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Guest Post: All About Sciatica

Hi there!

Today I have the pleasure of bringing you an information piece all about SCIATICA. (Even the word sounds scary :\)

For those of you who’ve experienced sciatic-type pain you know how terrible it can be. The pain can be excruciating and severely limit your ability to work, sit or even just enjoy life.

Lately I’ve been seeing a lot of this in my practice and I wanted to offer some education to those interested in hopes that you can help relieve your pain if you are suffering or to prevent it from ever occurring.

So I am super excited to bring you this interview with Dr. Shaun Batte, Chiropractor, Strength and Conditioning Coach, Active Release Therapist and Medical Acupuncturist. (AKA he is super smart haha)

Shaun is one of my colleagues at the Urban Athlete Sport Injuries clinic in Toronto, and I have been working along side him for about 3 years now. Not only is he an excellent practitioner, but he’s a really great guy. Shaun is definitely a family man; he’s married and has two boys. He’s also an excellent guitar player but he would never admit it 😉

Needless to say I trust Shaun a lot and see him regularly for my own injuries. He is super knowledgeable which is why I wanted to pick his brain for this post! 

If you like what you hear and want to learn more about Shaun and where to find him, I’ve included all his contact info at the end of the post.

I hope you enjoy 🙂

All About Sciatica. By Dr. Shaun Batte

All about Sciatica - What is sciatica, how to treat the pain and exercises to prevent it

This advice is not meant to replace advice from your current medical practitioner and any action that you take upon the information that you find on thehealthysweetpotato.com is strictly at your own risk. Please see disclaimer for more information.

Before we jump into Shaun’s take on the issue, I want to give you a proper definition of sciatica from a reliable source. Here is the definition from a 2017 BJSM article: 

All about Sciatica - what is sciatica, how to treat the pain and exercises to prevent it

Sciatica is an archaic term with a nebulous meaning. For most clinicians, it refers to a radiculopathy affecting the sciatic nerve but confusingly is used more generally to describe pain that radiates from the lower back down the leg. It is a common condition with a lifetime incidence of 13–40% and in up to 90% of cases, it occurs due to intervertebral disc herniation. On rare occasion, mass lesions involving the sciatic nerve or lumbosacral plexus can also produce sciatica-like symptoms.” (source)

Now I will let Shaun take over to explain what this means in English 😉

Sciatica is essentially an umbrella term for any radiation of pain down the back of the leg.

However, this tells you nothing about the pain or injury origin which is arguably the most important thing.

There can be several origins of sciatic pain. Some of the more common causes are listed below however, this list is not exhaustive:

  • Dural tension (tension of the tissue surrounding the nerve)
  • Disc herniation or “bulge”
  • Piriformis syndrome
  • Lateral stenosis of the spine
  • Traumatic injury 
  • Sitting on improper surfaces for long periods of time

The important thing to remember here is that once the sciatic nerve has been sensitized, it becomes “hyper-sensitive” which means it over reacts to normal stimuli. For example, if you think about a sunburn, normally when you try to get dressed or have a shower it isn’t painful (I hope :|). But when you have a sunburn those same activities become very painful.

Essentially the pain threshold of that tissue has been lowered and therefore it takes less stimulus to cause pain. Make sense? 

OK great. So let’s go back to the idea of the sciatic nerve getting irritated for whatever reason we outlined above. Now it is hypersensitive to a lot of things so the number one thing we need to do to decrease pain and improve function is to:

Offload the structure being compromised. All about Sciatica - What is sciatica, how to treat the pain and exercises to prevent it

How do we do that? Well first we have to figure out why and where the sciatic nerve is being “pinched” or irritated. If you aren’t sure where the issue is coming from, you need to book an appointment with a health care practitioner (AT, Physio, Chiro, Osteo, physican) to receive a proper assessment.

Once the cause has been determined, then we can start into treatment. Treatments will differ slightly depending on where the injury is stemming from, but all treatments will follow the same general principles:

1. Decrease sensitization to the nerve.

Constant tension on any nerve is going to reduce the threshold at which you experience and tolerate pain. Therefore, you need to reduce the tension in order to reduce the pain.

Things that can help:

  • Limit sitting. I know you’ve heard that sitting is the new smoking and it very well could be! Sitting can place a lot of tension on your already “overstretched” or pinched nerves. If you work at a desk, make sure to take frequent breaks to walk around. Try to stand part of the way on the subway and walk to work as often as you can and try to keep driving at a minimum.
  • Don’t “just stretch”. Be weary that the nerve can be under tension and stretching your hamstrings or back can actually make things worse. 
  • Strengthen your “anti-sitting” or your “postural” muscles. Postural muscles are the ones that get weakened from prolonged sitting. Just think about your posture for a second when you are sitting with your back and shoulders rounded, your head forwards and your eyes up. NONE of your muscles are working optimally in this position. Simply put: your back muscles are constantly being over-stretched and your front muscles are always being shortened. Weakness in the back, tightness in the front. Haha I just had to 😉

2. Move mindfullyAll about Sciatica - What is sciatica, how to treat the pain and exercises to prevent it

Sciatic nerve flossing, neurodynamic movement and isometric exercises can all be helpful to desensitize the nerve. These can be tricky to learn on your own so I suggest you see a health care practitioner to get instructions on proper technique. 

