Sean McCawley, Fit for Life: Exercises to avoid sciatica

From napavalleyregister.com/

Last week, we shed light upon a few noteworthy structures surrounding the sciatic nerve in the body. This region of muscles, tendons, ligaments, bones and nerves is referred to as the lumbopelvic hip complex, or LPHC.

The combination of connective tissue present in the LPHC is significant for the integrity of the lumbar spine and hip region. Appreciating the area's intricacies can empower us to decrease debilitating symptoms of lower back pain, hip tightness and, one of the most popular culprits in the LPHC community, sciatica. 

Described as sharp, searing or annoying pain originating from the centre of the buttocks, sciatica is a condition that sends nerve pain down the back of the leg to the heel. Discomfort is an understatement for severe cases of sciatica.

Symptoms of sciatica can originate from many root causes. Compressed or shifted vertebrae, bulging discs knocked out of alignment, or deconditioned muscles surrounding the hip region all contribute to sciatica causing this “pain in the butt” condition.

Before visiting a doctor's office to explore X-rays, MRI images and how surgical intervention can remedy extreme sciatica, perhaps looking at some low-hanging-fruit solutions can be helpful.

This simple yet effective tactic can be achieved by educating ourselves about exercises to strengthen the LPHC. If we reinforce the system of muscles, tendons, and ligaments in the LPHC, we will likely have less collapse of weak muscles and bones that push down on the sciatic nerve.

Underneath the gluteal muscles resides the piriformis muscle.

Physical therapists and fitness professionals consider sciatica a common culprit in people's lives. A prevalent cause of sciatica is the compression of the piriformis muscles pushing down the sciatic nerve. This deep gluteal muscle traces directly over the sciatic nerve path as the nerve travels inferiorly down the back of the leg. The primary function of the piriformis is to lift the leg up and away from the body's midline. This action is known as hip abduction.

When this muscle gets inflamed, it increases in size, just like a traffic jam at the Jameson Canyon to I-80 eastbound junction. Pressure, stress and pain ensues as this area of the hip gets congested, with a muscle that shouldn’t be as large as it is and is pressed down on the sciatic nerve. So, what happens when the piriformis pushes down on the sciatic nerve? “Ow” is what happens.

Identifying a common cause of sciatica, such as a deconditioned piriformis, is an efficient and effective first step to laying out a plan of action to solve the beginning periods of sciatica. Now that we know the disruptions the piriformis can contribute to the development of sciatica, what can we do to support our piriformis muscle, so it doesn’t go into a state of distress?

We input efficient and effective rehabilitative movement solutions into our personal training clients' exercise programs specifically to enhance the muscular strength present in the LPHC.

Targeting the muscles of the anterior and posterior portion of the lumbar spine muscles, such as the abdominals, deep psoas muscles, and hip flexors, help support the front part of the spine. If we keep the front portion of the spine and hips, we even out how much force can be pressed down the spine.

Additionally, exercises emphasizing muscular engagement of the glutes allow for increases in strength adaptions to various other piriformis muscles, allowing the demands of our body's hip movements. This means that the piriformis won’t be the only muscle performing all the work. Our gluteal muscles are responsible for moving our legs forward, backward and side-to-side. Balancing the strength of the piriformis and gluteal muscles allows the joint to operate as one unit.

Here are two exercises that target the muscles of the LPHC and have the potential to alleviate sciatica:

1. Pelvic tilt against a wall: Position your back flat against a wall and move your feet slightly in front of you to where you lean back against the wall. Position your back flat against the wall and “roll the crest of your hips toward your ribs.” This movement should stimulate a contraction in the abdominals and glutes. Perform at least five to 10 repetitions once per day.

2. Supine Isometric Hip Extension: This is a fancy term for what we commonly understand as hip bridges in yoga class. Lie flat on the ground with the knees bent at about 45 degrees. Then, while pressing your heels into the ground and ensuring the lower back is stabilized, lift the hips upward until a muscular contraction is experienced in the glutes and hamstrings. Hold this position for 10 to 15 seconds. Perform at least one set of holding for 15 seconds once per day.

