Sciatica. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com

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1 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com Sciatica Nagging, burning pain radiating down the back of the leg, or dull throbbing pain in the buttocks on one side can all be signs of a very frustrating condition referred to as Sciatica, or Sciatic Nerve Pain. If you have ever suffered pain from the sciatic nerve you know all too well how aggravating this pain can be. Even more, you know how difficult it is to get rid of this pain. If you are reading this article you have probably experienced, know someone who has experienced, or want to avoid the experience of this particular pain. With the proper treatment this pain does not have to linger. It can be prevented or taken care of with some simple steps. What is Sciatica? Sciatica is a name given to pain caused by pressure placed on the sciatic nerve. When a nerve is placed under pressure it sends out pain signals. It may radiate down the length of the nerve or be focused in a specific area. The muscles innervated by the nerve may or may not be directly affected.

2 Anatomy of Sciatica The sciatic nerve runs from the lower back, down through the hips and buttocks, and along the back of the leg into the foot. It actually originates from the L4 through S3 spinal nerves. It innervates the deep muscles of the buttocks and hips. It also serves the muscles of the hamstring group, the lower leg, and some of the muscles of the foot. It runs directly under (or in some cases around or through) the piriformis muscle, but it does not innervate this muscle. Any of the muscles that are directly supplied by this nerve can become affected. Both the Sciatic nerve and the Piriformis muscle can be seen in the diagram to the right: The sciatic nerve is the yellow nerve running vertically down the middle of the leg; while the piriformis muscle is the horizontal muscle at the top of the sciatic nerve. What Causes Sciatica? Sciatica has several possible causes. Any condition that puts pressure on the sciatic nerve can result in pain in the lower back, buttocks and back of the leg. The pressure may come from vertebral discs, bones or muscles. The causes of sciatica may be acute or chronic. A traumatic event may result in injury to the lower back or hip area causing pressure on the sciatic nerve through misplaced bones, spasm of a muscle or inflammation from the injury. Chronic causes of sciatica may be due to muscle imbalances, misaligned bones, or narrowing space in the vertebrae. There are four conditions that most commonly cause sciatica. Piriformis syndrome is one common cause and is the result of the piriformis muscle putting pressure on the nerve. This may be caused by misalignment of the pelvis and/or hip joint, which changes the position of the piriformis, placing pressure on the sciatic nerve. This misalignment is often caused by muscle imbalances. Herniated discs in the spinal column can also put pressure on the nerve. A herniation, or protrusion, of the disc can result from a traumatic event or from years of pressure from muscle imbalances.

3 A third possibility is spinal stenosis, or a decrease in the space between the vertebrae. This reduced space compacts the nerve where it leaves the spinal column. The narrowing is often caused by compression on the spine due to muscle imbalances. The fourth cause is Isthmic Spondylolisthesis, which is a condition where the vertebrae slips or moves out of position, pinching or placing pressure on the sciatic nerve. This may be caused by a traumatic event or a chronic muscle imbalance. Muscle imbalances are a common thread through the four possible causes listed above. This makes treatment and correction of the muscle imbalances paramount in the recovery and prevention of sciatica. What are the Signs and Symptoms of Sciatica? Sciatica is classified as pain in the sciatic nerve. This pain may be sharp, dull or burning. It may be focused in one area or it may radiate the entire length of the nerve. It is often felt in the lower back and buttocks region, and often spreads down the back of the leg. The pain is usually only felt on one side. Coughing, sneezing, squatting or extended periods of sitting can cause an increase in pain. The muscles that are innervated by the sciatic nerve may also spasm or cramp, causing additional pain. The pain in the lower back and hamstrings can also lead to inflexibility in the back and hips. Pain and stiffness in the opposite side may also result over time. Common signs and symptoms of sciatica include: Pain - This pain can vary from dull, aching pain, to sharp, burning pain anywhere along the nerve pathway. Numbness - This can also occur anywhere along the nerve pathway. Pain may be experienced in one area with numbness below it. Weakness - The muscles innervated by the sciatic nerve may become weak due to a decreased ability to send signals along the pathway. Tingling or "Pins and Needles" - This may be felt in the lower legs and feet. Cramping or Spasm - The muscles of the hamstrings or calves may spasm or cramp as a result of incomplete signals being sent through the nerve pathway. Exercise Provides Sciatica Pain Relief While it may seem counterintuitive, exercise is usually better for relieving sciatic pain than bed rest. Patients may rest for a day or two after their sciatic pain flares up, but after that time period, inactivity will usually make the pain worse. Without exercise and

