Sciatica, Herniated Disc and Back Pain


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.