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Sciatica, Herniated Disc and Back Pain

Sciatica
Sciatica

Searching for help and the right treatment for sciatica, back pain or a pinched nerve? (Your nerve isn’t really pinched though it may be compressed from a herniated disc.) Sciatica can be an irritating,  painful, sometimes scary, condition. I want to reassure you that it is possible to find effective treatment to manage and heal your sciatica – at least I’ve found this to be true in my 20 plus years working as a NY physical therapist, specializing in neck pain, spine pain and sciatica.

Do you have the hallmark signs of sciatica: pain, numbness, burning or tingling anywhere from your low back to your hip or further down your leg, even all the way to your toes on one side of your body? Do you have trouble walking, sitting, or exercising because of it?

Since sciatic nerve pain is most often associated with back pain, and since the causes of low back pain are not crystal clear, neither is the cause of sciatica. If you have a history of back pain plus radiating leg pain, has your doctor performed an MRI and found you have a bulging disc or herniated disc? Were you diagnosed with lumbar radiculopathy?

Physical therapists and other medical professionals describe sciatica as a set of symptoms, not a clearly defined disorder. When a patient comes in for treatment of her sciatica, a number of questions run through my mind. Is her low back pain or sciatica caused by a bulging disc or herniated disc? Does the pain arise because of an irritated or stuck facet joint (other joints on each vertebrae)? Or is her sciatica caused by inflammation or irritation anywhere in the low back or along the sciatic nerve in that one leg? Does she have arthritis in the spine or osteophytes? Does the pain arise from a biochemical reaction to injury? Or did she develop sciatica and/or back pain after taking a fall or some other compression injury to the buttocks? Even a tense muscle can pull the spine in such a way that you experience nerve impingement. Did you know that stress and how you work with it can be a huge contributing cause to pain? Then might you want to choose a physical therapist who, in addition to giving you the best treatment possible in nyc, also gives you the time and gentle care you need so you can work through all of the factors contributing to your pain and stress?

Sciatic pain can also be because of a tight or injured piriformis. This is called piriformis syndrome. What this means is that the piriformis muscle, a muscle deep in the buttocks, may be pressing on the sciatic nerve because of your structural anatomy or because you slipped and fell on your buttocks, or because the piriformis is overworked and tight, as can happen with dancers with overworked turn out. Most of the time, both in my experience and in the medical literature, the sciatic pain in your leg originates in your low back. The piriformis muscle is likely to be tight or implicated at the same time and needs to be treated as well.

Maybe you and/or your health care providers have thought that the pain in your buttocks was a hamstring pull, or the pain in the back of your ankle was achilles tendonitis. The missing link in treating plantar fasciitis may be related to the lower branches of the sciatic nerve. Is it possible you have a hip, leg, ankle or foot issue AND the nerve somewhere in the leg is out of whack? Oh yes. I have encountered this so many times in my physical therapy practice.

If you are treated for any of these seemingly unrelated injuries – a pulled hamstring, calf, achilles tendon, or plantar fasciitis – and the problem still lingers, you might want to consider seeing a physical therapist who is knowledgeable and skilled at treatment of peripheral or, in this case specifically, sciatic nerve pain.

Again, stress can be a huge contributing factor in chronic pain. Huge. Most of us intuit this, but we don’t know what to do about it. We also know that stress affects us physically, emotionally, mentally, or spiritually. Did you know that even your beliefs about pain can affect its intensity and duration? The question is how do you work with the stress which may be exacerbating your low back pain, lumbar radiculopathy or sciatica?

This is where Yoga Physical Therapy in NYC comes in. In one-hour private  sessions, you learn to become aware of the stress in your body and then how to work with it. Your insights into your stress are gold. Here, you will be instructed in different strategies for relaxation and mindful breathing. A mashup of gentle, targeted exercises – from yoga, Feldenkrais, dance, and physical therapy – are prescribed for their healing effects. By learning to breathe with and into the pain during these gentle exercises, you are doubly empowered to decrease and manage your own stress and your pain.

What are other best treatments for sciatica and back pain? Look for a physical therapist who knows neurodynamics, also known as nerve flossing or neural glides, who knows about nerve massage, which together can be super effective in easing the sciatic pain. Gentle hip stretches are among the first exercises to do to soothe and open the body and mind. Maitland’s spinal mobilizations are hugely effective. So is myofascial release to the trunk, hips and leg. Often yoga poses, like sphinx and cobra, are effective in the treatment of bulging and herniated discs. They don’t work for everybody. If they are the right treatment for you, they can help decrease back pain and stiffness as well as relieve pressure on the sciatic nerve.

