Sciatica Pain Relief

Sciatica Pain Relief Part 4: Treatment & Rehabilitation

As we gather to close out this series on Sciatica, talking this time on what care looks like in our office when someone presents with Sciatic Nerve pain, you will recognize some similarities from the previous Sciatica-related articles. That is because rehabilitation for Sciatica is similar to the self-care and prevention exercises we shared previously. So…if you haven’t taken a look at our Sciatica Pain Relief series parts 1-3, click the links below and check them out. Our goal is to have you work through those modules before seeking care. You will often find that spending a week on the exercises we shared, might relieve your pain, and if maintained with some frequency, may prevent future occurrences. Nevertheless, if you are here, are located in Salt Lake City and the surrounding area, we are here to help.


Treatment surrounding Sciatica takes on two parts: (1) Addressing the low back, regardless if low back pain is present and (2) Addressing the posterior hip, associated musculature, and its interaction with the sciatic nerve. One of these (#2) we can affect directly and often provide immediate relief. The other (#1) can be addressed by focused and modified daily action, joint mobility, decreased muscle tension, and…TIME.

Let's start with the low hanging fruit here. We have already discussed the association of the Sciatic Nerve and the muscles of the posterior hip. When it comes to treatment, our goal is to enact a change as fast as possible. We hope that patients come in having already tried stretching rolling, and increased movement to decrease the tightness and tension of the muscles in the back of the hip. From there, our job is to change the tissue in ways most can not do themselves.

Our typical treatment here is a combination or assisted progressive stretching, active and passive myofascial release movement, and dry needling…almost always dry needling.

To help understand what these treatments look like, check out these video demonstrations. These treatments have proven extremely effective in assisting patients to recover quickly from sciatica and sciatic nerve issues.


When it comes to rehabilitation, it is essential to understand that for the majority of people, even though the sciatic nerve radiating pain down the leg may have come on suddenly, it most likely took months to get to that point, leaving us with a bit of chronic muscle tension to address. THIS TAKES TIME.

When helping patients with their home care exercise plans, we look to address two areas, (#1) The Lumbar Spine, (#2) The Posterior Hip Muscles. If your problem is primarily in the hip/thigh region, exercise and daily life modification (usually sitting less) will bring quick and lasting relief. If your problem is primarily in the lumbar spine, our goal is to keep you as mobile and active as possible while the injury heals. Again…TIME.

POSTERIOR HIP MOBILITY


NERVE FLOSSING: Sciatic Nerve

 
 

LUMBAR SPINE MOBILITY & STABILITY

 
 
 
 

Sciatica is a common complaint, with a wide variety of causes. If you worked through our Sciatica Relief Series here and are still dealing with radiating leg and low back pain, please reach out to us with questions or come in for a consultation to further discuss your condition. If we can help you, we will let you know; if we can’t, we will get you to the best provider for your case.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Sciatica Pain Relief Part 3: Self-Care & Everyday Actions That Make Sciatic Pain Worse

If you are tracking along with us on this journey of everything Sciatica, your patience and dedication is about to be rewarded. In Part 1 of our Sciatica Pain Relief series, we discussed what Sciatic Nerve pain is and the associated anatomy (always my favorite part). In Part 2 we went a little deeper with the 5 most common causes of Sciatica and touch on a few of the red flags we want to rule out as soon as possible. Having made it through those two very information-heavy articles, it is time to look at what YOU can do to improve your situation as well as some of the most common everyday actions that may be the primary cause for your Low Back and Sciatic Nerve pain.


EVERYDAY ACTIONS CONTRIBUTING TO SCIATICA PAIN

SITTING:

To some, sitting may seem like a crazy thing to make sciatica worse. However, for those who experience this daily, it is a very real thing. To put this simply, sitting compresses the muscles of the posterior hip, possibly putting pressure on the sciatic nerve. Also, the position of sitting puts tension on the entire posterior chain (back, hip, glutes, hamstrings) potentially irritating the sciatic nerve at the spine, hip, or back of the thigh. Many people with sciatica report finding relief by standing and walking around.

Low-Back-Pain-Sciatica-Relief-Utah-Sports-Chiropractor.jpg

TRAVELING:

Traveling is similar to sitting in that you take the nature of sitting and compressing the sciatic nerve, and add in the cramped, tight situation of traveling on a plane or car. In addition to this, a hotel bed, or worse, your second cousins blow up mattress in their spare bedroom is not making the situation any better.

