Sciatica pain can affect every aspect of your life, and it can be confusing to find so much conflicting information on how to manage your pain. Here is a step by step guide to treating it yourself.
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Sciatica pain is not fun. And what makes it even more challenging is that when you go onto the internet, you are given so many different options when it comes to treating this sciatica pain. You’ll see one article that says bending forward helps your sciatica, so do this forward bend stretch. But then you look on the next page and it tells you how much forward bending can actually increase your symptoms. So this can be really confusing, challenging, and also ultimately scary because living in pain is not normal and you should be given the power to treat yourself.
So today, I wanted to actually share with you the steps that many Physical Therapists and Chiropractors go through, to help ensure that you are recovering the way that you deserve to be. And why am I sharing this with you? This is because I believe that everyone should have a role in their pain relief and it is very important for you to have control in regards to how you feel, and also the types of treatments that are available to you.
My biggest tip throughout this entire process is that you should be advocating for yourself. So if something isn’t working, please communicate with your practitioner. Now if you are tired of having to meet with practitioner after practitioner, doctor after doctor, medications, medications, and you don’t want surgery, the great news is that there is a lot of hope in regards to your pain relief. So today, I’m gonna be sharing with you the step-by-step process to help you relieve your sciatica pain on your own.
So the first step is actually just understanding what Sciatica is. The website ifixyoursciatica.com actually has a full explanation on what sciatica is, and what you can do to fix it. But if you are more of an audio/visual learner, this guide is going to be helpful, and I’m gonna walk you through literally every single step of the way.
So the first step is understanding what is Sciatica. Now sciatica pain, we have to learn that Sciatica Pain is actually an irritation of the sciatic nerve, and the sciatic nerve extends from your spine, and it goes down the back of your leg. But it actually originates over in the brain, because your brain is going to be the major center of where information gets processed when it comes to sensation, motor control, and just overall bodily function. So you have your brain, and then it actually extends down into your spinal cord, and your spinal cord runs down your spine, and it goes through in what we call innervates pretty much your entire body, and the sciatic nerve itself actually exits the spine. The nerve roots in the foramen of L4, L5, S1, S2, and S3. So it’s multiple nerve roots coming out, and they come together and they cross underneath your glute muscles, where it actually forms the sciatic nerve, and that sciatic nerve runs on the back portion of your thigh, and it actually splits into two major nerves once it gets to your knee which is going to be your Tibial Nerve, and your Fibular Nerve, also known as, in some cases, they call it the peroneal nerve. And the responsibility of the sciatic nerve is that it supplies a motor to your hamstrings, and also sensation to your hamstrings. But then also when it splits at your knee, it provides both motor and sensation to your lower leg, which is anywhere below the knee. So actions, such as getting onto your tiptoes, bending your knee, extending your hip, because it’s the hamstrings as well. Those are the functions that are gonna be influenced by the sciatic nerve. But then also from a sensation standpoint, it’s going to be the posterior aspect AKA the back portion of your thigh, but then also your lower leg as well because we’re looking at the irritation of the tibial and fibular nerves that are coming off of the major sciatic nerve.
So you have to determine: Are you actually experiencing sciatica pain? Because of the fact that if you look, sometimes people describe, “Oh, I have pain in the front of my hip that radiates the front of my thigh”. That is actually going to be another irritation of a different nerve. And so it’s not necessarily sciatica pain. But the great news is that, if you are experiencing back pain, pain in front of your thigh, those mechanisms are actually very similar to irritating the sciatic nerve. So a lot of things that we’re gonna be going over today can actually help those other things: back pain, front and thigh pain, and also hip pain. But really, the prime focus is to help out with the pain that you’re experiencing, which is sciatica pain that’s going to be on the back edge of your thigh, which could be your thigh or it could be your lower leg. So identify that right now, and just try to figure out where your pain is. And if you’ve been living in pain for a while, you absolutely know where your pain is located.
