/low back area, and in some people it can lead to muscle weakness in the lower legs. Sciatica occurs most frequently with people between 30 and 50 years of age, and although the patient may think that one event caused the pain it is usually an accumulation of wear and tear on the low back and upper glutes (butt) over time. If you have any of the following symptoms you may in fact have a form of sciatic nerve pain:

· A dull ache or pain in the butt that gets worse when you sit.

· Burning or tingling down the back of the leg

· Weakness or numbness in the leg that the pain originates

· Any type of shooting pain that seems to travel down the leg

· Low back pain (that is generally not as severe as the dull ache in your butt)

Now before panic sets in realize that sciatica is actually very common among first world nations. Our in-active lifestyles and failure to keep the muscles of the low back, glutes, hamstrings and core area strong and flexible is the primary reason that people have sciatic nerve pain at all. I doubt that our ancestors who were much more active and not chained to a desk every day ever had to worry about sciatica.

The Fix

The good news is that most sciatic nerve pain tends to get better with time (a couple of weeks to several months). The problem is the most people tend to think that when they are hurt complete rest is the best treatment so they stay home and sit on the couch (as part of the treatment). Wrong! The muscles of the low back and butt need to get an increased blood flow to the area and that simply won’t happen if you’re watching Gilmore Girls or football. Here are some treatment options you can implement right away to help fix your sciatica:

1. Part of the solution is to start walking (not running, cycling, swimming or walking hills), but just plain old walking. With walking you lightly stretch the hamstrings, glutes and low back through your natural stride. Running and hill walking will stretch the area too far, cycling tightens up the hamstrings, swimming is non-weight bearing and virtually useless in this treatment. Try to get in 20 to 30 minutes twice a day (especially if you have a desk job). You might want to include some stairs in your walk (if your low back and sciatica allows) to help strengthen the lower body.

2. After all activity, when you first get up in the morning, before bed and throughout the work day it is critical that everyone (sciatic pain or not) stretch. My dogs stretch whenever they get up or move around and I doubt they ever get sciatic nerve pain. The body is designed to move, bend, and stretch. As we “evolve” our lives we often forget this concept, and the body ends up paying the price for our evolution.

Now stretching shouldn’t be a painful exercise, rather we should stretch to feel good. Hold every stretch for 15 to 25 seconds and experiment to see what makes your body feel the best as it won’t be the same for everyone. Make sure to stretch the hamstrings, low back, quads, glutes, adductors (inner thigh) and abductors (outer thigh). If you don’t know how then seek out a qualified professional who can show you how.

3. Start light strength training. Movements for the hips such as RDL’s or hamstring deads (see picture below and note you don't have to use a weight to do this exercise) will go a long way to reducing inflammation and improving low back functioning. I have clients who swear by these two movements as the reason they no longer have back pain. Aside from these exercises you should be doing some kind of squat, lunge, and back extension to stretch and strengthen this area. Once again, if you don’t know how to perform an exercise then find an expert who can show you how.

4. The next task is to reduce the inflammation with a foam roll (see picture below). The foam roll is one of the best tools in the physical therapy side of training in the last 10 years as it helps to “roll out” muscle damage and soreness (much like a rolling pin flattens out cookie dough). I have clients use this type of treatment every session and often make them buy a roll just so they can use it at home or the office. You can buy these on my website, but if you can buy them elsewhere then help yourself. Have a fitness professional show you the correct way to use the foam roll as a means of injury rehabilitation. Once you are healed make sure to keep using the foam roll to prevent further injuries.

5. One of the most important activities you can do to help reduce inflammation and swelling of the area that is pinching your sciatic nerve is to use an ice pack exactly where the pain is (5 to 20 minutes of icing is plenty). I cannot stress this enough, and every client I have will attest to this…use ice as often as you can to reduce the swelling and inflammation from an injury! You will not hurt yourself by using ice and every application will help to make you feel better. If you say that you do not have time to ice then stop reading this article and sit on the couch watching ER (as my message is not getting through). You have to bring down the inflammation that is impinging the nerve and bring increased blood flow to this area…ice does that.

In addition to ice some people find that adding a heating pack after the ice is very beneficial to improving blood flow to the injury. Use for 5 to 15 minutes after icing and see what this does for you.