Each patient is unique and requires different treatment strategies. Therapeutic exercises need to be carefully chosen and monitored to see how they work for you at each stage of healing. I think of each exercise, carefully taught using a mindful breath, as a discreet dose of medicine. These exercises, knitted together with your ongoing feedback, are designed to ease and heal what hurts. Your feedback, questions and preferences are consulted at all stages of treatment. You set the tone and pace of your physical therapy, not the therapist. Not the insurance company.

As most cases of sciatica, or lumbar radiculopathy, arise from the low back, the spine needs to be evaluated and treated. I find a gentle, thoughtful approach is best. Effective physical therapy treatment will work first to decrease the pain. There are stages of stretching and strengthening which come next. But first I’m concerned, as I imagine you are, too, with finding the fastest and best ways to decrease your pain.

Sharon Gary, a NY physical therapist offering the best treatment practices in midtown Manhattan, will work with you one-on-one in private one hour sessions. Using these effective healing treatments, strategies and techniques, her approach with Yoga Physical Therapy has helped many people with herniated discs, low back pain, lumbar radiculopathy and sciatica.

 

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Tips and Help for Surviving Neck Pain in NYC

Did you just wake up one morning with neck stiffness, neck pain? Or did you have a stabbing sensation around your shoulder blade and you can’t turn your head? Do you feel pain radiating to your shoulder, deltoid, wrist or hand? Chances are that these symptoms start in your neck.

Here are strategies to get through it and back to feeling great.

First, try to identify the cause of your neck pain. Did you sleep in an awkward position? Did you overexert yourself the day before? Spend too many hours at the computer leaning into the screen slumping in your chair?

Next, reach out to someone in your network to help you — a good massage therapist, acupuncturist, physical therapist, doctor or physiatrist.

Rest lying down on your back with head on a low pillow. Apply a moist heating pad for 20-30 minutes. Longer if you have the time. Constructive Rest, breathing and meditation can be extremely helpful. It is amazing how much mindful  breathing in a supported position can melt away overall body soreness and tension.

Feldenkrais arm movements. Make the arms into a shelf by holding onto the forearm/wrists perpendicular to the torso. Keep a loose hold on both wrists and let the arms fall to the side. Breathe. Breathe deeply. Alternate sides 3x. These are my favorite neck exercises, which really help with neck pain.

Exercise Balls. I have nubby balls, and balls made with spikes to dig into the trigger points. Get some small balls to place under your shoulders, neck or back to dig into the painful or tight spots, wherever they help with the pain. You will want to use balls smaller than tennis balls. Golf balls are the perfect size but much too hard. You can probably find a rubber sports ball that’s the perfect size in your the gym section of big box stores or in a local sports store. Rubz for instance should be perfect.

Heat or Ice for at least 15-20 minutes. Different people respond differently to ice and heat. If you have an electric heating pad with a sponge for moist heat, or a microwavable heating pad, lie on it for 15-20 minutes, longer if you have the time. If you prefer ice and have gel packs, great. If not, many use a large bag of frozen peas or corn as an ice pack. You can also make your own by throwing 8-12 cubes of ice into a drip free plastic bag. If using ice, be sure protect your skin with a moistened towel.

Finally, don’t forget to take an anti-inflammatory medication, depending on your beliefs about medication. Your doctor may recommend something – use what works best for you. Many people swear by ibuprofen (Advil, Motrin and store brands). Or you might prefer Naproxen, aspirin or Tylenol. There are any number of topical creams or patches from the drugstore that may help. A homeopathic cream with arnica used by many people is Traumeel. If you live near Chinatown, you can find some great remedies there. Take something that works for you that will take the edge off the pain so you can begin to work your way through it. Tumeric is known to be good for pain. Lavender and chamomile teas before bed are relaxing.

Another tip. Paradoxically, I have found hip stretches to be great relievers of neck pain — secretary stretch, hip stirs, knee-to-chest stretch and the wonderfully relieving figure-4 stretch (sometimes called thread-the-needle).

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The Best Way to Relax

When you are suffering from neck, back, hip or shoulder pain, even if you’re just plain tired, Constructive Rest, practiced just 10 minutes a day, is the way to go.

Constructive Rest, pictured below, is a resting position of the body, in which the arms and legs are supported rather than held by the muscles of the neck and spine. By relieving the spine of the weight of the legs at their articulation with the trunk, the pelvis, trunk muscles, fascia and internal organs are also given a chance to rest. As the weight of the arms across the chest presses into the articulation of the shoulders where they meet the trunk, chronically tight and overworked neck, shoulder and back muscles are given an opportunity to reset, too.

