So you are suffering from back pain, Sciatica to be exact. You might have the feeling of pain shooting down your leg, and it’s getting pretty annoying. So what should you do about it? You have a friend that had it and he fixed it by…..WAIT! Sciatica is not that simple. Sciatica can be caused by many different things.
All sciatica cannot be treated the same. In fact, sciatica is generally described as irritation of the sciatic nerve resulting in pain or tingling running down the leg. What causes that pain in tingling has a major impact on the best possible treatment. When that sciatic nerve is irritated, you may feel the pain run down the leg, possibly all the way down to the feet.
So the big question is what is causing that nerve to be irritated? I see personal trainers all the time attempt to treat sciatica the same with every person they meet. They assume that just because it is the same name, it is always treated with the same exercises and stretches. The truth is, there are several things that cause sciatica to occur.
Bulging or Herniated Disk in the Lumbar Spine
One common injury is a bulging disk or herniated disk in the lumbar spine. The disks that you see between the vertebrae normally are well formed with an annulus fibrosis surrounding a nucleus. However, due to lifestyle habits and movements, we can actually herniate or rupture the disk. We could have been damaging it over and over again for a period of time, but a sudden bending and twisting motion might be the final thing to push it over the edge. When it herniates it compresses the nerve root and causes irritation and pain, and eventually numbness, tingling, and muscle weakness. This situation is tricky to treat. The sciatica is caused by the changes in the disk. Depending on the extent of the herniation, it might be treatable with physical therapy, a personal trainer, or surgery. If you are having radiating pain, it’s important that you see a physician.
If exercise is the best solution for you, trunk extension normally feels better. You should begin an exercise program that works on proper neutral spine alignment, core strengthening (not crunches), and learn to move through daily activities correctly without spine irritation.
Lumbar Spinal Stenosis
Sciatica caused by Lumbar Spinal Stenosis is treated completely differently. As we get older, our passageways can narrow and cause a nerve compression to occur. There are times that a disk herniation is the cause of the narrowing, but that’s not always the case. Nerve roots pass through the foramen in the spine, and when the space between these narrows, it can cause compression on the nerve. When someone is suffering from sciatica when they have a bulging/herniated disk, trunk extension feels best, but when they are suffering from stenosis, the opposite is true. Those who have sciatica due to spinal stenosis, usually prefer trunk flexion to get relief. Doing so helps take the pressure of the nerve root and relieve some pain.
If you begin an exercise program, it is important that your program focuses on trunk flexion, core stabilization, and learning to do daily activities in proper neutral spine position.
Spondylolesthesis is another cause of sciatica. In spondylolesthesis, a vertebrae slips forward over another vertebrae. The sciatica is caused by the spinal nerve root compression that occurs due to the spondylolesthesis. There are multiple reasons that a vertebrae will slip over another vertebrae. It could either exist since birth or childhood, or it could have occured later in life due to trauma, spinal degeration, or physical stress. An example of trauma could be due to a car accident or a fall.
So if spondylolesthesis is the diagnosis, there are different exercise parameters than the others. You have to continue to improve the core stabilization and learn proper mechanics in daily activities, just like the other situations. Trunk flexion is also important because it helps relieve some of the pressure on the spinal root. The exercises that you do are important to prevent further damage. If you have radiating pain, you should visit your physician and make sure he clears you for an exercise program. Trying to exercise improperly will only make the problem worse for you in the long run.
Understanding the Differences
It’s important to understand that sciatica is not always treated the same way. You must have a proper diagnosis from a physician in order to know how to design a proper exercise program. If you approach a personal trainer to help you design an exercise program, test them to see if they understand the differences between the different causes of sciatica. This is important. If they take you through a fitness program that emphasizes the wrong movements, your sciatica could actually get worse instead of better.
Personal trainers, if you have been treating all forms of sciatica the same, please take the time to learn more about this condition. I know that most certifications do explain the differences, but it is our responsbility to learn more ourselves. If you are looking for a certification to help you learn more, please consider taking a Medical Exercise Specialist certification. It will be well worth your time and money.
This is part 1 of my series on sciatica. Read part 2 of more causes of sciatica and how to treat it. If you are interested in learning more about back pain and exercise, sign up for my Back Pain Report.
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Great post Jason. Wish I had found you sooner!