A multitude of potential afflictions can impose symptoms of sciatica, impeding the productivity of our everyday lives. However, deconditioned fitness levels are one of the most common causes of sciatica. Therefore, pain mitigation through exercise adherence and performing exercises that prevent pain are simple and effective tactics that will keep us away from developing this “pain in the butt.”

https://napavalleyregister.com/lifestyles/health-med-fit/sean-mccawley-fit-for-life-exercises-to-avoid-sciatica/article_4eec069e-0e91-11ed-91cd-dbb9ddcd3b44.html

This Common Vitamin Could Stop Lower Back Pain in Its Tracks

From womansworld.com

One woman's story provides promising results for sciatica sufferers

Jolting awake, Barbara Farfan felt a stabbing pain shoot from her hip down her left leg. What is happening to me? she worried and quickly tried a series of stretches, hoping for relief. But to her dismay, the agony got worse.

An international pet-sitter, the Seattle native was staying in a small city in Mexico. It wasn’t the easiest place to find resources. As the shooting pain progressed, Barbara found it increasingly difficult to get out of bed. She’d crawl to the bathroom and the kitchen for water. But preparing meals required standing — which was excruciating.

After a week of searching for solutions, she identified a local chiropractor, and set an appointment. The chiropractor promptly diagnosed her with sciatica, a radiating pain along the path of the sciatic nerve, which runs from the lower back through the hips and buttocks and down each leg.

The chiropractor massaged along the nerve, which enabled Barbara to stand long enough to cook, but do little of anything else. She also tried acupuncture, with minimal relief.

Realising she needed access to better resources, Barbara took a flight to Mexico City. She was in so much pain by the time she landed, an airline employee had to escort her in a wheelchair. I can’t live like this, she thought.

Getty Images

How does vitamin C help sciatica?

After settling in, Barbara began researching natural sciatica treatments, and discovered that the powerful anti-inflammatory properties in vitamin C could be the key to relieving her pain. Even more, Barbara learned that liposomal vitamin C, where the vitamin is wrapped in little fat bubbles to improve absorption and allow for higher doses without causing digestive upset, was especially effective.

Hopeful, Barbara found premade liquid liposomal vitamin C supplements online, though not enough to take consistently. However, she also found a simple recipe for a potent vitamin C emulsion that combines sunflower lecithin (fat) with ascorbic acid (vitamin C) using an ultrasonic jewellery cleaner.

After gathering the ingredients and making the drink, Barbara began with a “superdose” by drinking one cup of the liquid, sipped over an hour, every morning. To her amazement, the pain and swelling in her leg dissipated immediately.

Over the next few weeks, as her symptoms improved, Barbara began tapering her dosage until, after two months, with her pain gone, she went down to two tablespoons every morning, which she continues to take today. “I’d read that sciatica never goes away, and here I am absolutely free of pain!” says the 61-year-old, who started SciaticaPainStop.com to share natural treatments. “I feel so amazing!”

Why does it work?

Every cell in the body uses vitamin C to defend against disease-causing inflammation, says vitamin C researcher Thomas Levy, MD. And since the primary cause of pain is inflammation, vitamin C supplements can work wonders. The caveat? Standard C is poorly absorbed by the body, he says. But liposomal C, a form where the vitamin is encased in fat, is absorbed nearly 100 percent (Buy on Amazon, $18.98). “The outer coating of a liposome is virtually identical to the cell wall, so it can literally merge into that cell membrane and become part of it.” Plus, it doesn’t bring the side effects (like diarrhoea) of regular vitamin C.

Barbara’s experience is promising, but as always, consult your physician before adopting new treatment therapies and/or making changes to your existing pain management plan.

https://www.womansworld.com/posts/pain-management/vitamin-c-treatment-for-sciatica

Solving the Puzzle of Hip and Low Back Pain

From thelaurelmagazine.com

Written By: Dr. Sue Aery

Managing low back pain and hip misery requires wise counsel and compassionate care

How do we differentiate between low back pain, sciatica, and hip pain? Well, let’s start with the chiropractor and the many tools we have to help diagnose and solve these issues. Using the information from an exam, the chiropractor will differentiate between hip pain (or pain in the ball and socket joint), and its surrounding components, low back pain (or spinal restriction), and disc herniation or impingement of the sciatic nerve in the buttock. 

