Kelowna Manual Therapy Centre Blog

Sciatica - What it is and what to do about it.

Sciatica is a very common condition that affects many of us at some point in our life.  Sciatic pain is typically a sharp electrical pain or dull ache that radiates down either one or both legs.  The more swollen and irritated the nerve is, the further down the leg the pain goes.  Typically the pain is felt in the lower back, buttock and leg, though some only feel pain in their buttock and/or leg.  The sciatic nerve is the largest and longest nerve in the body.   It is made up of nerves from the 4-5th lumbar, and 1st-3rd sacral nerve roots.  Nerves are normally able to handle compression and stretching that is part of day to day living without causing problems.  Due to some traumatic event, or an unusual or prolonged activity, i.e. bending and twisting in the garden all weekend, or a long drive,  the nerve can becomes swollen (inflammation).   Sciatic pain is often associated with changes to the structure of the spine, i.e. degenerative changes such as degenerative disc disease, disc bulging and herniated discs, etc.  Though it is important to understand that these degenerative changes are not always the cause, many of us have herniated discs and will never know it!  The degenerative changes themselves are typically not enough to create the sciatic pain.  It is the overdoing what are body can handle that causes the problem.   The swelling is a signal for the brain to protect the area causing the back and/or leg to become painful and sensitiized.  The swelling and sensiitization can then make movements and postures of the back and leg very uncomfortable.

Sciatic pain is usually worse with either sitting or walking/standing.  Sometimes the pain is worse with both.  Sciatic pain can come on very suddenly or can be gradual in nature.  Sciatic pain maybe also present in signs of nerve compression like pins and needles, loss of feeling or loss of strength in the leg muscles.

Sciatic pain can typically be managed very well with a combination of manual physical therapy, activity/posture modification, time and medication.

The manual physical therapy first starts with a history taking to identify where the pain is, what has caused or is causing the problem, what you have found worsens or eases the pain, any other past medical history, medications, hobbies, sports, work, etc.

The physical exam will involve:

• Looking at your mobility to see if particular motions increase or decrease the pain.
• Testing the physical health of your nervous system.
• Palpation and mobility testing of the vertebrae.
• Testing movement and/or positions to determine which relieve or aggravate the leg pain.

Once the physical exam is completed treatment can be undertaken.  There is good evidence that Manual Physical Therapy will get you better more quickly.  Treatment can consist of:

• Manual therapy techniques directed at improving vertebral mobility to open the space or take pressure off the nerve.  
• Exercises designed to improve mobility, open the space for nerve and/or reduce tension on the nerve.  
• Education on pain management strategies, postures, sleeping position and activities to help reduce the pain.
• Physiotherapy modalities such as electrical stimulation, heat and ice to help with pain.  
• Lumbar traction can be performed in a variety of positions to help reduce pain.

At home it is important to:

• Be patient and relax.  There are lots of scary stories and words associated with sciatica i.e. 'slipped discs', 'pinched nerves', etc.  Our body does an amazing job in dealing with the stress and strains we put it through.  Our body and nervous system does well dealing with the natural wear and tear we go through as we age.  Sometimes we over do it, then we need some treatment and need to let things settle down.  The more stressed and anxious you are,  the worse the pain will be.  Deep breathing and progressive muscle relaxation exercises can really help.
• Find and use the positions and postures your manual physical therapist has suggested.
• Try to remain as active as the pain will allow. Some discomfort with moving around is normal. Research has proven that keeping active i.e. puttering around (stand a little, sit a little, walk a little) will allow you to get better quicker.  
• Find and use sleeping positions that will help alleviate the pain.
• Use ice and/or heat.  If the pain is less than 48 hours old use ice.  Use heat if the pain has been present for more than 48 hours. Heat can be in the form of hot showers, an electric heating pad, a microwaveable pad or hot water bottle.
• If the pain is constant you may benefit from anti-inflammatory medication.  If the pain is keeping you from sleeping you might consider a muscle relaxant.  If the pain is unbearable then you might consider a pain reliever. It is best to discuss this with your physician.

Lumbar Spinal Stenosis

   

Low back pain is a common complaint for people attending physiotherapy.  Quite often the pain is worsened with prolonged positions, especially sitting.  This may be sitting at the office, at home or driving.