6. The last thing you can do on your own is use drugs. Ibuprofen (Motrin or Asprin) 3 to 4 times a day will help with the pain and inflammation (but it won’t solve the problem or reduce all of the pain). Additional drug options such as naproxen or COX-2 inhibitors (which also help to reduce inflammation) may also be helpful. In some cases you might ask your pharmacist about oral steroids that can help reduce inflammation (providing they are over the counter type of drugs). Keep this up in addition to icing, stretching, and activity until the pain is gone.

Seeking Help

Assuming you still have sciatic nerve pain and you have at least given all of the above treatments enough time to work (2 to 3 weeks at least), you may want to consult with your doctor. Usually they won’t be of much help but they will be able to refer you to a good chiropractor, physical therapist or other health care professional who can offer some valuable treatments.

1. Once you get into physical therapy and they finally agree that the sciatic nerve is being impinged then they start with the standard treatments. Good physical therapists employ various forms of massage to the area in order to get the muscle or damaged tissue to relax (which may stop the pinching off of the nerve). In addition to this you should ask for EMS (Electric Muscle Stimulation) on the area as this shoots an electrical pulse into the muscle many times a second which stimulates activity. When the EMS is removed the muscle or tissue is able to relax more deeply which may take the pressure off the sciatic nerve. Sometimes a physical therapist may use ultrasound to help break up the scar tissue in the injuries area (assuming that is the problem), or use a form of laser to stimulate increased blood flow. Make sure with every visit to the physical therapist you ask for all of these forms of therapy (especially the massage and EMS) as they can be very helpful.

2. Another form of treatment that some people may find useful is chiropractic work. Perhaps your problem is a misalignment of the spinal column and you need to get that back into the right path before the sciatic nerve pain is reduced. When I had my sciatic nerve pain the only thing that worked was going to the chiropractor who not only took an Xray of my back but adjusted my low back which fixed problems I have had for many years. Now this treatment will not work for everyone (as misalignment may not be your issue), but you might want to give them a try.

3. In certain cases the use of acupuncture is well tolerated by the patient. Thin needles are inserted through the skin into the points of pain where they are left for 5 to 20 minutes. The practice helps restore energy flow in the body and reduces inflammation. The use of acupuncture has been approved by the FDA (in the USA) and many insurance carriers recognize this treatment as an effective tool in relieving sciatic nerve pain. Seek out a qualified acupuncturist in your area by calling around and asking questions about their qualifications and experience.

4. Sometimes all the therapy that is stated above is slow to work (in severe cases of sciatica). At this point you may consult your doctor about having an epidural injection of steroids directly into the painful area. This treatment tends to be a temporary fix as it helps to relieve pain and inflammation for a short period of time, but it may allow you enough time to work on other forms of treatment (including strengthening and stretching of the area) so the pain does not return.

5. As a last resort it may be necessary to consider sciatica surgery (although this should be the last option). If all of the other forms of therapy simply have not worked for your sciatica and the pain is severe then surgery to remove a portion of the disc or damaged tissue that is irritating the nerve root is a viable option. The downside to surgery (other than expense, some risk, and inconvenience) is that all surgery causes scar tissue in the same area that you are trying to remove inflammation. Scar tissue is a buildup of damaged tissue that should be removed (by manipulation, ultrasound or laser therapy) in order for the problem to be solved. Sometimes surgery may fix the problem but sciatica returns without proper rehabilitation back to full activity from the surgery. Consult your surgeon for more information and ask what they plan to do in post-op to reduce scar tissue and return you to a normal state.

Conclusion

As sciatic nerve pain is a debilitating and painful injury we often don’t want to deal with the pain in attempts that rest will improve our condition. With sciatica you need to be pro-active in your treatment approach as your condition can progress to a very painful injury quite quickly. You may also note that in your treatment you have good days and bad days as sciatica is prone to flare-ups and set backs. Keep on track and make sure you tackle sciatica before it gets any worse. As a final recommendation you may want to evaluate your current lifestyle of physical activity, work environment and daily habits to see how these may impact future issues with sciatica. Good luck in your treatment!

"Fortitudine Vincimus"
(by endurance we conquer)