And then the next piece, the next step, once you identify, “Do you have Sciatica?”, is to actually identify the mechanism of injury:
- What happened that brought on your sciatica pain in the first place?
- Did you just wake up one day, and your sciatica or the back of your thigh or your leg was hurting you?
- Or you experienced weakness?
- Or was it like an actual incident?
- Were you in a car crash?
- Did you trip?
- Did you catch yourself?
Most people with sciatica pain, they noticed that their sciatica actually came on after sitting hunched forward on the couch for a long period of time. I love watching movies. So I know for me if I’m sitting in a slump forward position, when I’m watching any of the new Marvel movies, then I know that my sciatic nerve can actually get irritated as well. But this gives us an idea of what could impact, what can make it better, what can make it worse. And this is gonna be important because we have to get as much information as we can. And I know there’s so much information. I think there’s probably at least two million articles about Sciatica. So what is more information going to do other than confuse us? But what we’re going to do is take all the information and compartmentalize it. So you can literally address this one step at a time. So we have:
- Identifying – Do you actually have Sciatica?
- What is the mechanism of injury?
The next piece is going to be, we have to screen for red flags. Now, this is something that us Physical Therapists do depending on the state. Most states in the U.S. actually have this privilege called direct access, where we can actually see you without a doctor’s prescription, which means that we are actually the first line of defense for sciatica pain, for back pain, for a lot of physical therapy and pain ailments. But what that means is that it is our job to identify if there’s anything that is outside the scope of our practice. So when we screen for red flags, we need to see: Is the pain that you’re experiencing, is it actually caused by a musculoskeletal, also known as an orthopedic issue, whether it be your joints, your muscles, or a combination of both? Or is it something a little bit more sinister?
So a couple of things that you should be keeping in mind, which you can help screen yourself for red flags is:
One, have you had any sort of nausea or vomiting as a result of your pain? Have you lost or gained any significant amount of weight unexpectedly? Any changes in bowel or bladder function? That’s a very big red flag, that’s something that should be addressed by a physician. Also if you’ve noticed any sort of saddle anesthesia, which means that you have numbness in your nether regions or just complete numbness or loss of function in any one of your limbs. Those are things that actually require medical attention, and something that you should get assessed before you do any of the other things. So if you identify that you do have a couple of these red flags, then please seek medical attention immediately.
The next step is actually assessing posture. The reality is that posture, there’s no such thing as perfect posture. I do believe that there is an aspect of efficient and inefficient postures. And when you’re in a position for a long period of time, whether you be standing upright for a long period of time or whether you be sitting, you’re gonna be developing some aches and pains left and right, and it is important for us to incorporate a variety of movements and positions throughout the day. But this, assessing the posture just helps us understand what you’re gonna be more predisposed to. So the best way to assess your posture is by standing in front of a mirror, take your shirt off and look at yourself and be honest with yourself, don’t stand in front of the mirror and try to correct your posture from the get-go. Just stand the posture, give yourself a little shake and see where you’re at. Do you have a little bit more of a curve to your spine? Is your spine more rounded? Ultimately, if you look at yourself from the side or if you were to take a picture of yourself from the side, your body should make like a gentle S curve. If you’re looking straight ahead, your shoulder should be sitting on top of your hips. It’s a perfect opportunity to see it, “Are your shoulders shifted from one side to the other?”. Because the first thing, if you notice that there is some sort of off-balance from your shoulder position, we need to correct that first before you do any sort of other stretches. From there, we are observing, we’re clearing ourselves from red flags, we’re ensuring that we are in fact experiencing sciatica pain.