All soft tissue is subject to ‘creep’, which is a gradual stretch of the tissue in prolonged positions.   An important part of the ‘creep’ phenomenon is that the tissue does not immediately go back to its normal state.  This ‘creep’ is thought to cause stress and inflammation to the tissue.

This was researched here: http://www.ncbi.nlm.nih.gov/pubmed/12832168

Our body is designed for movement, so no matter how good your chair is or how good your posture is you need to get up and move. It is recommended that at a minimum we should get up every 30 minutes.

Attached is a link from WorkSafe BC, which is a timer that can be installed onto your computer that reminds you to get up and get moving:
http://www2.worksafebc.com/Topics/Ergonomics/Resources-office.asp

Low back pain is a very common occurrence and is said to affect 80% of people at some time in their life.  Common causes of acute low back pain are sudden unexpected movements i.e. bending: lifting while twisting, or trauma such as a fall or a motor vehicle accident.

Others can injure their lower back simply if bending to brush their teeth.  The low back pain can come on instantly, with acute muscle spasm or locking.  Sometimes it is impossible to move or to straighten to an upright position.  Other acute low back pain can come on more slowly; up to 2 days post injury, as swelling gradually accumulates.

What to do

• Relax! No matter how bad the pain is it will get better.
• If the pain is less than 48 hours use ice, use heat if the pain has been present for more than 48 hours. Heat can be in the form of hot showers, an electric heating pad, a microwaveable pad or hot water bottle.
• Try to remain as active as the pain will allow. Some discomfort with moving around is normal. Research has proven that keeping active i.e. puttering around (stand a little, sit a little, walk a little) will allow you to get better quicker.
• If you are unable to move or if movement greatly increases the spasm then you may require more rest. See the sleep position article for some advice on the best resting positions.
• There is good evidence that Manual Therapy will get you better quicker. Research has proven that Manual Therapy performed in the first 16 days and when the pain is in the back and thigh is most effective.
• Pain radiating down the leg will also improve with manual therapy but might also require specific exercises and/or positioning to relieve the pain. Traction can be of benefit especially when the leg pain is radiating below the knee.
• Modalities such as electrical stimulation can be of benefit.
• If the pain is constant you may benefit from anti-inflammatory medication, if the pain is keeping you from sleeping you might consider a muscle relaxant.  If the pain is unbearable then you might consider a pain reliever. It is best to discuss this with your physician or pharmacist.

With the recent good weather and opening of golf courses many eager golfers are taking to the courses.  The number one complaint of both recreational and professional golfers is low back pain, especially as the season starts.

Part of the pain can be due to the unaccustomed activity, this pain should settle within a few days and works itself out during the first few rounds.  More concerning is low back pain that is a result of a golf game or practice session that lingers more than 2 days.  It is important to consider all factors when assessing low back pain in golf.

The factors that should be assessed are the biomechanics of the spine, golf swing mechanics, poor flexibility and conditioning as well as the training techniques utilized.

The golf swing requires high levels of bending and twisting forces.  Low back pain is more common on the ‘trail’ side of the low back. The ‘trail ‘side would be on the right for a right handed golfer. The ‘trail’ side is under considerable stress during the clubs impact with the ball due to the combination of compression and side bending.

The low back is under more stress especially with a ‘hip slide’, a steep swing plane and too upright a finish position.   Most improper swing mechanics that cause low back pain can be traced back to improper set up position and improper hip rotation.   Correct posture at ball set up is the first place to start.   Proper position would be; back straight with normal spinal curves, knees and hips bent to 25-30° and both feet turned out slightly. (See Picture Below)

A manual therapist can also assess and treat any mechanical problems such as stiff lumbar, sacroiliac or hip joints.  Tight muscles can be treated with soft tissue techniques and stretching.  An exercise program would also be taught to strengthen weak muscles, stretch overly tight muscles.  Basic golf drill exercises will be taught to correct the swing mechanics.  More complicated swing mechanics are best analyzed by golf teaching professionals.

Other things to consider while golfing are the importance of proper warm-up prior to golfing which would involve hitting balls at the practice range and gentle stretching.   If you use a cart it should be pushed around the golf course, except on downhills where it is safer to have the cart behind you.  If you chose to carry clubs you should use a lightweight bag with backpack type straps.