Once the cause is determined, as long as there are no broken bones, treatment can begin. This may involve many aspects of chiropractic care, including some very effective therapies such as Tissue Regeneration Therapy/Stem Cell Activation, acupuncture, and electric stimulation. Chiropractic manipulation may involve balancing of the pelvis, which will remove stress on the hip joint, alleviate pressure on the bursae and tendons that surround the joint and relieve the irritation to the nerves that pass through the buttock and make up the sciatic nerve that can also cause pain in the leg.

Soft tissue work such as trigger point and myofascial massage are also two common techniques used, usually by a licensed massage therapist as directed by the doctor. Next, the cause of the pain and dysfunction must be addressed so that it can be removed or remedied for future health. A few common culprits involve leading a sedentary life or sitting too much without stretching and focusing on the complex movements that the normal hip can perform.

Remember, the hip is a dynamic joint with many planes of motion. When we deprive the joint of motion, we also limit the amount of blood flow into the joint, thereby accelerating the process of degeneration. Arthritic hip joints are far more prevalent now and many more people face impending replacement surgeries. These can often be avoided with proper preventive care, including chiropractic care. The lumbopelvic complex is intimately connected to the hip joint and should also be well taken care of to improve the skeletal health and prevent premature arthritis and pain.

So many pain processes can be avoided with maintenance care. If you plan on leading an active life, or want to return to this lifestyle, it will take some action and diligence to correct the problem and then take better care of your body going forward. As I often tell my patients – let’s use our body the way it was designed to be used well – and often!

https://www.thelaurelmagazine.com/lifestyle-and-wellness-in-highlands-nc-and-cashiers-nc/solving-the-puzzle-of-hip-and-low-back-pain

Exercising with sciatica: Here’s how to do it, according to the experts

From livescience.com

Worried about exercising with sciatica? Our experts explain how to do it safely and what exercises you should avoid

Exercising with sciatica might seem like an impossible task if you suffer from the condition, but it could alleviate your symptoms, experts believe. The sciatic nerve is the longest in your body, starting with nerve roots located in your lumbar spine (lower back) which then run through your hips, bum, and legs, down to your feet. 

According to Spine Health, sciatica pain affects 10-40% of the population and refers to diagnosable symptoms like numbness, pain, and tingling sensations in your back and legs caused by a myriad of factors like aging or a herniated disc. For the majority of people, acute (mild) sciatica eases within four to six weeks without medical intervention, but for others, it can develop into a chronic lifelong condition. 

Severe nerve pain can be debilitating and, sadly, it takes some exercises and styles of training off the table completely. The good news? Learning how to exercise with sciatica (rather than avoiding it altogether) could help you live a healthier, pain-free life. 

We spoke with experts to delve deeper into what sciatica is, why it occurs, and how exercising with sciatica to relieve sciatic nerve pain really does work, as well as what to avoid altogether.  

WHAT IS SCIATICA?

“Sciatica refers to pain that runs through the sciatic nerve, from your lower back down to your foot,” Miss Vivian Elwell(opens in new tab), consultant neurosurgeon at London Bridge Hospital, tells Live Science. “It’s caused by compression, irritation, or damage to the sciatic nerve which is usually caused by a herniated disc in the spine or a bone spur (bony projections that grow in joints) on the vertebrae.”

The sciatic nerve is responsible for motor function (helping your arms and legs move) and sensory function (enabling you to feel sensation in your legs and feet), so any damage to this nerve can cause some serious problems.

                                                                                       (Image credit: Getty)

Elwell explains that symptoms include shooting pains, numbness, and weakness in your leg which worsen when standing or walking. “Risk factors include age-related changes, obesity, prolonged sitting, and diabetes mellitus,” she says. “It can happen at any point in life, but men are three times more likely to suffer from this condition, and it normally occurs between the ages of 40 and 50.” 

Adam Foster, director at The Fibro Guy Ltd(opens in new tab) (a rehabilitation service for chronic pain and hypermobility syndromes), agrees that there is a myriad of ways for the irritation to set in, including nerve pinching and genetic abnormalities. “Luckily though, sciatica is rarely mechanical in nature, and issues like nerve impingement are rarer to come by because of the abundance of room at our nerve roots.”