Another great form of mindful exercise to incorporate is pilates. Pilates focuses on isolating and strengthening postural muscles that go unused, helping to prevent or improve conditions like sciatica. If you want to learn more about pilates, check out my Pilates post. 😉

One movement you should avoid if you are experiencing sciatic type sensations is forward bending under a load, i.e. bending over to pick up a heavy laundry basket or any weighted object. This doesn’t mean you won’t ever be able to do this action, it’s just something you should avoid until you’ve treated the cause of sciatica and have developed the foundational strength necessary to support such movements.

3. AcupunctureAll about Sciatica - What is sciatica, how to treat the pain and exercises to prevent it

Acupuncture can be extremely helpful with sciatica as its mechanism works primarily with the nervous system. When performing acupuncture for a nerve injury it is important to treat along the entire nerve pathway in case other areas of the nerve have become irritated due to the increased sensitization downstream of the initial “pinch” or irritation.

Acupuncture also acts to calm down the nervous system by decreasing sympathetic tone (decrease in stress response) as well as influencing the autonomic system.

In addition, it can decrease secondary aspects of neurogenic pain such as inflammatory and/or pain chemicals released in the surrounding tissue that can lead to increased sensitization. 

 

As I mentioned before, the treatment will vary slightly depending on the origin or cause of the injury and that is why it is so important to get an accurate diagnosis before starting treatment.

In the meantime, I’ve included some postural exercises and stretches that are safe to do no matter what the cause. These exercises are targeting your “anti-sitting” muscles and are excellent to do even if you aren’t currently experiencing sciatic-type pain.

1. Glute Bridge 

All About SciaticaAll About Sciatica

Step 1 – Lie on your back with your knees bent, feet shoulder distance apart and close to your bum, but not touching.
Step 2 –
Engage your abs and glutes (bum), push through your heels and lift your hips up until in a 45 degree line. Hold for 3 seconds and then return hips to floor. Make sure to keep your glutes engaged while you hold the position.
Do 2 sets of 20

2. Clamshells

All About Sciatica

All About Sciatica

Step 1 – Lie on your side with your knees bent, feet together and in-line with your hips, hips in line with your shoulders and head.
Step 2 – Keep heels together and open knee to hip height and then return knee to close. *Don’t let top hip roll back 
Do 2 sets of 20 on each side. You should feel this in the side bum (glute med.) of the moving leg.

3. Bird Dog

All About Sciatica

All About Sciatica

Step 1 –Start on all fours, knees under hips hands under shoulders. Engage your core.
Step 2 – Lift and reach one leg straight back while lifting and reaching the opposite arm straight forwards. Return to start position and repeat on opposite side. The goal is maintain core stability throughout the movement.
Do 2 sets of 20 (10 on each side).

4. Hip Flexor Stretch

All About Sciatica

 

 

 

 

 

Step 1 – In a kneeling lunge position, press your hips forwards until you feel a stretch in the front of your hip and/or thigh.

Step 2 – Reach the arm of the same side as the leg you are stretching upwards and overhead for an additional stretch. Hold for 30s to 1 minute and then switch sides. Repeat 1-2 times.

5. Glute/Piriformis Stretch

All About SciaticaStep 1- Lie on your back and bring your left knee towards your chest. Grasp the ankle of that leg with the right hand and pull the knee and ankle towards your right shoulder. You can stay here or move onto step 2 for a deeper stretch.

Step 2 – Bring your right leg up with the knee bent and place your left ankle over your right knee. Thread your left hand through your legs and grab onto the back of your right thigh. Take you right hand around the outside of your right thigh to meet your left hand. Pull your right leg towards your chest (as in the picture). You will feel the stretch in the left bum/outer thigh area.
Hold for 30s-1min then switch to the other side.  Repeat stretch 1-2 times.

6. Sciatic Nerve Flossing

All about Sciatica - What is sciatica, how to treat the pain and exercises to prevent it

This is a great way to improve the mobility of the nerve as well as help desensitize it.

As I said before it’s a good idea to see a practitioner to help you with this exercise but I found a pretty good youtube video that will be a safe way to floss the nerve on your own if you’re up for it:

Easy Sciatic Nerve Flossing Video

 

 

Thank you so much Shaun for all of your time and for providing such great information!

If you have any questions or would like to learn more about Shaun, I’ve listed his contact info below:

Dr. Shaun Batte, DC, BSc(hons), CSCS, ART, Med. Ac

 

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