- Dr. Brian Abelson DC
Sciatica Unraveled: Exercise & ADL (Part 4)
PRESCRIBING THE RIGHT - EXERCISES
It is crucial to prescribe appropriate exercises for patients suffering from sciatica. By understanding the mechanism of injury, we can gain valuable insights into the types of exercises that should be performed and those to avoid.
Professor Stuart McGill at Waterloo University has published over 240 peer-reviewed scientific journal papers on back pain. He often discusses which exercises to avoid and which to do. Stretches such as bending over to touch your toes should often be avoided, especially if you have a disc issue (forward flexion intolerance). (3,4)
The same applies to certain strengthening exercises, such as the "superman." This exercise places around 600 kilograms of compressive force on a hyper-extended spine. Doing a superman exercise with an injured back could lead to further complications. (3,4)
Exercise Goals - No Pain, All Gain
Initially, for a patient with sciatica, the goal of the exercise is to enhance neuromuscular control and muscular endurance. This means not pushing through the pain. Exercising in a way that causes pain can lead to the development of abnormal neuromuscular patterns, potentially resulting in further injury. For effective recovery, patients need to begin exercising within a pain-free range.
Traditional rehabilitation strategies often fall short because they do not address the underlying neuromuscular issues and frequently encourage working through pain (as in work-hardening programs). This type of program can create or reinforce abnormal motor responses, resulting in continuous pain (as the nervous system becomes more sensitive). The effectiveness of work-hardening programs has not been scientifically demonstrated.
Central Sensitization - The Windup Phenomia
Moreover, working through pain caused by tissue damage can increase the risk of developing Central Sensitization. When central sensitization occurs, the nervous system undergoes a process called Wind-Up (1,2).
During Wind-Up, the nervous system remains in a constant state of heightened reactivity, lowering the threshold for pain even after the initial injury may have healed. The only way to break this pattern is to perform exercises within a pain-free range. By exercising in this pain-free zone, patients can ultimately break the cycle of pain, whereas previous exercise programs may have only exacerbated the issue.
Exercise Examples
The exercises listed below are examples that may be prescribed to patients experiencing sciatica. The specific exercises chosen will depend on the patient's pain triggers and the underlying cause of their issue.
Please Note: These exercises are presented for demonstration purposes only and are not intended as a recommendation for a specific individual.
Cat Camel Stretch - First stretch of the day: This stretch is frequently recommended as the initial exercise to be performed first thing in the morning. It serves as an excellent spinal mobilization exercise. For individuals experiencing back pain. We also advise patients to refrain from engaging in intense exercises involving stretching or bending immediately after waking up. Allowing the body ample time to warm up is essential, as it takes approximately an hour for the excess fluid in the spinal discs to be expelled through normal movement.
Nerve Flossing - Spinal Cord and Sciatic Nerve: This technique focuses on releasing both the spinal cord and sciatic nerve. The nerve flossing video demonstrates various methods to mobilize entrapped spinal nerve roots and the sciatic nerve effectively.
4-Point Kneeling Exercise - The Bird Dog: This excellent exercise helps to train your nervous system effectively. It is particularly beneficial for those with low back pain and can even be performed shortly after an injury. The four-point kneeling exercise teaches your body to transfer energy from your lower extremity through your core to the upper extremity. Additionally, it enhances the stability and motor control of your entire body!
The Wall Plank: This is a great exercise to re-establish motor control of your core musculature after a back injury.
The "3 Minute Plank Routine – Beginner Level"
This routine is an excellent starting point for strengthening your core. Each set takes just over a minute, so repeat the sequence 3 to 5 times with a one-minute break in between. When first attempting planks, perform them from your knees and hold the position for no more than ten seconds. This approach focuses on developing slow-twitch muscle fibers, which are essential for building endurance and establishing a solid foundation for your core.
EQUIPMENT
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Activities of Daily Living
Paying attention to your daily activities is just as important as exercising within a pain-free zone, especially for those suffering from sciatica and low back pain. Following these recommendations can help reduce pain, speed up healing, and decrease the likelihood of re-injury. (3,4)
Identify Your Pain Triggers
Understand whether your pain increases or decreases with flexion, extension, lateral flexion, or rotation. Identifying pain triggers and avoiding them can make a significant difference in your recovery. Adjust your posture and position based on your individual needs.
Start Your Day Slowly
When dealing with low back pain or sciatica, refrain from stretching during the first hour after waking up. Spinal discs are swollen in the morning, and it takes time for motion and gravity to reduce the swelling. Take a hot shower and allow your body to warm up before engaging in exercises like the cat/camel stretch.
Embrace Variety
Static positions can worsen low back pain and sciatica. Avoid sitting or standing in one position for extended periods. Stand up and stretch at least every 20-25 minutes. When taking breaks, engage in activities that counteract your previous position. For instance, if you were sitting for a long time, walk around during your break.
Ergonomics Matter, But Movement Matters More
Proper workstation ergonomics are crucial, but they don't make up for staying in one position too long. Regularly change your position, adjust your chair height, and even swap out your office chair for a physioball every few hours to encourage movement.
Back Pain and Activities of Daily Living: In this video, we give you key information on Back Pain and your Activities of Daily Living. Performing everyday actions correctly can make the difference between a quick resolution of your pain or the development of a chronic condition.
Conclusion
In conclusion, addressing sciatica effectively involves a multifaceted approach that includes evidence-based manual therapies, such as joint manipulation and myofascial release, along with carefully selected exercises performed within a pain-free zone. It is crucial to identify pain triggers, adapt daily activities, and maintain a balanced lifestyle to promote healing and prevent re-injury.
By combining conservative treatment options and incorporating appropriate lifestyle modifications, patients can experience significant relief from sciatica and low back pain, improving their overall quality of life. Always consult with a qualified healthcare professional to develop a personalized treatment plan tailored to your specific needs and circumstances.
Sciatica Part 1 – What Are You Dealing With
Sciatica Part 2 – Causes & Diagnosis
Sciatica Part 3 – Treatment - Logic & Recommendations
Sciatica Part 4 – Exercise & Activities of Daily Living
DR. BRIAN ABELSON DC.
Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective and patient-centred personalized care.
As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under the name Kinetic Health. He has authored ten publications to date and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
REFERENCES - PART 4
Extensive reorganization of primary somatosensory cortex in chronic back pain patients., Flor, H., Braun, C., Elbert, T., & Birbaumer, N., (1997) Neuroscience Letters, 224, 5-8.
Generalized deep-tissue hyperalgesia in patients with chronic low-back pain., O’Neill, S., Manniche, C., Graven-Nielsen, T., Arendt-Nielsen, L. (2007)., European Journal of Pain, 11, 415-420.
Ultimate back fitness and performance, Backfitpro Inc., McGill, S.M. , Waterloo, Canada, 2004. ISBN 0-9736018-0-4. Fourth edition 2009.
Low back disorders: Evidence based prevention and rehabilitation., McGill, S.M., Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Second Edition, 2007.
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