We now have to actually establish a baseline, because one of the biggest reasons why treatments fail is because the therapist, the clinician has failed to create a baseline for you. And when there’s no baseline, you can’t tell if you are actually in fact, getting better. So the key thing is a couple of different areas and a couple of different ways on how you can actually establish a baseline for yourself is actually first off. Describing the type of pain that you’re experiencing: Is it a burning pain? Is it a soreness? Is it sharpshooting? This will also give us an idea and be able to determine what is the initial cause of pain. Now if you’re experiencing, say, burning, pins and needles, maybe a little bit of numbness, that’s really more so related to nerve irritation. If you are experiencing more of a deep ache, deep ache can also be related to a nerve irritation as well. But a deep ache can also be related to muscles that are engaged for a long period of time. And then if you experience the sharp shooting pain, that’s something that we want to decrease as well. And then from there, you also want to look at the area of pain, the size of the pain, and where it’s located. Because once we establish that baseline, the key is changing that baseline so that you feel better.
And from there, the next step is to actually go through a little movement assessment and see how your body moves. Throughout this entire time, it’s gonna be important for you to identify what makes you feel better, what makes you feel worse, and what has no effect on your symptoms. And this is actually going to guide treatment. So at this point, I want you to actually write down. What positions feel better? What positions make you feel worse? Even if it’s a weird position such as laying on your stomach with your hips to one side actually reduces your pain, you actually have to write that down. Because that is going to guide your own self-treatment. But then we move on to a movement assessment. Now there’s going to be a couple major spinal motions that we should be assessing. It’s gonna be forward bending, backward bending, side to side bending, and twisting. What you’re gonna do is just see how you’re feeling in these positions, also look at what your range of motion is like. But then also, if your body is too stiff or you are in too much pain, and you can’t move, the first thing that you need to do is, just provide yourself a little bit of relief. So whenever I’m meeting with patients, whenever I’m working with clients, and they’re in too much pain to do anything, the first activity after I do a little bit of a questionnaire, is to have them go through some gentle breathing. When you’re going through an active cycle of pain, your body tenses up, your body is creating a lot, your body’s going through a lot of stress, which will actually intensify the type of pain that you’re going through. So we have to turn the noise down by incorporating breathing activity, and this is something that I really love myself, and this is something that I do when I’m stressed out, and it’s called boxed breathing. It’s developed by the US Navy Seals, it’s an opportunity for them to clear their mind and put them in a position to actually make hard decisions under very stressful situations. So with you, with us, as people who are living in pain, this is a very good way to just calm everything down. So my favorite technique, boxed breathing, is a very simple technique. All you need to do is get onto your back with your knees bent or whatever position that you find to be the most comfortable.
From there, there are four stages to the breathing cycle: you have your inhale, you have the transition, you have your exhale, and then you have the transition afterward. So each phase of breathing, you are going to spend four seconds at each period: it’s a four-second inhale, four-second hold, four-second exhale, four-second hold. And you do that for about 10 to 15 cycles, you’re gonna start to notice that your body is going to loosen up and feel a little bit better, and the noise is starting to turn down so you can do a little bit more activity. This is something that you can actually do on a very regular basis. Again, this boxed breathing technique is going to be particularly helpful if you aren’t in a lot of pain or if you are just very very stiff in general.
Once we kind of loosen things up and build an assessment of your movement, “Are you able to touch your toes? Are you able to lean backward?”, we then have to do just a quick strength assessment. Now in the Physical Therapy Clinic, I can actually check your strength by pushing on your body. But if you’re doing this yourself, you’re not gonna be able to get the necessary leverage to see, “Are your legs, are your hips, is your body actually strong enough?”. So at this point, when you’re doing a self-strength assessment, look back and see how are your legs functioning. Do you notice that with the onset of your pain, you’ve been stumbling more or that it’s harder to get up and get standing? Because those are indications that your nerve has been so irritated, that it’s also affecting your strength. And so, that’s another way to establish a baseline. And then as we establish the baseline, the key thing is understanding, “How do we know we’re moving in the right direction?”. We know that we are absolutely in the right direction when your pain goes away, right? And I wish everyone who had pain could do just one exercise and their pain disappears. But unfortunately, if you’re experiencing pain for a long period of time, it’s a little bit more complicated than that. But I promise you, as we’re going through these steps, it becomes more simplified.
