What To Do for Sciatica in my Leg

Photo: John Ragal

There are multiple causes of sciatica or back pain that radiates down the leg(s). The most serious cause of sciatica is when a nerve root in the spine is being pinched by a bulging disc or by arthritis-type changes in the spine itself. Not only can this cause shooting pain into the leg(s) but also weakness in the leg and changes in the sensation in the leg (for example numbness or tingling in a portion of the leg or foot). If this is the case, it would be diagnosed through MRI and treatment options would be recommended by your doctor. 

Physical Therapists treat many patients with such sciatica. The key to relieving this type of sciatica is to stop the compression of the nerve root in the spine where it is being pinched. This can be done through positioning and exercises. If you are completely compliant with Physical Therapy and get no relief from any sciatica symptoms, then your doctor may try injections (usually with Cortisone) to provide some pain relief. This is a steroid, which provides an anti-inflammatory response. If you do not want injections, you may be prescribed oral medications for pain relief and/or anti-inflammation. 

Other conservative treatments for sciatica are going to a chiropractor, mechanical lumbar traction (requires a MD prescription) or getting acupuncture. Also some people get relief from inversion tables. Aquatic Physical Therapy (doing therapy inside a swimming pool) is another helpful tool for patients with sciatica.

Low Back Pain: Treat With One Exercise

Photo: Chakra-Jnana Yoga/Facebook

Backbends. Stand up, put your hands on your hips or low back, and bend backwards (obviously not beyond a comfortable stretch), likely around 30 degrees. Hold 1 second, then return to upright. Repeat 5-10 times. This is the single best exercise for the majority of patients with low back pain, and the following explains why.

1. Convenience. You can do this exercise anywhere to treat or prevent low back pain. It does not require equipment or even lying down. While there are various forms of back extension (lying on your tummy and pressing up onto forearms or hands, lying on your back and lifting your hips into a bridging position, various yoga poses, etc), this exercise is the easiest one to perform no matter where you are.

2. Back Extension Exercise helps 70% of patients with Low Back Pain. Moving your lower spine into a backward-bent position (arched) is one of the most effective ways to undo the force of continual forward bending and slumping that we all perform excessively every day.

3. Back Extension treats Low Back Injury which occurred in a flexed (forward bent) position. If you have Low Back Pain which began with a specific injury or traumatic event, think about the position of your back at that time. Were you lifting something? Bending forward to pick up an object? If forward movement caused your injury, back extension may be the direction of exercise to treat it. Even if you were injured in another way, this still is the direction of force that the majority of patients with low back pain need in order to minimize symptoms.


Caution: This exercise is not safe or appropriate for all individuals, so consult your physician first, especially if you have low back problems, painful medical conditions, balance problems, or anything else that may inhibit your safety. If performed in a gentle way, it is likely safe for most individuals without low back pain. No one should perform this forcefully or into an excessively far backwards position.

If you have low back issues and have not seen a Physical Therapist, ask your doctor for a referral/prescription, and find a spine PT near you!


Reference: McKenzie, Robin. Mechanical Diagnosis & Therapy: Lumbar Spine. 2009: The McKenzie Institute International, Part A.

Further reading: McKenzie, Robin. Treat Your Own Back, 9th ed. 2011: OPTP.

Back Health Survey: Am I At Risk For Low Back Pain?

1. How frequently do you perform moderate-high intensity exercise?
     a. 5-7x/week
     b. 2-4x/week
     c. 1x/1-2 weeks
     d. rarely

2. How many hours/day do you sit on most days of the week?
    a. <4 hours/day
    b. 4-6 hours/day
    c. 7-10 hours/day
    d. >10 hours/day

3. How often do you perform back strengthening exercise or core strengthening?
    a. >3x/week
    b. 1-2x/week
    c. occasionally
    d. what do you mean by back or core strengthening exercise?

4. What is your usual sitting posture?
    a. upright, with extra lumbar support (lumbar roll, rolled towel, etc)
    b. upright, without lumbar support (decent chair but no additional lumbar roll or cushion)
    c. mildly slumped
    d. severely slumped or rounded

5. What is your present weight status?
    a. ideal body weight
    b. mildly overweight
    c. moderately overweight
    d. severely overweight

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)?
    a. no major episodes
    b. 1 major episode or injury
    c. 2-3 episodes
    d. >3 episodes

7. How far down did your low back pain symptoms radiate?
    a. no major low back pain in my past
    b. low back only
    c. low back and buttock(s)
    d. down to thigh (not below knee)
    e. down below the knee

8. How did your low back pain resolve?
    a. no major low back pain in my past
    b. completely resolved
    c. partially resolved
    d. never resolved

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)?
    a. All the time; with both difficult and easy tasks
    b. Most of the time, especially difficult tasks
    c. Sometimes
    d. Rarely

10. How much heavy lifting do you regularly perform?
     a. occasionally-rarely. Always with good technique
     b. frequently. Always with good technique
     c. occasionally-rarely. Without considering technique
     d. frequently. Without considering technique

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)?
      a. rarely and not likely to in the future
      b. once every few years
      c. multiple times per year
      d. very frequently

12. How often do you perform standing forward bending exercises (such as touching the toes)?
      a. never. not since elementary school calisthenics
      b. occasionally, when I need to stretch my back
      c. frequently, during my usual workouts
      d. daily or multiple times daily


Score: Count your score by assigning points to each letter answer.
Legend
a: 0 points
b: 1 point
c: 2 points
d: 3 points
e: 4 points


Results:
>30 points: Get to know your Physical Therapist and spine surgeon. You will be seeing us a lot.
20-30 points: Moderate risk unless you make major changes immediately.
13-20 points: Mild-moderate risk. Consider ways to improve!
6-12 points: Mild risk. But beware and don't become complacent in these areas.
0-6 points: You have a healthy back and are at low risk as long as you continue good habits!

