What can I do for sciatica?

11/02/2014 By Den

 

Craig Liebenson, D.C.

L.A.   Sports & Spine, 10474 Santa Monica Blvd, #304, Los Angeles 90025, United States

Sciatica is a very common disabling condition frequently caused by a bulging disc compressing a nerve at the base of the spine. Sciatica involves pain, numbness or tingling down the back of the thigh and leg. There may be some low back pain, but there is usually more leg than back discomfort. There can even be weakness in the leg. Unfortunately, it can persist for months at a time and while rest is often prescribed this may actually do more harm than good (Abenheim et al., 2000; Deyo et al., 1986; Malmivaara et al., 1995).

Sciatica is usually aggravated by sitting, driving, bending forward, or lifting (see Figs. 1 and 2). A step-ladder approach to treatment is the best advice. Always begin by seeing your physician to confirm the diagnosis. Remember to avoid what harms you! This usually means don’t sit for longer than 20 min without getting up, and for most cases avoid bending forward, especially in the morning (Cholewicki and McGill, 1996; Snook et al., 1998; McGill and Brown, 1992). This will “spare the spine” and prevent further irritation to the nerve.

Sciatica what can I do What can I do for sciatica fig 2 bending forward

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The second step is to gradually bring the spine back into alignment by arching it (see Fig. 3). The yoga sphinx posture is ideal and can be progressed to the cobra pose or press-up. These may be uncomfortable in your back, but should relieve any leg symptoms (Long et al., 2004; Albert and Manniche, 2012). If they increase your leg symptoms then you should avoid them.

What can I do for sciatica fig 3 spynx posture

The third pillar of self-care for sciatica is to try to mobilize the nerve by gliding or sliding it back and forth without stretching it at all. This is called a nerve mobili- zation or sciatic slider (Neer and Butler, 2006). It should never be painful and in fact should immediately make bending forward better tolerated.

 

The sciatic nerve slider

  • Begin in a seated position
  • There are two basic phases of the nerve mobilizationWhat can I do for sciatica fig 4 sciatic nerve slider

 

Phase 1 (see Fig. 4)

  1. 1. Lift your head up until your are extending your neck and looking up to the ceiling
  2. 2. Stick out your chest until you are arching your lower back
  3. 3. Raise the leg that is affected by sciatica until the knee is straight and your toes are pointing up towards your knee.
  4. 4. Remember  none of these movements should increase the sciatic or back pain.

 

 

Phase 2 (see Fig. 5)What can I do for sciatica fig 5 sciatic nerve slider phase 2

1. Drop your leg fully until it is dangling

2. Bend your neck forward until your chin is against your chest

3. Allow your lower back to round forward into a slightly slouched position

 

Repetitions

  • Perform 12-20 slow repetitions

 

Sets

• once

Frequency • Perform 4-6 times/day

Duration • 1-2 weeks

Symptoms should improve with the slider. If they don’t be sure to consult an appropriately trained physician.

References

Abenheim, L., Rossignol, M., Valat, J.P., et al., 2000. The role of activity in the therapeutic management of back pain: report of the International Paris Task Force on Back Pain. Spine 25 (4), 1Se33S. Albert, H.B., Manniche, C., 2012.

The efficacy of systematic active conservative treatment for patients with severe sciatica. Spine 37, 531e542. Cholewicki, J., McGill, S.M., 1996. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin. Biomech. 11 (1), 1e15. Deyo, R.A., Diehl, A.K., Rosenthal, M., 1986.

How many days of bed rest for acute low back pain? N. Engl. J. Med. 315, 1064. Long, A., Donelson, R., Fung, T., 2004. Does it matter which exercise? Spine 29, 2593e2602. Malmivaara, A., Hakkinen, U., Aro, T., et al., 1995.

The treatment of acute low back paindbed rest, exercises, or ordinary activity? N. Engl. J. Med. 332, 351e355. McGill, S.M., Brown, S., 1992. Creep response of the lumbar spine to prolonged flexion. Clin. Biomech. 7, 43e46. Neer, R.J., Butler, D., 2006.

Management of peripheral neuropathic pain: integrating neurobiology, neurodynamics, and clinical evidence. Phys. Ther. Sport 7, 36e49. Snook, S.H., Webster, B.S., McGorry, R.W., Fogleman, M.T., McCann, K.B., 1998. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. Spine 23, 2601e2607.

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E-mail address: craigliebensondc@gmail.com.