Hello, my name is Dr. Ashley Mak and I’m a Physical Therapist and owner of Hudson River Fitness. We are an online company that specializes in helping busy adults live free of low back pain, and as a clinician, I grew tired of providing the same cookie-cutter experiences to clients who had low back pain and sciatica and so I knew there had to be a better way.
So I spent months and months studying from the best in low back pain rehabilitation and I learned a valuable lesson. We need to listen to our bodies and use that as a guide for our treatment and this revolutionized my practice. And over the past 10 years, I’ve helped over a thousand clients improve their back pain so that they can play with their kids, hike, and do all the activities that they love without the fear and frustration that comes with this issue.
Now, I’m really excited to share with you a step-by-step process to manage your low back pain in sciatica and this is a method that physical therapists, chiropractors, and doctors don’t want you to know about because that means that you won’t need them anymore to address your pain. Why am I sharing this with you? Because I truly care about your success and it’s my job as a Physical Therapist to ensure that you don’t need me and that you have the power to live a pain-free and full life.
So if you’re experiencing sciatica and back pain, come take a ride with me today into this step-by-step process to managing your pain. Now, this process is only helpful for people who are experiencing sciatica and back pain due to a musculoskeletal issue and not necessarily due to any other diseases. So if you have an underlying condition that can result in back pain such as cancers or other chronic diseases, please get evaluated by a healthcare professional before doing anything like this. So, here we go.
The first step is to Reflect on the Method of Injury. Was it caused in the, what was called, what was the cause in the first place? Was it a specific event? Did you wake up with the pain? Was it a traumatic incident? Most low back pain and sciatica issues, they’re often caused by an accumulation of stresses over time and there was one incident that was probably the last straw that broke the camel’s or your back, so this is also an opportunity for you to think about how your pain is influenced by daily activities.
- Is it worse with movement?
- Is it better with movement?
- What positions make you feel better or worse?
Now, it’s going to be important you write out everything you’re feeling and we’re going to use this for later in the process when it comes to identifying the best stretches and exercises for you.
The next part is Screening for Red flags. Now, these are signs and symptoms that indicate that a musculoskeletal examination and treatment would not be helpful because there is an underlying issue that stretching and exercising might not be able to help. Examples of red flags include having a fever, night sweats, complete loss of function or numbness in your extremity or extremities, any sort of unexplained weight loss or gain, changes in your bowel or bladder function, saddle anesthesia (which is also known as numbness in your nether regions), also any sort of digestive or urinary issues like blood in your stool or urine, constipation or unexplained vomiting. If you’re experiencing any of these or combination with your pain, please see a physician to rule out any other pathology.
And then the next step is to Assess your Posture. Now, this isn’t a time to correct and try to have the perfect posture. You have to be honest with yourself and just stand normally. Try to be shirtless when you’re looking at yourself and look at the front and see where your shoulders are in relation to your hips. You can take notice of some landmarks which include the tops of your shoulders, your head, your nipples, and your hips particularly the pointy part of it. And then turn to the side and then take a look at yourself. What is your spine doing? Now, normal spine alignment is an S-shaped curve with a little bit more of an arch at your neck, and your lower back and your upper back might be a little rounded forward to it and that’s perfectly okay. So from here, we are going to establish a baseline.
- How do you feel at rest?
- How do you rate your pain on a scale of one to ten, with zero being no pain at all and ten being excruciating pain?
- Where’s the location of the pain and what’s the size of the area?
Now, most failed treatments are due to a failure to establish a baseline. Without it, you don’t even know if you’re going to be feeling better or not. So rather than asking “Are you in pain?” or “Are you not in pain?”, we need to ask:
- How much worse or better are you feeling compared to your baseline?
- What’s the size of the pain?
- What’s the type of pain? The intensity?
- How different are you feeling before and after any sort of intervention?
And then we move on to our Movement Assessment. We have to record how you feel before, during, and after each motion and how much range of motion that you have. “Do you feel stiff?” or “Is pain limiting you?” and at this point just move within your limits and you don’t need to push past that.