EXERCISE ROUTINE:

Many patients will relate that exercises such as squatting, deadlifting, and rowing can cause their sciatic nerve pain to worsen. The end range of these exercises, tension on the sciatic nerve, and the repetitive nature of exercise all create the perfect storm to irritate a long-standing sciatic nerve issue.


HOME CARE OPTIONS FOR SCIATICA PAIN RELIEF

While many sciatica cases require some formal care, all can benefit from frequent attention through home and office-based stretches and exercises. Below are some of our favorite ‘moves’ to help relieve sciatica pain. The truth here is that sciatica relief and recovery takes time, effort, and focus. Do a stretch one or two times is not enough. You may need to perform one of these every hour. You may have to modify your workspace. Guidance here is one aspect of care in our office but the responsibility to complete these is on the patient. Simply put, the more you focus on care outside of our office, the faster your issue typically resolves.

*NOTE: If any of these stretches increase your symptoms, stop and seek professional care. These exercises are not intended to diagnose any condition. Understanding of these exercises and the prescription of these should be performed by a trained provider.

Seated Sciatica Relief - 2 Best Chair Stretches

Best Sciatica Stretch - Utah Sports Chiropractor

Sciatica Self Release - Foam Roller & LaX Ball

Flexion & Extension For Low Back & Sciatica Relief


RISKS & CONSIDERATION WHEN DEALING WITH SCIATICA

RED FLAGS:

We discussed these in Part 2 of our Sciatica discussion. They are worth reviewing, and if you are experiencing any abnormal or rapid increase in symptoms, professional care and imaging are most likely needed.

Sciatica-Relief-Sitting-Standing-Chiropractor-SLC-Utah.jpg

STRETCHING:

Something as simple as a hamstring stretch can light up your sciatica like Christmas. As we work through rehabilitative exercises and stretches, gradual progression is a must. Just like any other injury that involves peripheral nerves, more stretching is not always better. Stretching into the pain, or the discomfort zone, when dealing with a nerve issue will likely exacerbate the condition. Start with the above demonstrated exercises, and take it easy!

OCCUPATIONAL & LIFESTYLE MODIFICATION:

Imagine your workspace. Without going through an extensive ergonomics evaluation, what can you change to help your sciatica? Are you able to stand up and work? Do you have a water cooler to frequent? Can you set an alarm on your phone to remind you to stand up and stretch every hour? It is this type of lifestyle modification that is the long game portion of real sciatica relief.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Sciatica Pain Relief Part 2: Common Causes of Sciatica

In part 1 of our Sciatica Pain Relief series, we covered the basics of sciatica, sciatic nerve pain, and the general anatomy involved. While this may not interest everyone, it is useful in understanding the sharp, burning, and often debilitating pain that radiates down the leg that some people experience with low back pain. Our goal in this series is to inform, empower action, and give our fellow Salt Lake City, Utah friends the information and tools to help yourself through this condition as well as the understanding of when to seek care and a trusted source to do so if needed. In part 2, we are going to briefly discuss some of the most common causes of sciatica but before going forward, check out part 1 by clicking the button below.


TOP 5 COMMON CAUSES OF SCIATICA

1) Disc Buldge - Intervertebral Disc Compression

Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

Starting with the most common cause makes sense as this is what most literature supports and what most people fear when they have some incident or trauma that leaves them with sciatic nerve pain shooting down their leg. A disc bulge is just that, an outpouching, or bulge, of the disc (compressive and supportive tissue between each vertebrae that acts as a shock absorber and allows for movement of the spine) which then presses up against the spinal cord or a nerve as it exits the spinal column. Compression here can be mild to severe, bringing with it anything from pain, numbness, and tingling, to complete weakness of the muscles and limb supplied by the nerve being compressed.

Note: If you are experiencing the latter of those, please seek help immediately as progressive weakness is a red flag and often requires immediate imaging and intervention.

Now, the debate is out on this as disc, and other lumbar spine pathologies are considered somewhat normal. Chances are, before the injury or event that left you feeling this way, the disc bulge was ALREADY PRESENT! This event just aggravated it enough to cause pain.

For Review: Check out the chart in this article we did on spinal imagining and what the best, most current research supports. You will find that most people are walking around with ‘back issues’ with absolutely no pain or quality of life disruption.

THREE THINGS TO KNOW ABOUT SCIATICA & DISC ISSUES

  1. You are not your image. Chances are, your MRI will show things that were already present and may not be the primary source of your sciatic nerve pain.

