Sciatica – Symptoms, Causes and Treatments

Sciatica is painful and can be debilitating.  Up to 40% of the population will experience sciatica at some point in their lives.  But, what is sciatica, really?  Is the cause always the same?  Do other conditions mimic sciatica’s symptoms?  Is there help?

We’ve all heard of it.  If you’ve ever experienced it, you don’t want it back.  Sciatica is painful and can be debilitating.  Up to 40% of the population will experience sciatica at some point in their lives.  But, what is sciatica, really?  Is the cause always the same?  Do other conditions mimic sciatica’s symptoms?  Is there help?

What is sciatica?

Sciatica is a term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve from the lower back to the buttocks and leg. The medical term is lumbar radiculopathy.

The vast majority of sciatica symptoms result from lower back disorders between the L4 and S1 levels that put pressure on or cause irritation to a lumbar nerve root.

Most commonly, sciatica is caused by a disc problem, such as a herniated disc that is pressing against a nerve root.

It can also occur when a disc degenerates, which releases inflammatory proteins that irritate the adjacent nerve. There are many additional causes of sciatica.

Causes of Sciatica

Lumbar radiculopathy is a separate disorder from piriformis syndrome, although the symptoms may be practically identical.  The most common cause of sciatica is a disc problem, such as a herniated disc pressing against a nerve root.

sciaticaOther causes include degenerative disc and/or joint disease; spinal stenosis (a narrowing of the spinal canal); sacroiliac joint dysfunction; spondylolisthesis – a medical condition characterized by the slipping of a vertebra forward over the vertebrae found below; ankylosing spondylitis – an uncommon type of arthritis that can affect the vertebral column and the pelvis in which the bones of the spine tend to fuse together leading to a rigid spine; muscle strain; piriformis syndrome; pregnancy; poor posture,  spine trauma in the past, as well as remaining in certain positions for many hours during the day while working are all predisposition factors for back problems, including sciatica.

Because the causes of sciatica are different in every patient, the treatment for this muscle straincondition will also be different.  Regardless of the cause, however, sciatica will affect the surrounding musculature, which can worsen the symptoms.

Treatments

Some cases of sciatica resolve themselves within about 18 months.  But, don’t wait to see if that will happen.  It’s important to know what the cause of your sciatica is – a herniated disc is much more likely to resolve, for instance, than spinal stenosis or spondylolisthesis.

Clinical tests for sciatica

Examples of clinical tests for sciatica may include:

  • Straight leg raise (SLR) test. This test includes the patient lying on his/her back and lifting one leg at a time with the other leg flat or bent at the knee. A pain encountered while lifting the affected leg usually indicates sciatica.
  • Slump test. This test includes the patient seated upright with hands behind the back. The patient bends (slumps) forward at the hip. The neck is bent down with the chin touching the chest and one knee is extended to a degree possible. If pain occurs in this position, sciatica may be present.

These tests, however, may be positive only when the sciatic nerve is mechanically compressed at any point along its origin, such as from a herniated disc. Other causes of sciatica such as inflammation or chemical irritation of the nerve may not cause pain in these tests, so it’s important not to self-diagnose the cause of your pain.

spondylolisthesis

Your doctor may recommend various invasive therapies, injections, physical therapy, even traction or surgery depending on the cause of your sciatica.  And, that may be the route you choose.

There are less invasive alternative therapies that may also help.  The National Institutes of Health state that acupuncture is significantly more effective than conventional medication in the treatment of sciatic pain.  Manual therapies can also help you heal.

In some cases, sciatica can be controlled in just a few sessions.  Other more severe causes may require ongoing treatment, or even multiple therapies.  Adding functional and corrective exercises will give you the techniques necessary to help you control your sciatic pain.

The most important consideration is to get you comfortable again, and that’s what I do best.  Regardless of whether you choose traditional massage or the advanced techniques of bodywork therapies, the goal is to get you back to living your best life!

When you’re over 40 and they say just put a BandAid where it hurts . . .

Just put a bandaid

I see it all the time.  The wait to get treated until the discomfort is more than that person wants to deal with.

By the time you feel that level of discomfort, your body is already at the point where its ability to compensate is being tested.  And, generally, the time it takes to treat that issue is more complicated, and the problem may no longer be local, so treatment takes longer.

Here are some examples of this:

Case study #1:  An older gentleman was referred to me for severe sciatica, interfering with his lifestyle.  He had suffered with back pain for over 40 years, but only sought help when the sciatica was so long-lasting and severe there was nerve damage resulting in loss of feeling and strength in one leg.  MRIs showed remodeling in the spinal vertebra  resulting in anterolisthesis – a condition where the upper vertebra slips forward onto the vertebra below.  This gentleman, at this point, was desperate for pain relief and sought no other opinions or alternative treatments, and underwent a spinal surgery known as laminectomy.  This surgery creates space by removing the lamina — the back part of a vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.