So before we move on. Let’s review what we just talked about, we want to make sure that you first understand that you are in fact having sciatica, pain in the back of your leg, also in your back. But also the techniques will actually help with a lot of other back issues as well. But if you’re experiencing sciatic nerve pain, it radiates down the back portion of your leg. The next piece is clearing for red flags, making sure that what you’re experiencing is actually caused by a musculoskeletal injury. And then the next part is establishing a baseline, how are you feeling, what makes you feel better, what makes you feel worse. And then we do a movement screen to just see, where are we at from a flexibility standpoint.
Now let’s establish some criteria in regards to what’s gonna make you feel better or what does feeling better look like or feel like.
One, there’s going to be, you know that your pain is getting better when the intensity of your pain goes down. Now oftentimes, when it comes to pain assessments, we’re ranking the pain on a scale of 0-10. So if you are ranking a 10 out of 10 pain, and your pain goes down to a 9.5, you are in fact better. It might be a very small change but it is a change, and that’s the same thing, and we know that your pain is getting worse where it goes from like a seven to an eight, and that’s something that we want to avoid.
Another aspect of things are getting better is that the size of the pain area actually goes down. It becomes a little bit more localized and when it becomes more localized, that means that there’s gonna be a focal point that there is some sort of irritation and that we are heading in the right direction.
Another indicator is that the area of pain actually shifts closer to the midline, and this contact is what we call centralization of symptoms. It’s kind of like you have a tube of toothpaste, and as you push that toothpaste out, you need to roll up the edges a little bit so that you can use the entire tube. And that’s what’s happening when it comes to your symptoms, if you know that, if you’re feeling that your pain goes from your leg, and travels up towards your spine, and it’s much more localized in the spine, we are heading in the right direction. Even if your spine is killing you, but your leg isn’t.
And then the last piece is just seeing that the change in your symptoms, the change in your pain happens as well. So we have the entire spectrum of pain, where we have complete numbness, that means full-on nerve irritation, to no pain at all. And there’s going to be a slew of symptoms that you’ll feel, will help you identify, are you moving in the right direction or not. So this is how it works. On the most extreme side, we have complete numbness, we have complete weakness, loss of function, very very irritated nerves. And then from there, once we relieve the nerve a little bit of pressure, a little bit of irritation, we then transition onto, kind of like, pins and needles burning sensation. That’s where the electrical signals are traveling up the nerves, the nerves are kind of getting oxygen again, and they’re moving, and they’re like okay I’m working. But they’re not a hundred percent. The next thing is that we go from pins and needles. Maybe like a burning sensation, and then from burning, we go to more of like a sharp shooting, where it’s like, oh it’s much more localized, I can feel it, it’s much more specific. We then go from a sharp shooting pain and we transition on into what we call more of a deep ache soreness. And this helps us identify that the nerve is improving, because of the fact that it is evolving from a pain standpoint. We have that deep ache soreness, it’s just like, it doesn’t feel good. Then we transition on over into what we called, kind of like this heaviness type of feeling. A couple of the patients that I’ve worked with described it as if they were wearing a big stocking on their leg or just doesn’t feel the same as the other side. And that’s totally okay, because we are transitioning from complete numbness, irritation to no pain at all. And once you go from that deep heaviness, we can then transition on over into no pain.
The really cool thing about this pain cycle or this pain spectrum is the fact that you can actually skip a couple of different steps throughout that. So you can go from complete nerve irritation to complete function of your nerves., and that is okay, that’s fantastic. But knowing that you have that progression is going to be key to your recovery. So from there, we have to take a step back and look at what positions make you feel better, what positions make you feel worse. And this is why we actually start addressing the self-treatment. You’ve gotten a lot of information as it is, but then from here, we identify what’s going to make you better.
