Sciatica

Sciatica has become a general term for pain in the back of the leg (thigh or calf) that originates in the spine. The source of your pain may be from a disc, nerve, or one of the joints in the lower lumbar spine. You may not even feel any pain in the back. Symptoms are generally worse when you are sitting or standing still for a long time and often improves with walking. Pain varies from a dull ache to sharp, fiery pain and may change locations. You often feel like you can’t really touch the location of the pain. If there is numbness in your foot or leg it is even more likely that your symptoms stem from the back.

Most often, sciatica is the result of accumulated stress and strain to the back and hence, to recover you need to take a good look at how you treat your back. If you get leg pain after sitting for a long time, then limit sitting time and consider getting a better chair or support. If your leg pain is worse when you bend forward then limit the bend and instead squat or kneel to pick up your shoes. Did your symptoms get worse after lifting a fifty-pound bag of dog food? Then try better mechanics or get some assistance (or smaller bags).

When you are seeking help for back pain it can be confusing to know what will work best for you. This is partly due to the complexity of the back and our individual variations. There is some recent research that may help to direct your efforts. The program is based on the idea that there are basically four non-surgical types of treatment for lower back pain and sciatica. You simply choose the category that comes closest to matching your situation. You may find that you fit into more than one category or that over time your situation changes and you need to shift categories.

Specific Movement Category: Certain movements can have a beneficial effect on your symptoms. If you find that lying on your stomach and propping up on your elbows decreases the pain in your leg or the pain moves more centrally towards your back then perform several repetition of this movement. If your pain decreases or moves more centrally towards the back when you lie on your back and pull your knees towards your chest, then perform several repetitions.

• The specific movement technique is best described in Treat Your Own Back by Robin McKenzie; it is available at most bookstores and well worth the money.

Manipulation Category: Manipulation is more commonly described as getting your back adjusted or popped. If your symptoms are less than sixteen days in duration and your pain does not descend below your knee, then it is more likely that you will benefit from manipulation.

• Manipulation has probably been a method of treating backs since we began walking. Physicians (usually D.O.’s), physical therapists, chiropractors, spouses, hairdressers, and teammates have all joined in on the action, with varying degrees of success. There are several manipulation techniques and theories about them. What is known about this treatment is that a reflex muscle relaxation occurs following it. You will generally feel less tense and be able to move more freely because of the relaxation. The current research also indicates that there is no change in the position (alignment) of the spine after treatment. The perceived “misalignment” is perhaps a result of muscle tension. I suggest that you get a good reference before seeking treatment.

Stabilization Category: Stabilization has become a buzzword in the exercise world. Basically, it is an approach to exercise that focuses on developing trunk strength to help support or “stabilize” the spine. If you have had three or more prior episodes, or are generally very flexible then trunk strengthening / conditioning (stabilization) should be more beneficial for you.

Treatment:

• Abdominal strength / endurance. My grandma use to say “there’s more than one way to skin a cat”. When it comes to abdominal exercises there are so many approaches that choosing the right one for you is confusing. The approach I prefer is to teach people how to contract the transverse abdominus, which is the abdominal muscle that is reported to be most effective in providing stability to the spine, and then use this type of contraction while performing whatever abdominal exercise you prefer. So the best abdominal exercise is the one that is challenging, doesn’t hurt and you emphasize contracting the transverse abdominus. An excellent routine is presented in The Injured Runner A Balanced Solution. To help you learn how to contract the transverse abdominus try the following exercise. Position yourself on your hands and knees - keep your back in a relatively straight, relaxed posture. Next, let your abdomen relax and hang down somewhat. Now, take a deeper breath in through the nose, allowing your abdomen to further expand; as you slowly and gently breathe outward through the mouth purposefully draw your stomach inward. For some of you this will feel like just the opposite of what seems natural. Practice drawing the abdomen in while breathing outward and you will learn how to use the transverse abdominus and not substitute with other muscles. This is not a vigorous exercise, but you can use it to learn how to contract this specific muscle. You should feel some tightening around your lower ribs as well as the sides of your abdomen; you may even sense some tension in your lower back.
• Lower back strengthen / endurance. There has only been one study, that I am aware of, that has shown that a particular exercise will increase the size / strength of your lower back muscles. These exercises were performed on an exercise ball with the position held for five seconds and repeated to fatigue (see Superman and Double Leg Lift). If the position was not held for five seconds there was no change in the size of the muscle, so make sure you hold at least five seconds. You can also perform this exercise on a roman chair, which is my preference if you are looking for a vigorous workout. For added benefit try performing a transverse abdominus contraction while doing these exercises.

To test your endurance you can perform the Sorenson test. Research has shown that the average time that a person without back pain can hold this position is two minutes and thirty seconds if you are a male and three minutes if you are a female. Most runners I test seem to be able to do about a minute longer than the average.

Traction Category: Traction is a technique that may take pressure off your painful area. It is similar to pulling on your finger to relieve a sore knuckle. To see if this approach is beneficial for you, you will need a friend to assist. Lie on a firm surface and have your friend grasp your lower leg and raise it about thirty degrees directly upward then gently pull as if to lengthen the leg. If you notice a distinct relief of symptoms then this is the category for you.

Treatment:

• Have a friend pull the leg as described above. Hold the pull for fifteen seconds and release for five seconds. Repeat this cycle ten times, once or twice per day.
• A physical therapist or chiropractor can perform the traction for you. Some have tables or machines that do the work, or portable units that can be rented for home use. In my experience, manual traction is more relieving than the machine but difficult for the one pulling.
• An inversion table (see inversionusa.com) allows you to traction your self with the help of gravity. Clip into the ankle supports and spin yourself upside down (or however inverted you want to be). There are some precautions with this approach. Be sure you read about the precautions before purchasing, if in doubt talk to your doctor.