  2. A true disc injury and resulting sciatica take time to heal. The body will do most of the work. Chiropractors and therapists are here to help with symptoms, function, and assuring you are in the best position to heal. There is NO magic pill for this, TIME heals.

  3. If you are experiencing sudden weakness or progressive numbness that does not let up, seek care immediately as intervention is most likely needed to assure permanent damage is not experienced.



2) Lumbar Spine Stenosis - Canal & IVF Narrowing

Sciatica_SciaticNervePain_LowBackPain_SLC_Utah_Chripractor.jpg

Similar to a disc bulge, Sciatica related to Spinal Stenosis is a physical compression of the nerve roots that make up the sciatic nerve. However, this is more of a slow growing, progressive problem. In most cases, these do not wake up in severe pain overnight, these patients report constant discomfort, on-again-off-again radiation of pain, slow loss of range of motion, and typically do not have a time or event to relate a start of the pain.

As we age, the spine and discs degenerate. In the disc, this happens by a loss of height, dehydration, and loss of flexibility of the tissue. In the spine, and other high-stress bone and joint areas, degeneration happens by bone growth, bone spurs, and rigidity of the joints. This degeneration can cause enough of a response that bone will grow around areas where nerves pass from the spinal cord to the rest of the body (Intervertebral foramen or IFV) taking an already small space and slowly closing it down.

3) Piriformis Syndrome - Posterior Hip Tightness

We hit on this at length in the first part of our sciatica series. The relationship between the sciatic nerve and the piriformis muscle is well established. Most people have a sciatic nerve the tracks superficially (toward the surface) over the top of the piriformis muscle or just inferior to it. However, there is an appreciable percentage of the population where the sciatic nerve or a branch from it, pierces the middle of the piriformis muscle. It is believed to be the main culprit of 2-12% of sciatica pain with research on both sides stating over and under-diagnosis. Either way, anatomical and occupational variants are common causes of sciatic nerve pain as well as low back pain.

 
Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

 

4) Double Crush Syndrome

Double Crush Syndrome, many of the cases we see fall into this category. Let me explain.

A patient presents after a fall, accident, or just a bad nights sleep with a chief complaint of sciatica with low back pain. An exam reveals a limited range of motion in the lumbar spine, tightness of the muscle in the posterior hip, namely the piriformis muscle, and numbness and tingling down the leg. Let's say that an MRI was ordered and it revealed a mild to moderate disc bulge.

Crush One - The disc bulge, assumed to be caused or irritated by the incident, it mildly compressing the nerve. Crust Two - In response to this injury, the body goes into defense mode and muscles begin to tighten, namely those of the posterior hip.

The initial compression at the spinal level causes a 3/10 pain, when you add in the tightness and compression at the hip, the patient is now up to a 7/10 pain with shocks of pain during specific movements. This is a Double Crush.

As with most, the disc issue is hard to affect with treatment directly, but focus can be directed toward the hip muscles, proper movement of the area and exercises to help with mobility and pain are prescribed, bringing the person back down to a 4/10 pain and allowing them to maintain most daily activities while the disc heals…remember, TIME heals discs.

5) Pregnancy

While this is not a diagnosable cause of Sciatica, sciatica is a very common complaint from expecting mothers. The cause here can be as elusive as any other, but pregnancy, the position of the baby, and the mothers specific size, anatomy, and lifestyle habits and experience with sciatica pain before the pregnancy. While there are many unknowns here, sciatica pain typically affects mothers-to-be in the latter half of the pregnancy, and most will respond to conservative care.

RED FLAGS

SciaticaPainReliefRedFlags_Utah_Chriopractor.jpg

Sciatica is a very well described condition. The direct cause can be challenging to uncover, but there are a few things to be aware of if you are suffering from sciatic nerve pain. If you are experiencing any of the below items, we suggest you seek care immediately to assure the condition does not cause long term issues and to direct you to the right healthcare provider. Most cases can be managed conservatively (Chiropractic, Physical Therapy, or At Home) while others require medical intervention (injections, imaging, or surgery).

  • Progressive neurological symptoms. If you are experiencing numbness, tingling, or weakness that is worsening, please seek help from a trained provider.

  • If your injury is the result of a fall, auto accident, or home/work accident, consulting with a healthcare provider will help rule out any significant issues and speed our recovery.

  • As with other serious low back injuries, if you experience any loss of bowel or bladder control, this is an immediate ER referral.

  • If you have have been dealing with sciatica for more than 1 week without any relief, it is time to get help. Most self-resolving injuries and pain will let up after a couple days.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.