However, because some movements can aggravate the compressed nerve, many people believe that exercise should be avoided entirely – which isn’t the case at all. Gentle exercise can help alleviate pain and speed up recovery, but it’s crucial to differentiate between the types of exercises that can help and ones that can hinder.

So, what exercises can you still enjoy safely?

BEST EXERCISES FOR SCIATICA

“Bed rest has been a popular treatment for sciatica for the better part of the last few decades,” Foster tells us. “But the best thing we can do is to keep relatively active.”

In terms of published evidence, most meta-analyses and reviews show that there are no significant benefits to bed rest over staying active when it comes to sciatica pain (and vice versa). However, as mentioned in a review posted in Spine, “because there is no considerable difference between advice to stay active and advice for bed rest, and there are potentially harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active.” 

Jodie Breach, physiotherapy lead for Nuffield Health,(opens in new tab) agrees. “Most people will find gentle movement helps settle their pain,” she says. “Likely, you’ll still get some pain while exercising, but this doesn’t necessarily mean it’s causing damage. The key is finding the right level of exercise.” 

Foster recommends combining a mix of stretching and mobility work. However, stretching has more of an effect on your nervous system than the actual tissue, so he advises moving slowly and carefully. “Gentle dynamic movement can be incredibly beneficial for your range of motion,” he advises. 

                                                             (Image credit: Getty)

Elwell advises working closely with a physiotherapist who can direct which exercises are beneficial for you. “Slow and gentle stretches are advised,” she agrees. “Yoga(opens in new tab), Pilates, swimming, walking, and stationary indoor cycling are all great options, and it’s important to remain as active as possible with your day-to-day activities.”

A good guiding principle is that pain should be tolerable and settle relatively quickly post-exercise, so if that isn’t the case, intensity should be reduced.

EXERCISES TO AVOID IF YOU HAVE SCIATICA

“There are several helpful exercises for anyone struggling with sciatica, but there are also several which can aggravate pain,” explains Elwell. “Any high-impact exercise should be kept to a minimum, including contact sports, running, football, and tennis. These sports put sudden and intense strain or rotational forces through your back and can potentially worsen your underlying symptoms.”

Elwell recommends going to the gym, but jumping, bending forward, twisting, and lifting both your legs together could aggravate pressure on the sciatic nerve. She recommends avoiding exercises like:

• Burpees
• Double leg raises
• Toe touches
• Weighted squats 
• Bentover rows, and
• Outdoor cycling 

Instead, stretches that gently target the lower back and glutes – performed on some of the best yoga mats(opens in new tab) for support – could help release muscle tension. Think knee-to-chest stretches (laying or standing), reclined pigeon pose, and yoga for back pain(opens in new tab). 

OTHER WAYS TO MANAGE SCIATICA

Both Elwell and Foster recommend applying heat or ice pads to relieve pain, improve blood flow, and relax muscles, but if you’re struggling with numbness this should be used with caution. And seeking a spinal assessment or visiting your doctor is also advisory if your pain worsens.

“Heat won’t do much for the nerve of the piriformis muscle (one of your deeper gluteal muscles) that can irritate sciatica,” warns Foster. “But it will provide some relief to calm your nervous system. Likewise, vibration therapy reduces muscle soreness and can help treat muscle inflammation.” 

Most importantly though, remember that prevention is key and ensure you look after your back and general health by remaining active, managing your weight, and investing in a good quality mattress. Learning how to get a stronger core(opens in new tab) and how to improve your flexibility(opens in new tab) could also help you to protect your lower back during exercise. 

https://www.livescience.com/exercising-with-sciatica

6 Things You Should NOT Do When You Have Sciatica or Back Pain

From rehabrenegade.com

Let’s Start With The Bad News…

Sciatica and Back Pain are the two most common complaints that I hear. When I ask patients, “What do you think would help resolve your pain?” I usually get a confused look in return or an annoyed look, which I completely understand. It is an annoying question. Most people will ask, “Isn’t that why I came here?”

The reason I ask this question is to get an idea of what they are expecting from the appointment and to see what preconceived notions they have about Sciatica or back pain. Shockingly, the answers are all over the map!

Answers are typically dependent on what your doctor told you, advertisements on television, videos on Youtube and articles like the one you are reading right now. What’s unfortunate is that the message always seems to be a little different depending on your source. This obviously creates a great deal of uncertainty and frustration. 