Now, if you are in too much pain and are too stiff to move, then try this little gentle strategy which is going to be laying on your back with your knees flexed, feet flat on the floor, and then slowly breathing through your nose and out through your mouth. Do a body check and as you’re breathing, let your body relax. Be in this position for about three to five minutes before carefully getting up. You might be able to move on to the next step. If not, if you’re in too much pain, it might actually be best to speak with the doctor to help take the edge off of that pain so you can move around a little bit more. But if you are ready to move, here are some motions that you can check out.
The first one is going to be bending forward by gently touching your toes. Next, you’re going to lean backward by putting your hands on your buttocks and then leaning back as if you’re doing a limbo. The next is going to be shifting your hips right and let your shoulders move left and then you’re going to shift your hips left and let your shoulders move right. Put your feet together and then look over one shoulder turning over your shoulders, that is called rotation. And the last is turning over and looking over to the other side. Now, at the clinic, you would do a muscle test right after this range of motion assessment. But since you are assessing yourselves, it can be difficult to get the necessary strength measurements. So it’s actually still going to be important to take note in regards to your strength. So take an overall body scan and notice any sort of asymmetries when doing your daily activities and we can use that as a baseline as well.
Now, it’s time to take some measurements and come up with a plan to make improvements. But it’s also going to be important to be on the same page in regards to what an improvement in symptoms truly means. An improvement or feeling better means the following:
- One, it’s going to be a reduction in your pain intensity, meaning that your pain goes from a 10 out of 10 to a little bit less than that even if it’s half a point. Anything less than what you were experiencing before is an improvement.
- Number two, the area of your pain location gets smaller in size. If it becomes a little bit more localized, we are heading in the right direction. If it spreads out, we are headed in the opposite direction.
- The next point is that your symptoms should be moving up closer towards your spine, meaning that if you have pain in your calf and you are moving the pain or tendons moves into your hamstring, buttock, or it even intensifies in your lower back, we are moving and heading in the right direction. That is called Centralization. Think about your body as kind of like a toothpaste tube, and we’re looking at pushing everything out, and out or towards the middle of your spine.
- And the last piece is that you just identify that your limbs and extremities feel a little bit stronger after you’re doing these stretches. Another point is that a decrease in tension can also be deemed moving in the right direction.
Now, go back into your posture. If you had some sort of shift when standing during the posture assessment, the first thing to do is to actually correct that shift. So take your hand, put on your hip, and move it in the direction that would allow you to put your hips underneath your shoulders. This can improve or have no effect on your pain, but we have to actually correct your shift and it might increase your pain but as long as you feel the symptoms get closer to your midline and to the spine, you are heading in the right direction.
Now, it’s time to retest these motions. Now, you should have felt an improvement in your symptoms, an improvement in your range of motion, or no change. Once you’ve corrected that shift, if you never had a shift in the first place, we can get to this point now.
Now, the next stage is to start bringing your pain down. Most clinicians will, at this point, start giving you the five most common exercises which include a pelvic tilt, a bridge, clamshells, a knee to chest stretch, and a leg raise. But this is way too early in the process to provide any sort of exercise or to conclude that you have a weak core and that’s the source of your low back pain. The goal of pain relief is to reduce your pain. And I’ll tell you, most pain does not reduce with plank holds or pelvic tilts. So remember how I said to reflect on the positions that actually make you feel the best or better? This guide is going to help you take those next steps, so focus on what makes you feel better.
Now, if sitting and bending forward actually makes you feel better, then try that out. Then try forward bending a couple of times. You can get onto your back and pull your knees to your chest for a gentle stretch or simply bend forward and touch your toes, keeping in mind that you should be flexing at one vertebra at a time and you should be completing this motion 10 times and then retest. Remember, if you feel better as a result of this motion, then flexion is going to be your preferred direction, You would want to focus on doing this movement two to three times a day as long as it continues to help you out. You don’t need to investigate any other motions right now if forward bending is really helpful for you. And this is often associated with an anterior pelvic tilt and some arthritis.
