A number of nerves exit the spine and come together to make up the sciatic nerve. The nerves exit between lumbar spine 4- sacral spine 2. It travels through the pelvis and descends down the back of the leg. Pinching of the nerve causes pain, numbness, tingling and if severe enough, loss of strength. There is a distinct pattern of pain, weakness and loss of sensation which allows the clinician to know which nerve root(s) is affected.
Herniated discA herniated disc is when the disc between the spine pushes into the space where the nerves live. Due to the the structure of the disc, the soft material gets pushed backwards onto the nerves. This usually happens when the body is forward flexed and there's a force. Squeezing or coughing while bent forward is a common way to sustain this injury. When the disc is herniated, any sitting or bent forward position increases pain. This position puts more pressure onto the disc which pushes onto the nerve.
StenosisThis injury occurs when the space the nerve exits the spine narrows. This happens when the disc looses it height or when the arthritis in the joint. When the disc loses it height the ligaments surrounding the spine buckle which takes up space where the nerves are. Imagine a curtain on a wall and what it would look like if the ceiling height got lowered. The curtain will buckle. This type or injury gets inflamed with upright activities and be more comfortable sitting.
Alleviate the painThis is the 1st step! The body will compensate and muscles are shut off when there is pain. Number one goal is to decrease the pain to allow the nerve pathways to the muscles. This can be achieved by using ice/heat, resting positions and taking pressure of the nerve.
People often think they are improving because their pain is decreasing. In reality, they may not feel pain because MORE nerve fibers are being pinch and they are losing sensation. Eventually the muscles no longer get the signal from the brain and will get weak.
For a true herniated disc, laying on your stomach will help to take pressure away from the disc. These are known as Mckenzie Extension exercises. While for stenosis, sitting or laying with the legs at 90 degrees will allow opening of the joints. These are called William Flexion exercises.
Traction in these positions will further accelerate the healing process.
Core stabilityFocus on developing the muscles that stabilize your spine not move your spine. People have a tendency to perform big movements like back extensions and sit- ups. However, when your back isn't stabile these movement can contribute to shearing of the spine leading to early degeneration arthritis. Poor posture allows the core stabilizers to atrophy. Bigger muscle groups function as stabilizers. This contributes to nerve pain as the spaces narrow.
Mobility Above and Below
Most commonly the thoracic spine and hips have limited mobility.
HipsThe hips and pelvis are important region as it serves as a base for the lumbar spine to sit on. However, it's mobility is often limited. When I walk into an exam room, I see my client's back rounded. To improve posture, hip mobility needs to be assessed.
|Good sitting form: Hips are at approximately|
90 degrees and back has good curvature
|Poor sitting form: Hops are rounded forcing the|
back to round.
They are unable to get > 90 degrees of flexion in the hip. This is problematic because it leads to poor posture. There is an increase stretch to lower back, poor alignment and shuts down muscles.
Thoracic spineThe thoracic spine area is a victim of gravity. Gravity pushes down on the shoulders while we sit and standing causing the thoracic spine to curve forward. The thoracic spine is also stiff due to it's job as the protector of all things vital... our heart and lungs. Due to the rib cage, the thoracic spine doesn't have a lot of motion compared to the neck and lumbar spine. However, this area should have the most ROTATIONAL motion of the spine. It's inherent stiffness limits mobility forcing rotational motion upon it's neighbors, the neck and low back. Have you ever heard of anyone with thoracic spine arthritis? It's highly unlikely because the low back and neck usually works harder to make up make for the lack of motion in the thoracic region. That is the reason arthritis is so prevalent in the low back and neck.
****Stay tuned for the next post! I'm traveling for 7 weeks! How to stay injury free and fit while on the road!