Your Personal PT, Rachel Tavel, is a Doctor of Physical Therapy (DPT) and Certified Strength and Conditioning Specialist (CSCS) at Shift Wellness in NYC, so she knows how to get your body back on track when it’s out of line. In this weekly series, she gives you tips on how to feel better, get stronger, and train smarter.
Being quarantined and having life as we know it suddenly stop might be taking a toll on your body—particularly your lower back.
Low back pain is one of the most common complaints a physical therapist will hear. It is also one of the leading reasons people see an MD. The cause of low back pain is not one size fits all; many different variables can contribute to developing the aching, uncomfortable issue. But there is one familiar diagnosis that nobody wants to experience for themselves: sciatica.
Sciatica is, by definition, a pain caused by compression of the sciatic nerve. The sciatic nerve is the largest nerve in the body and one of the most famous, for better or for worse. This nerve emerges between spinal segments of the lumbar spine and travels through the pelvis and down the legs, terminating in the feet. It actually branches into two separate nerves as it travels down the leg, the tibial nerve and common peroneal nerve. But to keep it simple, we’ll refer to it as one nerve.
The sciatic nerve can be like a sleeping bear; it’s quiet and it won’t bother you unless it gets poked. Once you poke the bear, which commonly occurs with sudden loaded bending and twisting movements such as trying to lift something too heavy with poor body mechanics, that bear will begin to roar. You don’t want to poke the bear. But if you do, don’t worry, there are things you can do to soothe the pain.
Fibrous cartilaginous discs (think of this as a donut) and a gelatinous nucleus pulposus (think this as the inside of a jelly donut) separate each vertebrae and can become compressed, causing part of the disc to protrude outwards towards the spinal canal where the nerve roots are located. When this happens, pain is the result. (This would be the poking of the bear.)
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Sciatica pain is often described as “radiating” or “shooting” pain. It may be felt in one specific spot and position (for example, sitting a certain way especially in a hard chair), or it can present as numbness or tingling in the lower extremity. The sensation typically affects one side of the body (and people will know which side is affected pretty quickly), but it can also switch from side to side depending on what’s actually happening in the spine. Sometimes the nerve pain is accompanied by low back pain, but often people will report that they mostly feel symptoms in their buttock, hip, leg or foot.
Bottom line: it’s not fun. You’ll want to put the bear to sleep. Thankfully, sciatica often resolves with the right exercises, stretches and adjustments to body mechanics that can help to push that bear to retreat back into its cave, so to speak (the disc returning to its space).
That said, as always, treatment depends on what’s really going on in your body, which requires a proper individualized assessment by a physical therapist and/or MD. Many factors such as age, medical history, and mechanism of injury (how you hurt yourself in the first place) can also help guide treatment.
Core stabilization, education on proper lifting and bending techniques and likely some posture tips will certainly be an important part of treatment. But if you are in desperate need of a stretch or two to reduce your symptoms, these stretches are a good place to start.
Piriformis stretch: The sciatic nerve goes right below the piriformis muscle, so this is a key stretch for anyone experiencing sciatica symptoms.
Lie on your back with your knees bent. Cross the affected side’s ankle across the opposite knee so you make a “figure 4.” Grasp hands behind the unaffected leg and gently draw the thigh closer to your chest, creating a stretch in the affected side’s hip/buttock area. Don’t worry if it’s stiff and sore at first—the pear-shaped piriformis muscle can become quite tight when the sciatic nerve is inflamed, so ease into this stretch, breathe and try to hold the stretch for at least 30 seconds. Do it 2 to 3 times daily.
Knee to opposite shoulder stretch: Lying on your back with legs straight, slowly bend the affected side’s knee and hug the knee to your chest.
Hold this stretch, then draw across your body towards the opposite side to deepen the stretch. Breathe, hold 30 seconds, repeat 2 to 3 times.
Prone prop: In many cases, sciatica can arise due to a disc bulge or herniation leading to a portion of the disc protruding outwards towards the spinal canal. In a young spine (one without stenosis) and a person who typically injures themselves by bending, lifting and twisting (though just sitting all day in poor positions can cause similar symptoms), you’ll want to apply the McKenzie Method to help “centralize” symptoms and promote a return of that disc into its space.
One of the most important stretches to do is the prone prop. To perform, begin lying on your stomach. While relaxing the muscles in your back and abdomen, use your arms to slowly press yourself up onto your forearms or hands (wherever you can get with relative comfort). Hold this position for about 10 to 30 seconds, then return to lying flat. Try this for 5 holds 1 to 2 times daily.
Symptoms should reduce gradually over several days. If they do not or if symptoms worsen, do not continue with this exercise and seek treatment from a medical professional.
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