Basic Position: open your feet hip-width apart with the heels outside the toes in a slightly pigeon-toed position. Let your knees fall together so your legs support one another. Cross and drape your arms one over the other, resting them on your chest like empty coat sleeves. Your hands should be relaxed and open, falling off the arms.*

In The Thinking Body, Mabel Todd, who originated Constructive Rest, recommends it for “relieving the spine from strain of leg weights and favoring a return of blood to heart.”² She describes how, throughout nature, cycles of work are always followed by a dynamic pause, or rest. Different from sleep, these dynamic rest periods are intrinsic to life — from the tiniest cells to the heart, lungs, digestive and neuromuscular systems. The moment of rest and silence in the lub dub of the heart is when the heart’s atrial chambers fill with oxygenated blood in preparation for the next squeeze of the heart, which then sends newly oxygenated blood out to each and every cell in the body. It is a dynamic pause.

Lulu Sweigard, a student of Todd’s, wrote in the Human Movement Potential that “the distribution of its structural weight should balance the body so that no muscle work need be added to maintain equilibrium in the position.”³ What we are seeking to accomplish with Constructive Rest, then, is to bring the body into effortless mechanical equilibrium.

Constructive Rest creates an opportunity for the spinal curves, from head to tailbone, from left to right, to relax and lengthen onto the even surface of a supportive ground. Tense muscles, tissues, joints and organs throughout the body can relax and literally unwind from the demands of maintaining an upright position against gravity.

Remember, the point is to be absolutely comfortable and use as little muscular effort as possible to maintain the position. If you don’t find this position comfortable, perhaps another variation on Constructive Rest might work better for you.

Practicing Constructive Rest only 10 minutes a day has delicious effects. By supporting your body in dynamic relaxation, you can unwind from pain and fatigue while you tune into your breath and your body, relax and let go.**

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NOTES AND REFERENCES

* Try not to forcefully bend your arms or hold your arms in place by gripping with your hands.

** Other benefits may be similar to those of meditation and yoga where lowered stress levels, decreased anxiety, lower blood pressure, decreased heart rate, improved mood and energy levels are well documented. However, to discuss these bonus effects is beyond the scope of this article.

¹ Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.

² Todd, Mabel Elsworth, The Thinking Body: A Study of the Balancing Forces of Dynamic Man,  Dance Horizons, Incorporated, 1937, p.290.

³ Sweigard, Lulu E., Human Movement Potential: Its Ideokinetic Facilitation, Harper & Row, Publishers, Inc., 1974, p. 216

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Variations on Constructive Rest

In a previous blog post, The Best Way to Relax, I described the many benefits of Constructive Rest. Here, I wish to offer a few variations on the basic position, pictured at left. At different times, or because of your body type, you might find one of these variations more comfortable. And comfort is what we’re looking for here.

  • Try placing a small pillow under the head if you have a deep chest (thoracic kyphosis) or forward head. If you notice your chin is pointing towards the ceiling and your head is cocked back, you need a pillow. If you simply feel strain in your neck or back, try a pillow. It should be as small as possible to comfortably support your head and neck. The goal is to support your body’s neutral alignment in a comfortable, balanced way so that you can let go of all muscular holding.
  • If the backs of the hips are tight (this is true for many men), try lining up your knees with your hips and ankles rather than trying to force the knees together. Then cross the arms over your chest. If your legs stay in place on their own without drifting to the sides or falling open, this may be the optimal position for your body.
  • If you have a large chest, or if for any reason you are simply uncomfortable crossing your arms over the chest, try resting your arms about 45 degrees away from the trunk of your body with your palms facing up. Allow the weight of the arms to release into gravity.
  • You can loosely tie your thighs together with a scarf or theraband to keep legs from falling open.
  • If the floor feels hard or uncomfortable, try putting more padding down.
  • Sometimes a small pillow placed under the pelvis or low back may feel good.
  • Another approach to Constructive Rest is to prop the legs, bent 90 degrees at the hips and knees, onto a chair seat or sofa. Open the arms out to the sides, palms up, or cross your arms across your chest as in the basic position.

Whichever adaptation you choose, try lying in the same position for 10 minutes a day for a few days. Notice the difference in how you feel.

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* Image provided by Ann F. Cowlin, Yale University, and Dancing Thru Pregnancy.