The surgery gave him temporary relief, but when the pain returned, it returned with a vengeance.  Had this gentleman taken advantage of alternative treatments, had he been educated in the self-care he needed to aide in his recovery, his outcome might have been much different,  But, this gentleman was looking for the “magic wand”, was not invested in doing exercises, was not willing to learn how to make his recovery successful.

He came to see me originally for relief from the sciatica.  That didn’t take long – a few visits.  I warned him the results would not last unless he was willing to correct some other musculoskeletal imbalances, or really put effort into strengthening his core, the muscles supporting the spine and correcting his very poor posture.  He needed to be on a regular treatment schedule.  But, whenever we achieved his goal for pain relief, he’d stop exercising, forget about the effect his postural distortions were having on the spinal column and leave off treatment.  Before long, he was again in severe pain and at that point, he’d go back to seeking medical advise: epidurals, physical therapy, etc.  He was looking for the “magic wand”.

This gentleman was any medical practitioner’s worst nightmare – Waiting to get help until it’s too late.

The moral here is don’t wait years before seeking treatment – while you’re “toughing it out,” the damage inside continues.

Case study #2:  Another older gentleman was referred to me for low back pain.  He had “thrown his back out” the week prior.  Assessment showed a tortioned pelvic girdle so severe, one leg was 1-1/2 inches shorter than his other leg.  One of his body’s compensations was to develop scoliosis (curvature of the spine).  After determining  the scoliosis was functional, muscle testing showed how to unravel the muscular imbalances that led to the pelvic torsion.  The first treatment saw much improvement, and his back pain was reduced by 60%.  I had him return within the week, when full correction was achieved and his pain was gone.

The moral here:  Even though this man’s musculoskeletal imbalances had been in place for many years, he sought help when he developed pain.  Don’t wait to seek treatment – while you’re “toughing it out”, the damage inside continues.

The best way to keep your body balanced and reduce your risk of developing long-term, musculoskeletal issues is to get on a regular schedule of self-care.  But, don’t expect that a monthly massage will do it all – You’ve got to do your part with exercise and eating right, too.

Waiting to get treated, delays recovery.

Call, e-mail or request your appointment online today!

 

 

Is Your Pain Due to Musculoskeletal Imbalances?

Another reason would be degeneration in the skeletal structure – as in degenerative disc disease.  The brain “stabilizes” the area by having the surrounding muscles brace the area.  This works really well short term; however, long term the results can be disastrous.

Once a muscle(s) becomes dysfunctional, other muscles take over to compensate.  Of course, it doesn’t take too long before those secondary muscles become overworked, since they are doing double duty, then a third group of muscles begins compensating for the first two groups – and that pattern mushrooms.  Soon, instead of a really tired upper trap, the dysfunction runs from the head to the pelvic girdle or into the chest and down the arm.

musculoskeletal imbalances

Another reason would be degeneration in the skeletal structure – as in degenerative disc disease.  The brain “stabilizes” the area by having the surrounding muscles brace the area.  This works really well short term; however, long term the results can be disastrous.

Another common reason would be poor postural habits.  Picture a person slouching with the shoulders and head rolled forward.  In this case the muscles in the front part of the neck and chest shorten while the muscles in the back that hold the neck and head in proper alignment get stretched out and weak.  Or a person who sits most of the time – in this case, the hip flexors will become weak and can cause groin, leg and hip pain.

Common areas where dysfunctional patterns emerge are the shoulders, hips to knees and the low back.  But dysfunctional patterns can emerge anywhere in the body from the head to the toes.  

Why doesn’t massage address these dysfunctional patterns?  Massage therapies are systems of structured palpation or movement of the soft tissue of the body.  Massage does not address the brain/nervous system/movement relationship. 

I find it sad that we are so in our heads these days, we don’t feel these patterns developing.  It’s understandable if the cause is trauma – there’s not much we can do to prevent a motor vehicle collision, for instance – but we tend to ignore the early signs of dis-ease.  I have one client that ignored his back pain for 40 years!  I wish that were the exception, but it’s not.

Another client was recently referred to me who treated his long term back pain with western medicine, until that didn’t work anymore.  When he came to see me, he was a mess, and looking for the “magic wand”.  I developed a treatment plan and after just 4 sessions, he was pain free!

Don’t ignore what’s happening in your body.  When you feel pain, address it.  Pain is a request for change.  Believe me, I understand the draw of reaching for the bottle of ibuprofen or tylenol and sometimes that is just fine.  But if the symptoms keep coming back, it’s time to get help.  

