You have pain in your leg, related to an issue with your lower back and suspect you've got sciatica. Or your general practitioner may have diagnosed you with it and prescribed bed rest and pain pills in the hope of calming it down.
But, then what? When the pain pills and bed rest don't make you better, what do you do?
First of all, it's helpful to establish if it actually is sciatica. I'm going to cover what sciatica is, what its most common causes are, and what else the problem could be if it isn't sciatica.
Then, I'll show you what you can do to relieve your pain (try the lying posture demonstrated below to see if it provides instant relief).
I'll then explain what you need to do to allow your back to heal. And finally, what you need to do to make your back more resilient to injury in the future.
Sciatica is the common name given to radicular pain, which means: 'of, relating to, or involving a nerve root'. It occurs when a spinal nerve gets compressed or inflamed, causing pain to be experienced anywhere along the length of the sciatic nerve.
This descends from the lowest two lumbar vertebrae—L4 and L5—and the sacrum, down through the buttock area, behind the hip joints, down the back of the thigh (where it splits into the tibial and peroneal nerves), down the front and side of the shin, and into the foot and toes.
The most common cause of a compressed or inflamed spinal nerve is a disc herniation which usually (about 95% of the time) occurs at either at L4-L5 of the lumbar spine or L5-S1 where the lumbar spine meets the sacrum.
The position of the herniation in the disc determines which nerve root becomes irritated, and consequently, which leg becomes affected.
Other possible causes of sciatica include arthritic bone, ligaments that have been thickened by arthritis, or joint capsules that have been damaged by injury and overuse.
A strong indication that you have sciatica (radicular pain) is that you experience a stabbing or piercing sensation that travels in a narrow band down the back of your leg (along the sciatic nerve), sometimes going down into the foot and toes.
Pain in the big toe indicates irritation to the fifth lumbar nerve root (L5), while pain in the four little toes indicates irritation to the fourth lumbar nerve root (L4).
If you also experience numbness or weakness in the leg or the foot, this is a sign of radiculopathy: a loss of nerve function which is caused by an injury to the nerve root.
Numbness indicates damage to the sensory fibres that innervate specific areas of your skin (dermatomes), whereas weakness, for example 'drop foot', indicates damage to the motor fibres that innervate specific groups of muscles (myotomes).
Dermatomes of the lower limb
However, not all pain felt in the leg (in conjunction with low back pain) is radicular pain (sciatica) or radiculopathy.
Harmful stimulation of structures in the lumbar spine, that doesn't involve irritation of nerve roots, can produce referred pain that spreads to the legs, in addition to the affected structure.
The resulting pain usually manifests as dull, aching or gnawing and can expand while being more difficult to localise precisely. It's also non-dermatomal, so doesn't correspond to the dermatomes outlined above in the case of radiculopathy.
Patterns of referred pain commonly associated with injury at different levels of the spine
While the pattern of pain is inconsistent between individuals, it often appears in the gluteal area (buttocks) and the upper thigh, while sometimes appearing as far down as the foot.
The reason the pain appears in this way is because sensory neurons from these areas in the leg converge with sensory neurons from the lumbar spine on the same second order neuron in the spinal chord.
The brain can't distinguish between the two inputs, so therefore creates a pain experience for both (even though the lumbar spine is the only site of actual tissue damage).
Irrespective of the pattern of your pain, an assessment is required to establish its suspected source. This will allow you to address the cause of your pain instead of just treating the symptoms (which is what pain pills and bed rest attempt to do).
An integral part of a thorough assessment involves identifying the specific postures, movements and loads that provoke your pain. This is necessary so that you can learn how to move in ways that don't provoke your pain.
Succeeding at this will allow your pain to desensitise and your back to heal. However, if you keep provoking your pain triggers, your pain will become further sensitised and you'll prevent your back from healing.
In a similar way that a cut on your arm is prevented from healing if you keep picking the scab off. You need to stop picking the proverbial 'scab' to allow your back to heal.
In addition to finding out what provokes your pain, you also need to find positions of respite that reduce your pain, preferably all the way down to zero on a scale of 0 to 10. These can be your 'go to' positions to allow your pain to calm down, instead of letting it gradually become worse throughout the day.
A good place to start is to find a pain-free position lying down.
But, before you try, you need to learn a couple of movement tools that will help you avoid provoking your pain as you get up and down from the floor.
The first is the abdominal brace. You'll need to apply this just enough to stabilise your spine in a neutral position while you get up and down from the floor.
The second is how to lunge down to the floor with a neutral spine (which you maintain with the bracing you learned in the video above) in order to minimise stress on your back and avoid provoking your pain.