When you’re experiencing sciatica pain and you’re experiencing pain for a long period of time, the priority is to actually reduce your pain. One of the big challenges when it comes to treatment is when people say, okay you’re in pain, well your hamstrings are tight. Well, that’s just a really hard generalization because many people’s hamstrings are tight, and I’ve seen people who had sciatica pain with flexible hamstrings. So to be able to say that generalization, that makes it really really challenging, it makes it hard for you to recover. So we have to identify: your big priority is to reduce your pain, get your pain as close to zero as possible, and with that being the case, it’s not gonna be planks, it’s not gonna be all these other strengthening exercises. We need to make sure that whatever position you’re in is bringing your pain down.
So we have a bunch of different motions. We have forward bending, backward bending, side to side, and rotation. Each one of these will actually contribute to a piece of your pain, and each one of these motions will also help you figure out what is the cause of your sciatica in the first place.
So let’s talk about forward bending. If you were to forward bend, if you were to be sitting in a chair, sitting on a couch, bending forward to touch your toes. If you realized, that type of motion is actually really beneficial, it reduces your pain and makes your body feel a lot better, then your sciatica pain could actually be caused by some sort of arthritis in the spine. Arthritis isn’t a scary thing. In fact, it’s something that happens to all of us, it’s a normal process of aging, like wrinkles. But in some cases, that arthritis and development of bone, and inflammation, can actually cause issues at the spine. So when you bend forward, it actually opens up the spaces for your sciatic nerve, and can provide relief. If that’s the case, then focus on forward bending. You can sit in the chair, touch your toes, you can stand up and touch your toes, your hamstrings might be talking to you for a little bit. But that’s totally okay, if you know that it is relieving you of your pain.
Another very simple forward bending exercise is like that yoga pose, the Happy Baby. When you get onto your back and you pull your knees up to your chest, let those knees fall out and you’re really getting that spine to open up. Again, these motions will only help you, if it in fact actually relieves you of your pain. So if you notice that actually bending forward doesn’t provide any sort of relief, and in fact makes your pain a little worse, then I would say, hold off on bending forward for a little bit of time.
Which then brings us to the next motion, which is going to be a backward spin. So how do you know if backward bending is going to help you? Well if your pain is relieved by getting up from a chair, by standing up, laying flat on your back, then extension might actually be a much more beneficial position or stretch for you, as compared to forward bending. So what happens there? It could be related to a spinal disc. A couple of theories out there when it comes to spinal disc issues is that the disc itself in your spine is kind of like a jelly donut, and the jelly contents of that donut will move in the position of least amount of pressure. So if bending forward actually causes you to have a lot more pain, it is theorized that jelly donut is pushing out on one of those nerves that’s irritating your sciatica. So with that being the case, a really great backward bend exercise or stretch is what I call a standing back bend. When you put your hands on your butt and you lean back, kind of like you’re doing the limbo, which is like one of my favorite wedding dance songs, but something that you can do is doing a backward bend. In yoga, they call it like the baby cobra or even the upward-facing dog. And if extension makes you feel better, remember if it reduces your pain, if it changes your pain sensation, reduces the area of your pain, or even just completely resolves of your pain, then just focus on extension, backbends, press ups, and stuff like that.
Now, forward bending, backward bending, doesn’t help at all, the good news is that we have a couple of other motions that will help out.
One, we have side-to-side bending. Now, each direction will indicate what can actually be the cause of your sciatica, if you find out that if you lean away from your side of symptoms, and that actually causes a significant reduction in your pain, then we’re probably dealing with some sort of arthritis, where the space between your vertebrae, where the nerve exits, your arthritis can actually make that space a little bit smaller. And so, if you lean away from the side of pain, it actually opens up the area, provides more freedom for the nerves to move. And as a result, you have less nerve irritation. So if that’s the case, if leaning away from the side of pain actually helps, then focus on leaning aside, away from the pain. You don’t have to go to the other side, you don’t have to investigate other motions if you know that this one position makes you feel a lot better.
Now, if you lean to the side of pain, and it actually feels a lot better, then we’re probably dealing with possibly a disc issue in regards to when you lean into the side of pain. We can push the contents of the disc back into the vertebrae or back into the disc itself, resulting in less nerve irritation.