More often than not, I am seeing people that got less than thorough evaluations from their Physician during their speedy 15-minute session. The result of that is non-specific treatment recommendations that leave people with a poor understanding of WHY they have back pain or Sciatica in the first place.

You walk away thinking the issue is a “medicine deficiency” or that you are doomed because of arthritis or a less than perfect MRI or X-Ray. Instead of a treatment plan, you get some catch all recommendation like “try Yoga, Pilates or Water Aerobics.” And if that does not work you’re convinced that your pain is because of some extra pounds.

Let me start by saying, I feel your pain. I have been in your shoes and I understand how frustrating it is when you are getting conflicting advice from different medical providers, as well as different “health experts” on the internet. Especially when that advice is telling you to just deal with the fact that pain is your “new normal.” I am here to call bull crap on that one!

 

Now, The Good News…

Getting out of pain and back to an active lifestyle is easier than you think. I am always excited to share that with people at the start of our session. Regardless of your age, weight, medical IQ, what your MRI and X-Ray look like, or how busy you are… there is hope!

My own experience with Sciatica and Back Pain, and my experience treating people with Sciatica Pain and Back Pain has made me very attune to seeing what strategies work and which one’s fall short. Many people falsely assume that they need to start adding a bunch of things to fix their pain. They assume that their improvement is dependent on a new workout plan, lots of “corrective exercise,” Yoga, Pilates, Swimming, the perfect diet, meditation and so on…

In reality, finding relief from your pain requires SUBTRACTION. 

Everyone mistakenly thinks that their pain is just going to vanish with one exercise, medication, cream or whatever. This is far from the truth. You need to understand the Aggregation of Marginal Gains. This a concept made famous by British cycling coach Dave Brailsford, who led the British cycling team to 10 gold medals at the 2008 Beijing Olympics.

To quote James Clear, “In the beginning, there is basically no difference between making a choice that is 1 percent better or 1 percent worse. (In other words, it won’t impact you very much today.) But as time goes on, these small improvements or declines compound and you suddenly find a very big gap between people who make slightly better decisions on a daily basis and those who don’t. This is why small choices don’t make much of a difference at the time but add up over the long-term.”

The first thing we have to do is Eliminate the things that are triggering your pain.

The list below will describe the most common mistakes people make that keep them in pain. Believe it or not, research has shown that most people are doing the very things that are causing their pain. Many of these activities will actually bring you a sense of relief in the moment but end up delaying your progress.

6. “Flat” & Rounded Back Posture

Stop This.

Notice the slight curvature (hollow) at the lower back.

The “Flat Back” picture shows a loss of this curvature.

The reason I put the word flat in quotations is because a flat back is technically a rounded back posture. Somewhere along your journey you were told that good posture meant a flat back. Maybe this cue was given to you with sitting or when exercising. For example, it is common for people to falsely think they should be flattening their back against the ground with exercise.

If you weren’t coached into this posture you gradually adopted a flat (rounded) lower back posture before or after your pain started. This is a compensatory posture that the body often adopts when in pain that can actually exacerbate your symptoms over time. This is a sure-fire way to make your back and Sciatic nerve SUPER angry.

Some degree of curvature (hollow) is naturally built into your lower back. Respecting this posture will prevent back pain and keep your Sciatic nerve from being compressed by a herniated or bulging disc.

How much of a curvature (hollow) you adopt is based on your anatomy and preference. If you have ever used a lumbar roll or lumbar support in your car, you know that the Goldilocks Rule applies. You need to find the amount of hollow that is just right for you.

Words of Wisdom: In some cases a slightly rounded back posture is adopted by those with a condition called Spinal Stenosis, which typically happens later in life. Even though a slightly rounded back can be helpful for this population, I would still argue that it should not be extreme and you want to minimize it to avoid excessive stress at the lower back.

5. Stretching Your Hamstrings

This may feel good in the moment, but it is really stressing your Sciatic nerve in a way that is going to exacerbate the pain in the long run.  An already angry nerve doesn’t like to be tugged on! If stretching were the secret formula for getting better, you would not be here. And honestly, I’ve met almost no one who has contributed stretching to relief from Sciatica pain. Interestingly, some of the most flexible people are the ones coming in complaining of back pain and Sciatica most frequently.

