Sciatica Part 4 – EXERCISE & ACTIVITIES OF DAILY LIVING
Updated: May 7
PRESCRIBING THE RIGHT - EXERCISES
It is essential to prescribe the correct exercises for a patient suffering from Sciatica. By considering the mechanism of how the injury occurred, we can obtain considerable insight into the type of exercises that should be performed, and which exercises to avoid. Professor Stuart McGill at Waterloo University has produced over 240 peer-reviewed scientific journal papers on back pain. He often talks about which exercise to avoid and which to do. Stretches such as pulling one or both legs into your chest, bending over to touch your toes should in many cases be avoided, especially if you a suffer from a disc issue (forward flexion intolerant). (3,4)
The same goes for certain so called strengthening exercise such as the "superman". Doing this exercise results in placing about 600 kilos of compressive force on a hyper-extended spine. Doing a superman exercise with an injured back could be a recipe for disaster. (3,4)
Initially, for a Sciatica patient, the objective of exercise is to increase neuromuscular control and muscular endurance. This means NOT pushing through pain. Exercising in a manner that causes pain will develop abnormal neuromuscular patterns that could lead to further injury. For effective recovery, the patient needs to start by exercising within a pain-free zone.
Conventional rehabilitation strategies often fall short because they do not address the underlying neuromuscular problems, and are often designed to make you work through your pain (as in work- hardening programs). This type of program can causes you to create, or reinforce, abnormal motor responses which in turn continues to keep you in pain. The effectiveness of work hardening has not been scientifically demonstrated.
In addition, if you work through pain that is caused by tissue damage, you run the risk of developing Central Sensitization. When central sensitization occurs, the nervous system goes through a process called Wind-Up. (1,2)
When in Wind-Up, the nervous system remains in a constant state of high reactivity.
This lowers the threshold for what can cause pain, long after the initial injury may have healed.
The only way to break this pattern is to perform your exercises in a pain-free zone. By exercising within this pain-free zone, patients are eventually able to break their pain cycle (where previous exercise programs only made the problems worse).
The following exercises are examples of exercises that we may prescribe to our patients suffer from sciatica. Which exercises we prescribe will vary greatly depending on what triggers the patients pain, and the cause of their problem. Note, the front and side plank are not to be performed during the acute stage of an injury. These exercises are presented for demonstration purposes only, and not as a recommendation for a specific individual.
Cat Camel Stretch - First stretch of the day: This stretch is often the first stretch you should perform in the morning (about an hour after you have gotten up). This is a great spinal mobilization exercise. If you are suffering from back pain avoid intense exercises that involve stretching or bending first thing in the morning. Give your body time to warm up. It takes about an hour for the extra fluid in your spinal discs to be squeezed out through normal motion.
Nerve Flossing - Spinal Cord and Sciatic Nerve: Releasing both the spinal cord and sciatic nerve. This nerve flossing video gives you several ways to mobilize entrapped spinal nerve roots and the sciatic nerve.
4-Point Kneeling Exercise - The Bird Dog: This is great exercise for grooving your nervous system. An important exercise if you have low back pain, and can even be performed shortly after an injury. Four-point kneeling teaches your body to transfer energy from your lower extremity through your core to the upper extremity. It also acts to increase the stability and motor control of your whole body!
The Wall Plank: This is a great exercise to re-establish motor control of your core musculature after a back injury.
Core Exercise - Front Plank: In this video, we show you how to perform both the Beginner and the Standard plank. Both are great core exercises that work to stabilize the shoulder and strengthen the muscles of your core. Ensure that you only do this exercise within your pain-free zone.
The Side Plank - Core Exercise: The side plank target the glutes, obliques, quadriceps, hamstrings, abductors and adductors. This exercise strengthens your lower back and spine, and protects you from injury.
ACTIVITIES OF DAILY LIVING
Just as important as exercising within a pain free zone, is being aware of your normal daily activities. This can make the different between a quick resolution of a problem, or the development of a chronic condition. The following recommendations apply to patients suffering from sciatica and low back pain. Following this advise will help you reduce pain, speed healing time, and reduce the chances of re-injury. (3,4)
Learn to Identify your Pain Triggers
Does you pain increase or decrease with flexion, extension, lateral flexion or rotation. Learning to identify what positions are triggering your pain and avoiding them can make a huge difference. Once you know these positions you can adjust your posture and position, which will greatly speeding the recovery of any injury. What is important to note is that the exact position of relief will vary from person to person.
Begin Your Day Slowly
When you are suffering from low back pain or sciatica it is important not to do any type of stretching for the first hour when they get out of bed. Your spinal discs are swollen, it will take time for motion and gravity to reduce this swelling. Take a hot shower move around, give your body time to warm up. Then perform stretches such as the cat/camel before getting into other exercises.
Variety is Your Friend
Static position positions exacerbate low back pain and sciatica. Don’t sit in any one position for long period of time. Stand up and stretch at least every 20-25 minutes.
When you take a break make sure it is the opposite of what you where just doing. If you have been sitting for a long period of time get up a move around, don’t just change your position to another seat in the room. If you have been standing in one position a long period of time go for a walk.
Ergonomics Count But!
Good work station ergonomics are essential, but they do not compensate for staying in one position for to long.
Get up and move, change the height of your chair several times per day. Even switch out your office chair for a Physio Ball every few hours.
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 in the right way can make the difference between a quick resolution of your pain or the development of a chronic condition.
Life is so short to be dealing with the constant pain of Sciatica. The good news is that most cases of Sciatica respond extremely well to a combination of manual therapy (manipulation and soft tissue therapy work) in combination with an appropriate exercise program!
If you are dealing with sciatica, get the help you need and take control of your life!
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. Ultimate back fitness and performance, Backfitpro Inc., Waterloo, Canada, 2004. ISBN 0-9736018-0-4. Fourth edition 2009.
McGill, S.M. Low back disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Second Edition, 2007.
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.
Dr. Abelson is the owner of Kinetic Health, a partner in BKAT Motion Specific Release, and a partner in Rowan Tree Books.