Don’t let that nagging pain in your neck go for a long time.  One of my clients had poor posture throughout his lifetime.  Because he ignored his pain for so long, the body stabilized areas of dysfunction with bracing, which contracted the spine and eventually caused vertebra to fuse.  

Think of it this way:  If you’re changing the oil in your car more often than getting massage or bodywork, you are definitely taking care of the wrong vehicle.  After all, if you don’t care of your body, where will you live?

Why Everyone Needs a Massage

Bodywork therapies can help correct the postural imbalances, nerve impingements, inflammation in the tissues and trigger points caused by overuse of these thechnological wonders, as well as reducing the symptoms caused by nerve compression due to improper posture. 

From smartphones to tablets to laptop computers, you can’t look anywhere today without seeing someone on one of these devices and sometimes more than one.  I constantly see the postural issues related to using these devices which will eventually cause pain.

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Narrow keyboards cause strain on the hands and wrists.  Improperly carrying a laptop can cause neck, shoulder and arm pain.  The manner in which smartphone and tablets are held can also cause problems.  In order to relieve strain in one area, you may be causing strain in another.  Placing the device at a good height to avoid neck strain, for instance, can mean straining the arms as they elevate a tablet or smartphone to eye level; but lowering the device to protect the arms can compromise the neck through excessive flexion.

Carpal Tunnel Syndrome and cubital tunnel syndrome are two issues that people in an office setting may face and, with these conditions, come a variety of symptoms that massage therapy can help relieve – pain being but one.  “Pain, fatigue, weakness, and stiffness in the affected areas are the most common symptoms of these injuries,” explains Deborah Kimmit, a massage therapist and educator from Missoula, Montana.  “Numbness and tingling, as well as trigger point referrals are also common.”

Along with overuse, Kimmit also sees poor posture being the cause of painful conditions affecting the neck, shoulder and back.  “For example, a forward head posture can lead to neck pain as the person unconsciously reaches forward with the head to better see the screen,” she says.  Additionally, improper posture can sometimes be the result of other conditions like carpal tunnel syndrome.  “Sometimes, improper posture occurs because the body is trying to find a comfortable position,” Kimmit says.

Bodywork therapies can help correct the postural imbalances, nerve impingements, inflammation in the tissues and trigger points caused by overuse of these thechnological wonders, as well as reducing the symptoms caused by nerve compression due to improper posture.  These imbalances are not limited to the neck, shoulder and arms, but are widespread throughout the pelvic girdle, abdomen, the low back, mid back and shoulder girdles as well as the arms, upper back and neck, sometimes even the legs will be involved.

Knowing which muscles to release, which to stimulate, and which to leave alone is key to correcting these postural imbalances.  

If you are having problems from overusing your computer, laptop, smartphone, tablet or even your gaming console, perhaps it’s time to schedule a session to find out what can be done to help you.  

Call now to schedule!  (619) 818-5397.

 

Shoulder Pain

The muscle testing protocols I use allow me to unravel the musculoskeletal cause of dysfunction.

Many people suffer from shoulder pain, but, because the shoulder joint is the most complicated joint in the body, it can come from many different sources.  It’s important to get it diagnosed correctly.  Sometimes it’s from a rotator cuff tear, which may or may not need surgery.  Sometimes the long head of the bicep comes out of its groove, causing weakness and discomfort.  A frozen shoulder is quite common, with painful abduction and external rotation. Any of these can be the result of poor biomechanics and joint compression.  Most commonly shoulder pain is from poor posture and improper use.

A thorough assessment, both biomechanical and neurological, is necessary.  Since there is no one cause, there can be no one treatment.  While the muscle testing protocols I use allow me to unravel the musculoskeletal cause of dysfunction, treatment outcomes may be dependent on how willing the client is to do “homework” which is very specific for the individual.

Why is homework necessary?  Most postural problems develop over a lifetime.  So, while I can and most often do correct the deviation during one or a few sessions, in order for the brain, nerves and muscles to hold the corrections, the client must be involved in correcting his bad habits.  It’s that simple.  There is no magic wand.  The benefits of doing your homework far outweigh the disadvantages of not doing your homework, though.

Correcting your posture goes a long way to correcting pain syndromes you may have developed – shoulder pain, back pain, even foot and leg pain!

Call for your appointment today!

 

 

The Pain Stress Cycle

When it first starts, you may not even notice how that “little” injury is affecting your stress levels, but over time if not properly dealt with, the effects of that “little” injury grow . . . and grow . . . and grow . . .  Before too long, that “little” injury turns into stress manufacturing pain.

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When it first starts, you may not even notice how that “little” injury is affecting your stress levels, but over time if not properly dealt with, the effects of that “little” injury grow . . . and grow . . . and grow . . .  Before too long, that “little” injury turns into stress manufacturing pain.