4 movement, the back muscles and spinal structures become deconditioned and less able to support the back. The deconditioning and weakening can lead to back injury and strain, which causes additional pain. In addition, active exercise is also important for the health of the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy and prevent pressure on the sciatic nerve. Typical features of any sciatica exercise program include: Core muscle strength. Many sciatica exercises focus on strengthening the abdominal and back muscles in order to provide more support for the back. Stretching exercises for sciatica target muscles that cause pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and are less likely to experience future episodes of pain. Specific diagnosis. Most exercise programs will be tailored to address the underlying cause of the patient s sciatic pain, such as a lumbar herniated disc or spinal stenosis. Doing the wrong type of exercise can worsen the sciatic pain, so it is important to get an accurate diagnosis from an osteopath prior to starting a program of sciatica exercises. Hamstring stretching. Regardless of the diagnosis, most types of sciatica will benefit from a regular routine of hamstring stretching. The hamstrings are muscles located in the back of the thigh. Overly tight hamstrings increase the stress on the low back and often aggravate or even cause some of the conditions that result in sciatica. Exercise correctly. As an adjunct to the above point, doing the right exercises but doing them without proper form can make the exercises relatively ineffective, and possibly may lead to continued or increased pain. It is generally advisable to learn the exercises under the guidance of an appropriately trained health practitioner, such as a physical therapist, chiropractor or physiatrist. Aerobic exercises. In addition to specific sciatica exercises, aerobic conditioning may also be encouraged for general body fitness. Walking is an excellent form of exercise for the low back because it is relatively low impact but can provide all the benefits of an aerobic workout. If possible, it is best to gradually progress to doing up to three miles of exercise walking at a brisk pace each day. Caring for sciatica should be considered part of one's daily living, not just something to add to the routine at the end of the day. In addition to an exercise routine, patients with sciatica should minimize everyday stress on the lower back, including using appropriate

5 ergonomics while lifting, maintaining good posture, making sure the lower back is supported while sitting, and avoiding sitting or standing for long periods of time. Before beginning any exercise program, patients should see an osteopath to get a correct diagnosis for their pain and to rule out any more serious problems. The proper exercises differ based on the condition that is causing the sciatic pain, so patients should not try to self-treat their sciatica before consulting an osteopath. Advanced Sciatica Exercises for Abdominal Muscles and Back Muscles As the patient s pain works out of the lower extremity (leg) and centralizes in the low back, the exercises typically are advanced to strengthen the low back and abdominal muscles to prevent recurrences of sciatic pain caused by a herniated disc. Low back muscle strengthening exercises: Upper back extension. In the prone position with hands clasped behind the lower back, raise the head and chest slightly against gravity (Figure 4) while looking at the floor (stay low). Begin by holding position for 5 seconds, and gradually work up to 20 seconds. Aim to complete 8-10 repetitions. In the prone position with the head and chest lowered to the floor, lightly raise an arm and opposite leg slowly, with the knee locked, 2 to 3 inches from the floor (Figure 5). Begin by holding position for 5 seconds, and complete 8 to 10 repetitions. As strength builds, aim to hold position for 20 seconds. Abdominal muscle strengthening exercises: Curl-ups. For the upper abdominals, the patient should lie on the back with knees bent, arms folded across the chest, and the pelvis tilted to flatten the back. Then curl-up lifting the head and shoulders from the floor (Figure 6). Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls. Do not attempt to lift the head up too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head to support the neck. For the lower abdominals, tighten the lower stomach muscles and slowly raise the straight leg 8 to 12 inches from the floor (Figure 7), keeping the low back held flat against the floor. Hold leg raise for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten lifts.

6 Water exercises are also excellent to strengthen the lower abdominal muscles, and even just walking in waist-deep water can be helpful. See Water Therapy Exercise Program Degenerative Disc Disease Exercises While Lying on the Back Examples of the dynamic lumbar stabilizing exercises done while on the back include: Hook-lying march. While lying on the back on the floor, with knees bent and arms at sides, tighten the stomach muscles and slowly raise alternate legs 3 to 4 inches from the floor. Aim to 'march' for 30 seconds, for two to three repetitions, with 30-second breaks in between repetitions. Hook-lying march combination. Same exercise as described above, but includes raising and lowering the opposite arm over the head.

7 Bridging. Start by lying on the back with the knees bent, then slowly raise the buttocks from the floor. Hold bridge for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten bridges. These exercises should all be performed with a rigid trunk. The pelvic tilt, tightening the lower stomach muscles and buttocks to flatten the back, can be used to find the most comfortable position for the low back. Practical point Exercise has both mental and physical components. By increasing their conscious awareness of the position of their spine, patients can assume the most comfortable stance and better control their pain symptoms. Degenerative Disc Disease Exercises While Lying on the Stomach This same pelvic position (tightening the lower stomach muscles to flatten the lower back) is maintained while performing stabilizing exercises from the prone position (lying flat on the stomach): Raise one leg behind with the knee slightly bent and no arch in the back or neck Hold for four to six seconds, then slowly

8 lower to starting position. As strength builds, aim to complete two sets of ten leg raises. Lying face down, with elbows straight and arms stretched above the head, raise one arm and the opposite leg 2 to 3 inches off the floor Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of opposite side raises. Similar stabilizing exercises can be done in the 4-point position (kneeling on hands and knees), raising the arms and legs only as high as can be controlled, maintaining a stable trunk and avoiding any twisting or sagging: Raise one leg behind with the knee slightly bent and no arch in the back or neck Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises. For a slightly more advanced exercise, raise one leg with the knee slightly bent and no arch in the back or neck and also raise the opposite arm Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.

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