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Why Sciatica Happens and How to Fix It!
- 3 hours ago
- 12 min read
This article is a transcribed, edited summary of a video Bob and Brad recorded in December 2024. For the original video, go to https://youtu.be/shEBSy-4fkM
Mike: Are you dealing with sciatica and not sure what to do about it?
Brad: Well, you're in luck because in this video, we're going to explore seven different options to self-treat it and calm it down and maybe actually get rid of it.
Mike: So first, we want to explain what is happening when you have sciatica, and typically it involves a herniated disc pushing on your sciatic nerve root.
Brad: That's right, and once one of those nerves becomes irritated and compressed, it'll send pain, numbness, tingling down one side. And it can't go all the way down into the toes when it's at its worst. So we're going to explain how that works, and we have a model here. Can you show what level they're at using that model?
Mike: So we are at the L4- L5 level. These are your lumbar, fourth, and fifth vertebrae, and here you can see a disc. These discs are all normal. The red one has a protrusion, and it's hitting those nerve roots, making that sciatica pain worse. And what causes this, Brad?
Brad: That's right, so if we look at that bulge, this model really does a nice dynamic representation. So, as you bend forward, it pushes the internal content of the disc out, and it bulges, and it pushes into the nerve. It's not exactly like this. This is a little bit exaggerated, but you get the idea.
Brad: Now, if you turn, if you go sideways, it can actually come out from the side. So either way it doesn't matter. Well, it doesn't matter which way it goes out, but it will pinch the nerve. Typically, a peripheral nerve, which may mean it's going to go down one side, is very common.
Mike: Now your spine can normally handle these, but over time, consistently doing it, and maybe you're holding weight while doing it, it's going to be problematic, and you won't even feel the pain. Initially, it could take years, but once it manifests itself, it's hard to get rid of, and it's quite annoying.
Brad: Alright, so let's get to the seven things that you need to try and see if you can alleviate or get rid of this pain.
Mike: The first thing we want to do is try to keep your spine nice and neutral. We don't want to be too flexed over. I don't know who sits like this, but you wanna show some flexion there?
Brad: Yeah, I mean, so we're talking about the lower back. If we're flexed, it means we're leaning forward like this for whatever reason, not being aware of our spine posture, or in a chair, maybe we're sitting like this or like this. Either way, the spine is flexed, and it has more potential to have that bulge to go out and press into that nerve.
Brad: So we're going to scoot our butt back into the chair, sit upright, and it works really well, and it doesn't cost anything except for taking a pillow from the bed, putting it vertically in a chair, and using that. And that helps your spine stay in that neutral position. It's comfortable, and it really works well.
Mike: Now, if you're sitting on a couch or recliner that's kind of worn out on the bottom, you can take a smaller throw pillow and put it behind your lower back, and that may work as well.
Brad: That's right, right in there. You know what I mean? Some of these older or even newer ones that aren't built well have a big hollow spot right above your belt. Fill it in with a pillow for good support.
Mike: Now, the next tip to try is to actually stretch out your hip flexor. Now you're thinking I have back pain. What the heck does that have to do with my hip? If your hip flexors are tight, they can essentially tilt your pelvis anteriorly or forward, and you can see the back is going to arch more, causing a different pattern, which can cause some sciatic pain to happen.
Mike: So, what we want to do is stretch out these front hip flexor muscles and see if that can help.
Brad: There you go.
Mike: So there are numerous ways to stretch your hip flexors. Most people are uncomfortable kneeling down, but there's a simple way if you lie on the edge of the bed, hopefully your mattress is firm. You could try it on the kitchen table or cupboard if you can get up there. But what you're going to do, if I'm going to stretch my left ones tight, I'm going to bring both knees to my chest. I'm going to drop this down in a straight line. I'm going to bend my knee on this side, bring the opposite knee to your chest, and you're just going to hold this for 30 seconds or so. And you notice once I pull up my hip comes up a little bit, that means I'm a little tight there. You're going to do one side, reset, and perform on the other side. You may notice one side is tighter than the other. Most commonly, if you're having sciatica and this is helping, the side is going to be tight on your painful side.
Brad: There you go. So again, be careful with this one. If your sciatica has flared up and it's uncomfortable to get in this position, you'll have to wait until things feel better and go to the next option.
Mike: Then one nice thing about this stretch for sciatica and stretching your hip flexor is your back is supported and it's in a neutral position already. So that's going to help if you're doing a kneeling one, some people might arch their back too much, and it would hurt. So there you go. Just like that.
Brad: Yeah, that hurts my knee. That's why I don't like to do that one.
Mike: Alright, tip number three, we need to set up our props.
Brad: Okay, we'll take a break. Now, the next thing we need to address, particularly if you are in a car for any extended period of time, is your seated posture in your car. You'll know it's bad because when you drive, you're sciatic, it gets worse, and it may be able to get corrected by simply changing the position of your back. Some people, and I've had many patients, I say, "Do you adjust your lumbar support?" And they say, "I don't even know if I have one." So we go out to their car. Sure enough, they have a button, and you can adjust the lumbar support to get it in a comfortable position. You may not have that. You can simply use the pillow trick that we talked about before and use it in your car seat. Make sure you adjust your seat forward and backward so it gets you in a comfortable position. It can make a tremendous difference while you're driving.
Brad: Alright, let's go on to the next option.
Mike: The next tip is to strengthen your hip abductors. These are your glute medius and minimus on the side of your hips here. What they do is keep you upright when you're walking. Some people who have back pain have weak hip abductors. So we're just going to strengthen them. You could do it many different ways for beginners. We'll just stand, and you can kick out to the side. Make sure to hold onto something if you have pain or you feel unsteady. I'm bending my knee on the stationary leg, so this hip abductor is working to keep me upright. We're going to do 10 to 15 reps, and then you're going to switch sides. Notice we're not rotating our toes out to the side because those are different muscle groups, nice and straight. Good posture.