So as we’re going through this, we’ve done forward bending, backward bending, side to side bending, and if you find any one of those positions is actually causing you to experience a relief in pain, run with it. Ensure that you are going through it, and that you use this exercise on a regular basis so that your pain goes down. And remember, any of those positions that actually cause your pain to go up, avoid those positions for the time being until your pain goes down.
And from there, the next step is now, for example, side to side bending doesn’t work. We still have two more positions that we can do, which is going to be twisting.
Now, if you were to stand and you were to look over one shoulder, the really cool thing is the fact that you are doing some spinal twisting in your low back. But you’re also twisting your hips, also your shoulders as well. So keep in mind that happens, and if you were to rotate towards one side and that actually helps out significantly, what you can actually do is continue to rotate in that direction. If you actually rotate towards the side of pain, then you’re looking at possibly, a little bit more arthritic changes. Because we’re trying to open up the spaces for the nerves.
If you rotate away from the side of the symptoms, then we’re probably dealing with some sort of spinal disc possibly as well. But again, the structures themselves aren’t necessarily the most important, because we’re not treating, we’re not fixing the specific tissue that’s irritated, we’re treating your pain.
I want you to make a note that when you’re experiencing pain, it’s a 100% independent and unique to you, and it’s something that you’re experiencing. So the big thing is that fact that we are treating your pain, we’re not treating diagnosis, we’re not treating a specific tissue. But for some people, it could be helpful understanding what structures are being involved. It gives them a little bit more power to that.
So if you know that you’re turning towards one direction and it feels a lot better, focus on rotating to that specific direction, so that your pain continues to go down. So from there, you find your positions that actually make you feel better, and you do that. I usually recommend 10 repetitions, two to three times a day. And why ten repetitions? Well, ten is a good number. In fact, it’s actually just more so an arbitrary number for dealing with pain. You can do more or less depending on how you’re feeling. If you do one repetition and your pain is gone, awesome! Maybe do one more just ensure that the pain doesn’t go away. But in some cases, you might need to do 10, 15, 20 repetitions to really bring your pain down, especially when you’ve been experiencing pain for a long period of time. And then while you’re doing that is to really, for the time being, avoid those other motions that actually irritate your symptoms. And how do you do that?
One, just ensure that you don’t bend in that direction. But then also two, if you notice that a lot of your behaviors are actually facilitating you to be in these positions, make modifications so that you don’t have to bend forward or you don’t have to lean backward. Your body is telling you what it needs and it is very important for you to actually look deep inside and say, “What is making me feel better? What’s making me feel worse?”. And from there, there are a couple of other pieces to the puzzle in the event that, forward bending, backward bending, side to side bending, or even rotation doesn’t help you. But for a good 75% of people who are experiencing some sort of sciatica issue, this is actually a very good starting point, and you have some very useful information.
So if you get to this point and you don’t have all the relief that you want, it’s actually perfect timing to actually reach out to a clinician, whether it be a Physician, a Physical Therapist, or a Chiropractor, or even a Massage Therapist and letting them know what makes you feel better, what makes you feel worse. You’ll be able to save a lot of time trying to share some information with them because if you go into a clinic and say, I know what positions make me feel better. We can already start getting to work in helping you recover. Now, if you can’t find a Clinician in person, the great thing about virtual or the amazing aspect of technology is that you can work with professionals such as myself. Actually, regardless of location because of the internet. We can meet via zoom, we can meet virtually, and you can do this all in the comfort of your own home. So you don’t have to worry about scheduling, you don’t have to worry about leaving your home, you also don’t have to worry about spreading any sort of illnesses if you’re really concerned with that too. And the really big thing when it comes to your pain recovery is ensuring that you are focusing on how you’re feeling, on how you’re doing this all, and using your body’s cues, your symptoms, the behaviors of it to manage and drive your care.
So if you have any questions, email us, reach out, we’d be happy to help. But really, use this guide to your benefit and I hope this is of good use too.