If you are thinking, “Well I don’t have Sciatica, only back pain,” my recommendation is the same. Localized back pain can have a muscular component, but pain at the back is more often related to irritation at some structure local to the spine (i.e. disc). Your stretching actually tends to put the body in positions that irritate these already irritated structures.

4. Self Back “Cracking”

Sciatica is often triggered by an injury to a disc in your back. In many cases back pain is also triggered by an injury to a disc in your back. With disc injury comes a little bit of instability in the lower back. This instability is often to blame for your back “locking up” or muscle spasms with even the most subtle movements.

The remedy for a painful lower back is usually enhancement of postural awareness, movement quality and strengthening at the back and hips, NOT stretching. Your back “cracking” (manipulation) might feel good for a second, but it is only a temporary solution that leads to more instability and chronic pain over time.

Words of Wisdom: Back manipulations have a time and place, especially in the first 4 weeks after an injury. After that they show little help for long term improvement. Stopping back pain and preventing back pain require you to understand how to maintain good “Back Hygiene.”

3. Stretching Your Lower Back

Many think their “tight back” is causing their Sciatica or Back Pain and take steps to become more flexible in that area. In reality your tight back is often a symptom not the cause of your pain. Stiffness in the hamstrings, back and butt muscles are often because of an irritated disc and/or Sciatic nerve. You are not going to stretch the pain away.  Think of your lower back more like the foundation of your house. You want it to be strong, stable and secure! When you start adopting this mindset, and learn the proper way to move and exercise you will finally get the relief you have been looking for.

Words of Wisdom: Certain stretches can actually be beneficial for back pain, but the focus is more on adopting positions that help reduce a disc bulge or take pressure off the Sciatic nerve. For instance, we will often prescribe simply lying flat or propped up on your forearms while on your stomach.

Rounding your back while stretching might bring some temporary relief because of a stretch reflex, but the increased pressure placed on the disc and nerve actually cause more harm than good.

2. “No Pain, No Gain” Mindset

This is a great way to build mental toughness, but a TERRIBLE way to rehabilitate your lower back. You need to learn how to pace yourself appropriately when returning from a back injury. You need to think of yourself like a marathon runner rather than a sprinter. If you come off the starting line at a 4-minute mile pace you are going to crash and burn before you know it.

Healing and pain are NOT the same thing. Asking, “how long will it take to heal?” is a totally different question than “how long will it take for the pain to go away?” You can be Pain Free with a back that is still healing if you learn how to pace appropriately. Avoiding painful postures can help desensitize angry nerves. Allowing you to do more activity with less pain over time.

Words of Wisdom: Understanding that “hurt does equal harm” is just as important. A little bit of pain here and there is ok but keep it to a minimum. If you can only tolerate walking, shopping, housework, etc. for a short period of time you need to do shorter, more frequent bouts of activity. This strategy over time will lead to steady progress without setbacks.

1. Crunches and Twists

I saved this one for last because I think it has become more common knowledge that these are a “no, no.” Though it is subtle, he is bending into a rounded spine posture in the picture above, which is placing increased stress on the spine. You know not to lift with a rounded back so why are we tricked into thinking that any exercise with a rounded back is acceptable?

It has taken years for the Army to remove them from their Physical Fitness Test, but it finally happened. Exercises like crunches, side crunches and russian twists are an excellent way to injure your lower back. The lower back (lumbar spine) is meant to RESIST not create motion. One of the biggest mistakes I see in the gym is poor lower back posture with lower back strengthening (Core Exercise), general strengthening and cardiovascular exercise.

Conclusion

Stopping the pain, or “putting out the fire” requires you to stop doing the very things that are starting the fire in the first place. Resolving pain is more about subtraction than addition when you are just getting started. This doesn’t always mean doing less. It means you stop doing the things that are surprisingly contributing to your pain.

Being active is important for healing and pain reduction, but you need to be more calculated. Remember the Goldilocks Rule. We need to pace appropriately during the day. Too much, and we trigger a flare up in pain that keeps us sidelined for days, if not weeks. Not enough, and we’ll never see any progress.

https://rehabrenegade.com/6-things-you-should-not-do-when-you-have-sciatica-or-back-pain/