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.
Article Index:
Introduction
Renowned back pain expert, Professor Stuart McGill of Waterloo University, with a prolific contribution of more than 240 peer-reviewed papers, provides insight on exercise selection for back pain. He cautions against certain movements, like toe-touching stretches, which can exacerbate conditions like disc-related issues due to forward flexion intolerance. Similarly, exercises that induce hyperextension, like the "superman," can impose significant compressive forces — approximately 600 kilograms — on the spine, potentially aggravating an existing injury (3,4).
Exercise Goals - No Pain, All Gain
For those suffering from sciatica, initial exercise aims should focus on improving neuromuscular control and endurance without exacerbating pain. Painful exercises may lead to atypical neuromuscular patterns and further damage. Recovery exercises should be performed within a range that does not cause pain.
Traditional rehabilitation approaches can be inadequate, as they often overlook the fundamental neuromuscular dysfunctions and might advocate for exercising through pain, such as in work-hardening programs. Such programs may perpetuate or even initiate improper motor patterns, leading to persistent pain due to increased nervous system sensitivity. The efficacy of work-hardening programs lacks robust scientific support.
Central Sensitization - The Windup Phenomia
Additionally, persisting with exercise in the presence of pain from tissue injury may heighten the risk of Central Sensitization. This condition involves a phenomenon known as Wind-Up, where the nervous system becomes increasingly reactive and sensitive to stimuli (1,2).
In a state of Wind-Up, the nervous system's reactivity is elevated, reducing the pain threshold even after the original injury might have recovered. Interrupting this cycle requires engaging in exercises that do not provoke pain. Exercising within such a pain-free threshold is crucial to disrupt the ongoing cycle of pain, contrasting with prior exercise regimens that may have inadvertently intensified the problem.
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. Note these exercises are presented for demonstration purposes only and are not intended as a recommendation for a specific individual.
Cat Camel Stretch - Your Day's Opening Movement
Often suggested as the day's first activity, the Cat Camel Stretch is an exceptional choice for mobilizing the spine, especially beneficial for those with back discomfort. It's recommended that patients avoid strenuous stretches or bending activities right after rising. Giving the body enough time to warm up is crucial since the spinal discs require about an hour to naturally expel the excess fluid accumulated during rest.
Nerve Gliding Exercises for the Spinal Cord and Sciatic Nerve
This approach is designed to liberate the spinal cord and sciatic nerve. The instructional video on nerve gliding showcases different techniques to successfully mobilize trapped nerves in the spine and the sciatic nerve.
Bird Dog from Quadruped Position
This stellar exercise is designed to train your nervous system efficiently. It's especially advantageous for individuals with lower back pain and is safe to perform even in the early stages post-injury. The quadruped exercise, often referred to as the Bird Dog, educates your body on energy transfer from the legs through the core to the arms. It also improves overall stability and motor control.
The Wall Plank Exercise
This exercise stands out as a highly effective method for reinstating the motor control over your core muscles following a back injury. By engaging in the Wall Plank, you actively work on rebuilding strength and coordination in the core stabilizers, which is crucial for spinal support and injury recovery. This foundational movement not only aids in restoring muscle function but also serves as a stepping stone to more advanced core exercises, promoting a safer and more resilient back over time.
Beginner's 3-Minute Plank Series
Ideal for core strengthening, this series is structured for novices, with each set extending slightly past one minute. Aim to complete 3 to 5 cycles, allowing yourself a minute of rest in between. For plank newcomers, start on your knees, maintaining the plank for a brief ten-second interval. This method emphasizes the cultivation of slow-twitch muscle fibers, pivotal for enhancing muscular endurance and laying down a robust core base.
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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.
Managing Back Pain During Daily Routines
Our video provides essential insights on managing back pain through your everyday activities. Proper execution of daily tasks can be the deciding factor in whether you experience a swift alleviation of pain or a progression to chronic back issues.
Conclusion
In summary, managing sciatica effectively requires a multifaceted approach, incorporating accurate diagnosis, personalized treatment, and targeted exercises. Understanding that conditions like disc herniation often result from progressive degeneration highlights the importance of ongoing monitoring and conservative therapy.
The Motion Specific Release (MSR) technique exemplifies patient-centered care, integrating evidence-based practices from various disciplines to address the complex nature of sciatica. It is not merely the exercises themselves, such as the Cat Camel Stretch or the 3-Minute Plank Series, but also how they are integrated into daily routines and adjusted to meet individual needs that will ensure a successful recovery. A comprehensive approach that includes neuromuscular control, core stability, and ergonomic considerations can help prevent chronicity and maintain long-term spinal health under the guidance of a healthcare professional.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.
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References - Part 4
Flor, H., Braun, C., Elbert, T., & Birbaumer, N. (1997). Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters, 224, 5-8.
O’Neill, S., Manniche, C., Graven-Nielsen, T., & Arendt-Nielsen, L. (2007). Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. European Journal of Pain, 11, 415-420.
McGill, S.M. (2009). Ultimate back fitness and performance (4th ed.). Waterloo, Canada: Backfitpro Inc. ISBN 0-9736018-0-4.
McGill, S.M. (2007). Low back disorders: Evidence-based prevention and rehabilitation (2nd ed.). Champaign, IL: Human Kinetics Publishers. ISBN 0-7360-4241-5.
McGill, S.M. (2015). Back Mechanic: The Step-by-step McGill Method to fix back pain. Waterloo, ON: Backfitpro Inc.
McGill, S.M., & Kavcic, N. (2005). Transfer of loads between lumbar tissues during the flexion-relaxation phenomenon. Spine, 30(17), 1996-2004.
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