Once you're confident you can get up and down from the floor without further aggravating your pain, lie face down on the floor with your hands flat under your chin. Hold this position for 20 seconds, then if your pain hasn't increased, place a fist under your chin to raise your head slightly.
Does this make your pain better or worse? If it's better, relax into this position and take some deep breaths, allowing your lumbar spine to descend on each exhale as it rediscovers its natural curve (lordosis).
You can also try putting a second fist on top of the first to see if that's better still. If it is, continue breathing in that position. If it's not, then go back to the most comfortable position (one fist or hands flat).
For some people, these positions are uncomfortable and may even increase your pain. In that case, you can try placing a cushion or a rolled up towel under your tummy, directly below your lumbar spine. This also takes the stress off your spine, but without letting it go into too much lordosis (the natural curve of the lumbar spine), which is a pain trigger for some people.
After a 2-3 minutes in your preferred position, taking deep breaths and allowing your pain to wind down, you can get back up again whilst bracing your abs and taking care not to move through your spine, as demonstrated above.
Now that you're standing, do you feel better or worse? Have your sciatic symptoms improved or disappeared? If it's better than before, then congratulations, you've now discovered a valuable tool to use as part of your recovery program.
In addition to finding a pain-free lying posture, it's also necessary to find pain-free sitting and standing postures.
Spine hygiene refers to how you take care of your back whilst going about your day. If you want to succeed in eliminating your back (and/or leg) pain you'll have to stop engaging in the faulty movement patterns that provoke your pain, replacing them with movements that don't stress the tissues of your spine.
Apart from finding pain-free postures whilst sitting, standing and lying, you'll have to learn how to move in more spine-sparing ways by moving through your hips and shoulders more, instead of through your back.
If you haven't previously thought much about it, you probably move through your spine every time that you sit down or get up from a chair, go to the toilet, pick something up off the floor, clean your teeth, empty the dishwasher, get in a car, open a door, etc.
This cumulative stress on the discs in your spine can cause them to delaminate, weaken and eventually herniate which can compress a nerve, resulting in sciatica.
Learning how to apply the appropriate movement tools to all the movements you engage in daily is therefore an essential part of your recovery.
Once you've learnt how to avoid provoking your pain, it's important to develop the muscular endurance of the muscles that stabilise your spine. This will allow you to prevent painful micro-movements, hold spine-sparing postures for longer and have more control over your spine as you go about your day.
The 'Big 3' exercises identified by Professor Stuart McGill apply maximal stimulation to the most important stabilising muscles of the anterior, posterior and lateral torso, whilst applying a minimal amount of stress to the joints of the spine.
These are: the bird dog, the side plank and the modified curl-up.
The Bird Dog
The Side Plank
The Modified Curl-up
There are progressions and regressions of each exercise (and additional variations to accommodate concurrent injuries). It's important to choose the appropriate version for you and carry out the correct dosage (number of sets and reps).
Your individual assessment will reveal an appropriate starting point for you. Then, once you've mastered these, and become pain-free, you can progress to more challenging exercises.
Send me an email to arrange a free consultation to see how I can help you get on the path to becoming pain-free and building a resilient back. All sessions are conducted 100% online (I may ask you to have a friend or family member present to assist with part of the assessment).
'I had been suffering from a sciatica for the past two years and despite seeing osteopaths and trying all sorts of pain killers and exercises, I never managed to get rid of it permanently. I got used to living with it, never feeling comfortable, waking up at night etc.
It had become so normal that I hadn’t even mentioned it during my intial consultation with Andy. However, during our first session he immediately noticed something was up. When he realised I had a chronic sciatica he changed my program to focus on that specific problem.
I still thank him every time we meet because not only did my sciatica disappear, but two years down the track, it has NEVER come back - even during pregnancy and after having a baby! So I would more than wholeheartedly recommend Andy for any health and fitness goal you are wanting to achieve.'
'How lucky to have met Andy! For several years I had been suffering from back pain in the lumbar region. I had a series of lower back pain issues despite physiotherapy and regular physical activity. Everything got worse after my pregnancy, and I was starting to despair!
The Low Back Pain Rehab Program saved me! I learned to relieve my pain, to perform the right movements on a daily basis, to restabilize my back and to build my muscles properly.
I appreciated the professional follow-up, the presence and the involvement of Andy, all by video, simple and effective! Thank you!!! I recommend 100%!'
'My back has been pain free!
It's been great. Keeping up with regular walks at least twice per day and occasional workouts and really sticking to back hygiene, it's ingrained now.
Thanks for your help through this journey, it really helped to have someone who understood the problem - something that other physios I worked with lacked.
It certainly gave me confidence in knowing what movements and exercises are good/not good for me.'
READ MORE TESTIMONIALS HERE