Chronic pain can limit your everyday activities, affecting how involved you are with friends and family members.  Unwanted feelings, such as frustration, resentment, and stress, are often a result. These feelings and emotions can worsen your pain.

The mind and body work together, they cannot be separated. The way your mind controls thoughts and attitudes affects the way your body controls pain.

Pain itself, and the fear of pain, can cause you to avoid both physical and social activities. Over time this leads to less physical strength and weaker social relationships. It can also cause further lack of functioning, reduced range of motion and pain.

Stress has both physical and emotional effects on our bodies. It can raise our blood pressure, increase our breathing rate and heart rate, and cause muscle tension. These things are hard on the body. They can lead to fatigue, sleeping problems, and changes in appetite.

If you feel tired but have a hard time falling asleep, you may have stress-related fatigue. Or you may notice that you can fall asleep, but you have a hard time staying asleep. These are all reasons to talk with your doctor about the physical effects stress is having on your body.

Stress can also lead to anxiety, depression, a dependence on others, or an unhealthy dependence on medicines.

Depression is very common among people who have chronic pain. Pain can cause depression or make existing depression worse. Depression can also worsen existing pain.

A family history of depression, increases the risk that you could develop depression from your chronic pain. Even mild depression can affect how well you can manage your pain and stay active.

Signs of depression include:

  • Frequent feelings of sadness, anger, worthlessness, or hopelessness
  • Less energy
  • Less interest in activities, or less pleasure from your activities
  • Difficulty falling asleep or staying asleep
  • Decreased or increased appetite that causes major weight loss or weight gain
  • Difficulty concentrating
  • Thoughts about death, suicide, or hurting yourself

What’s the answer?  Get help.  The severity and length of your pain and dysfunction is the best indication of the direction you should take.  In mild cases of acute pain, massage therapy may be the quickest way to relief.  If your pain has moved into the chronic category, bodywork therapies may help – especially if your range of motion has been affected.  Other alternative therapies such as acupuncture and chiropractic may also help.  Seeing your doctor may also be appropriate.  I have yet to find a medical practitioner with x-ray vision – arranging for radiographic imaging may be appropriate and helpful.

The benefits of massage therapy include reducing/improving:

  • Anxiety
  • Digestive disorders
  • Fibromyalgia
  • Headaches
  • Insomnia related to stress
  • Myofascial pain syndrome
  • Soft tissue strains or injuries

Moving up to bodywork therapies increases the benefits to also include improving:

  • Sports injuries
  • Joint pain

Moving up to Myoskeletal Alignment Therapy, increases the benefits to include:

  • Improving overall posture
  • Releasing joint restrictions
  • Returning to a normal, pain free life

Begin your path to wellness by making the call to schedule your session today!

 

Tackling the Dreaded Dowager’s Hump

As we age, aberrant patterns become habitual, repetitive and narrow; pain/spasm/pain cycles develop; we have injuries; our posture worsens.  The conversation between body and brain becomes increasingly difficult and unreliable.  Eventually, coordination, balance and movement may become very limited.

One of the primary postural goals for manual therapists is restoration and maintenance of proper vertebral curves, which exist for a reason:  to provide the least amount of strain to muscles, tendons, ligaments and joints so they can carry on with daily chores.  If compromised, the risk of injury, protective muscle guarding and development of pain/spasm/pain cycles escalates.

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It’s not entirely clear what causes it.  Most likely, there are many underlying causes.  Dowager’s Hump, hyperkyphosis, may be a multifactorial problem:  Length-strength imbalance, motor  control issues, degenerative disc disease, ligament laxity, and possibly certain metabolic problems top the list of potential causes.  There may also be a genetic link as well as it seems to run in families.

Since it’s more obvious when viewed from the side (and most people view themselves in the mirror from the front), hyperkyphosis can progress quite a bit before anyone seeks help  for it.

Dowager’s Hump can cause neck, rib pain and breathing disorders, but can also be asymptomatic.

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Even in moderate cases, it can be difficult to lie on the back comfortably because the head is flexed so far forward.

Neuroscientists tell us our movement patterns are more or less hardwired by the time we are in our 20s, so why do dowager’s humps often develop later in life?  When asked, the legendary Dr. Moshe Feldenkrais, founder of the Feldenkrais Method (mindful movement to bring new awareness and possibility into every aspect of your life), simply responded “lack of variety of movement patterns”. 

As we age, aberrant patterns become habitual, repetitive and narrow; pain/spasm/pain cycles develop; we have injuries; our posture worsens.  The conversation between body and brain becomes increasingly difficult and unreliable.  Eventually, coordination, balance and movement may become very limited.

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The first line of defense is postural therapeutics, i.e. Myoskeletal Alignment Therapy, in conjunction with home-retraining rehabilitation or referrals to competent functional movement specialists, including Yoga.