Now, if standing up or laying down feels better, then extension is going to be helpful. Something simple like laying down on your stomach, then you progress to your elbows, kind of like a little baby cobra, and then ultimately pressing your chest up away from the floor called an Upward facing dog, also known as a Press-up. Remember, if your symptoms lessen in intensity, gets smaller in size, or moves closer to your spine, then you’re heading in the right direction. And then upon standing, complete a standing backbend for about 10 repetitions. You should be feeling better after this if you’re experiencing pain related to a disc bulge or herniation. So, complete this exercise two to three times per day, and at this point, you would want to avoid forward flexion at the spine for the time being.
Now, if forward bending or backward bending isn’t helpful, then a side bend could be a successful ingredient for you.
Which side? Now, it’s going to be important that you actually test a side bend in each direction by placing your hand on one hip and then pushing it in the opposite direction. So rather than side bending, we’re actually shifting the hips to or away from the side of symptoms.
Which position will feel better? Your symptoms are actually going to be providing guidance in regards to what truly feels better. So if leaning your shoulders towards the side of pain, means that your body prefers closing down on those symptoms and if that’s the case, complete 10 of those side bends followed by 5 to 10 backbends to see if you can seal the deal. If you can’t tolerate the standing backbends, then just stick with your side bends for a set of ten every two to three hours.
If leaning away from the side of the pain is helpful, then you’re benefiting from opening up that side and this is where we’re dealing with arthritis or stenosis. So try to follow the following: 10 side bends with a forward bend for about 10 repetitions and if that feels great, awesome! Do that combination of movements every two to three hours. But if not, just stick with the side bend away from your symptoms, first out of 10 every couple hours.
So, we had forward bending, backward bending, side bending. Now, if none of those work, then try rotation. And here’s the key: you have to lay down on one side, whether it be on the bed or the floor, and the bottom leg is going to be straight, and the top foot will weave behind the bottom knee. Your goal is to try to get your shoulders to be even with the surface or the floor and have the knees rotate to one side. You can move in and out of the tension by lifting one shoulder off the ground and bringing it back down to the floor, and your goal is to complete about 10 pulses. How does that feel? Does it improve or worsen your symptoms?
Now, try the other side. Which side feels better? Whatever position feels better, you have to focus on that specific direction of movement and at this point, you don’t need to add any sort of other extra motions. Complete every two to three hours and carefully get up from the ground, the floor, or your bed. If you’re leaning on the side of symptoms, then your body also probably prefers extension as well. So, try some backbends after the rotation for 10 reps but as long as it continues to help you out. If it doesn’t help, then just stick with rotation.
Now, if you are leaning on the opposite side of your symptoms, your body might actually prefer flexion. So try adding forward bending after you do a rotation for 10 repetitions and see if there is a difference. If it helps you out, then continue to add the forward bending followed by rotation to your day. If not, just stick again with the rotations.
If your pain is influenced by movement, then one or a combination of these movements should help. You will eventually be able to do all these movements without pain but at this point in time, the focus is on bringing the pain down.
This self-guided approach can significantly help with a lot of low back pain in sciatica cases. The first priority to pain relief is in fact, your pain relief. If you find little to no change in these positions, then we have to take a deeper dive into your spine and how your body reacts to movement. This is where you should either be reaching out to me and the team at Hudson River Fitness for a virtual strategy call or see a practitioner in person.
Now, there are benefits to both and I’ve seen positive outcomes from both in-person and virtual sessions. Now, speaking on behalf of virtual consultations, there are many benefits to working with us and they include the convenience where you don’t even have to leave your home. Safety, because you are within the safety of your house and it’s actually 100% focused on you. No one else is going to be on the screen or in the clinic during the session, meaning that we can make adjustments a lot faster resulting in better outcomes, better results, and fast results for you. Overall, with better pain relief, you will use fewer medications and avoid surgery.
So if you need help navigating this painful situation, then book a strategy call by clicking on the link below or emailing me at ashley@hudsonriverfitness.net. I hope this was helpful and I’ll talk to you soon.