Mike: If that seems easy for you. You can take a loop band like this, you can take a cuff weight, you can take a big band like this and just put it around your hips, and then you've got some resistance to make it harder because we want to progress over time, build up those hip abductors.
Brad: A big thing not to do is a common mistake is this. The upper trunk needs to stay stable and upright, so we isolate those side muscles so that the pelvis stays stationary, helping the back.
Mike: Now, with strengthening, you can just do this every other day, Monday, Wednesday, Friday. Just do the strengthening exercise, let them rest on the other days, and recover. What's our next one? Oh, walking with soft knees.
Brad: There you go.
Mike: Now, this pertains to many other joints in your leg and even your lower back. So most people commonly walk around with a heel strike, a straight leg like this. The impact forces are going to go to the ankle, knee, hip, and lower back.
Mike: If we can put a bend in the knee, some of the shock absorption will go into the muscles, so it can take pain off your lower back if you're experiencing it. So what we suggest is when you're at home, walk around barefoot or in slippers, maybe socks. If you feel comfortable, do your normal walking pattern like you always would and place your hands on your buttocks while you're doing it. Feel how much your glutes are or are not engaging. Then we want you to go on your tippy toes. Now feel how much your glutes are engaging. They should be activating a lot more this way. So that means you're doing it right. However, we're not going to walk around on our tippy toes all the time.
Brad: Yeah, there's the tippy toes thing I don't go for. No one's going to walk around like that.
Mike: You can feel it, though. The activation of your actual muscles.
Brad: I'd say, just walk on your forefeet. So you're balanced.
Mike: So, just make sure to have a nice, soft bent knee. You can land slightly on your forefoot or with a flat foot in the house; you're going to take shorter steps. But if you're noticing your back pain is feeling a lot better, then this is the right step for you.
Brad: Right, and this is one of those things where we've had people, you change that, and they say, " Oh, walking's not so bad anymore." You'll know right away.
Mike: What's the next one? Glute strengthening. So some people have what is coined as gluteal amnesia, meaning their glutes aren't firing properly. Changing your walking pattern can help, but if you're still not feeling a lot, a way to isolate your glutes is to do some glute pumps. Now you can do this in a standing position if you are not comfortable getting on your hands and knees like this. But if I'm doing my left one, I'm not gonna do the full glute pump. You commonly see we're going to go somewhere in mid-range here, and we're going to do a little oscillation. Do 30 repetitions total. And then if you're not feeling much activation, say your hamstrings are kicking in too much, turn, and then we're going to do it this way. If you need to do three sets of 10, two sets of 15, do all 30 at once, whatever you're comfortable with, just make sure to work both sides.
Brad: That's right. You can also do this one standing. I'll demonstrate here, hands-on, a cupboard or firm piece of furniture. Keep your back in that neutral position, not arching this way or rounded. And we'll do the same motion right here. Get that butt muscle firing, you'll feel it. Rotate it in
again. 10 to 20 and up to 30 reps as you feel stronger.
Brad: Okay, very good. Let's go to the next. This is the next stretch, actually is going to open up that side, releasing that pressure from that disc bulging out. And you can do this, you can do it with a doorway if you're tall enough or not too tall, Mike will demonstrate it that way. And I'll demonstrate a way if that's not an option for you.
Mike: So you're going to lean into the door frame with your painful side going in. You could do this on a pull-up bar, too, if you happen to have one at home. My palm is going to face away from me. We will say my left side is a painful one. I'm going to lean into the door to start, and then I'm slowly going to bend my knees, and I'm just going to kind of hang, but I still have pressure through my feet. This is going to decompress that spine and give you some pain relief if you're having an episode of pain. It's also going to stretch out all these muscles in your back that may be tight. So you're just going to hold this for about 30 seconds. You can do it on both sides if you want, but you mainly want to focus on the painful side.
Brad: That's right, if that does not work for you, you don't have a good handhold on the door, you're too tall or too short, you can simply take a buoy stick or just any kind of a broom or sandal that's strong enough. Maybe a piece of dowel or PVC pipe. You need a rubber tip. If you don't have that, simply put it on a shoe on your cupboard or chair so it does not slide. Palm turned away. And again, I'm standing here, I'm leaning, that's putting the stretch right through here. You can see my shirt is starting to tighten up, and that's what's going to happen with your muscles. They're going to stretch, relax, and I'm bending my knees to get an adjustable or variable stretch on there. Again, it should feel good to open up and allow that bulge to get back in, or they call that reduction, and that feels good.
Mike: We should mention that if you happen to be walking and you're having this pain and you know that helps, you can try just sticking your arm up in the air for a little bit while you're walking, then put it behind your head, and then down at your side if you're having pain while walking.
Brad: Yeah, so you find yourself walking down the sidewalk like this and feeling good, and yes, people will talk.
Mike: Yeah, they always do. Anyway, give all seven of those a try, and see which ones work for you. You do not have to do all of them. Pick out two or three, and make sure to stay consistent with them if they're helping your pain, and what else should they do?
Brad: Well, actually, you'll find that maybe two or three of them clearly make the pain better down the leg. But after a week or two, they change, go back to this, and retry some of the other ones because that's the progression. Sometimes you may end up not doing well with the one on the door or the stick, but later on, as things progress, that becomes one that works very well. So you need to work with it. You'll learn very quickly how your body responds.
Mike: If you want to see more videos on sciatica, watch "Only 1 In 5000 Know This About Treating Sciatica."
Brad: So instead of one in 5,000, we're trying to make that much more. Alright, take care and enjoy. Good luck with your sciatica.
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