Tune in next time for more discussion about these questions/answers!

Post your answer in the comments section. There will be three prizes awarded!
 

How to avoid BACK PAIN with reaching/bending

My patients with back pain typically fall into two categories: trauma vs non-trauma. Traumatic injuries can come from a major accident or an easy task done incorrectly (bending down to pick up shoes from the floor and then patient is unable to stand back up). Non-traumatic back pain frequently comes from repetitive poor postures and bad bending/reaching habits.

Based on my posts "How many times per day do you reach to the floor," the number is likely more than 30 times and may be even higher than 50 for those of you with small children. So how can you modify these RTF's (reach-to-floors) so as to decrease your risk for back pain, back spasm, back strain or worse?

First, check your back position each time you reach down to the ground or a low surface. You can squat (with your back straight) or use the golfer's grab (kick 1 leg back behind you). You can sit on a stool or chair. You can kneel. You can get on your hands and knees. You can sit on the floor. Be creative; there are many ways to reach down without straining your back. It simply takes the effort to think twice before you bend.

Next, modify where you place the objects that you use the most to be at an easy-to-reach height. For example, store your dish soap in a decorative container on the counter instead of under the sink. What objects do you have in your lower cabinets, cupboards, drawers and shelves? They should be the ones you use rarely. Anything you use multiple times/day should be easily accessible with minimal reaching required. This is especially true for those of you with back problems (which limit your ability to bend) and knee problems (which limit your ability to squat).

Finally, always give yourself the mechanical advantage. Use your big muscles to do the work they were made for (thigh, buttocks muscles). They are easily able to do the work of lifting so your back does not have to.

Wrong Way To Feed The Dog (Video)

The danger of your first episode of Low Back Pain

Did you know that one of the biggest risk factors for low back pain is prior low back pain? It sounds obvious, but this has huge implications for you. It means that preventing a first episode of low back pain decreases your chance of having future episodes. Therefore, you are less likely to have chronic low back problems in your future.

Each of you is in one of these categories:
Group 1. No prior low back pain
Group 2. Prior low back pain

Here is my advice for both groups.

Group 1. Prevent an initial back injury and a first episode of low back pain through good posture, body mechanics/ergonomics, lifting correctly, avoiding bending/twisting and regular exercise. This is urgent for you because if you hurt your back once, you will very likely hurt it again. So prevent it now, before it is too late.

Group 2. See a Physical Therapist if you have frequent episodes of low back pain. Prevent future episodes through good posture, body mechanics/ergonomics, lifting correctly, avoiding bending/twisting and regular exercise. It is harder for you to prevent future back pain than group 1 because you have already injured your spine in the past. But Physical Therapy treatment can be very effective to teach you how to manage and prevent symptoms.



Ref: McKenzie Institute International. Part A. Mechanical Diagnosis and Therapy of the Lumbar Spine.

A busy mom's PAINFUL Christmas

This is a true story.

There was a busy mom who had four children. She hurt her back one day when she was at work. Her work was pretty strenuous; she cleaned houses. This was no minor back injury--she could barely stand up and walk. So working was out of the question. But how could she take care of her kids and maintain her home? She was used to doing all the cooking for their family of six, in addition to all the usual activities busy moms do.

It turns out she needed back surgery! While recovering, her children often found her lying on her side on the living room sofa. At least that way she could be in the same room with the rest of the family. She could not believe this happened, but all she could do was pray for a fast recovery. She was powerless to do anything for her children during that time. For once, her kids and husband had to serve her instead of the usual way of life.

The worst part was that she had been the only parent working full-time because her husband was in graduate school full-time. Christmas was coming, and they did not have money for presents; they barely had enough for groceries. But God answered that busy mom's prayers and provided some gifts for the children to open up that year.

That family truly felt the cost of a major injury. Hopefully you never will, so practice PAIN PREVENTION today!

Daily tasks that cause LOW BACK PAIN

These are some specific types of injuries that cause low back pain.

1. Falls. Falling can cause numerous injuries, from broken bones to torn muscles/tendons to internal bleeding and worse. So do whatever it takes to prevent falling.
2. Lifts. Lifting wrong is a major cause of low back pain. The heavier the object you are lifting, the higher the risk for injury. So be sure to lift the right way, whether you are lifting a 5-lb. or a 50-lb. object.
3. Housework. Doing housework can easily cause low back pain if you do it incorrectly. So be sure to check your body mechanics with every part of your housework.
4. Yardwork. Similar to housework, yardwork also needs to be performed with caution and with intentionally good technique. This is especially true when working with heavier equipment or with strenuous outdoor tasks.
5. Exercise. Exercise is so important for improved health, and I recommend it to all my patients. However, I have also treated many patients who injured their backs from exercising. So be sure to learn the proper exercise techniques. Then check your technique every time you do the exercise.
6. Sports. Some sports injuries are pure, unavoidable accidents. But many are preventable, with proper warm-ups, stretching, staying warm (ex: baseball), shoewear (ex: running), slowly working up to higher levels, and/or sports-specific strengthening.

Over the next few days I will talk more about these areas in greater detail. Stay tuned! You do not have to live with low back pain if you take the necessary steps to prevent it!