Worse/Better for Sciatica

This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2023. For the original video go to https://www.youtube.com/watch?v=DR3-H5uXtKs&t=179s

Mike: Say goodbye to unbearable sciatica pain with these tips.

Brad: Right, you’re going to want to discover what activities worsen the symptoms or actually alleviate them.

Mike: So I will be asking Brad five common questions we hear as therapists about sciatica.

Brad: And I am going to actually answer these questions with the worst and the best practices to manage sciatica pain.

Mike: Is it better or worse for sciatica pain to centralize?

Brad: Good question Mike. Why don’t you turn around and we’ll explain it. With sciatica, from the back oftentimes you have pain, numbness, and tingling, all these symptoms can go all the way down to the leg, foot, and toes. For this, we’re just going down to the ankle.

Brad: Now, centralizing means the pain is actually alleviating, or getting better, lower in the leg and progressing up to here. For example, we do some exercises and the pain, numbness, or tingling gets better. In other words, no symptoms from the ankle to the knee, but you still feel it from the knee to the hip and the back. Now if it happened to go the other way, and there were no symptoms in the back, but the pain down the leg actually got worse, that’s not a good scenario.

Brad: So we want the pain to centralize. It’s going to go up. So we keep doing the right exercises and the pain in the lower leg is gone, then the next couple of days we do some more, and the pain in the upper leg is gone. And then it goes to pain only in the back. Now you can see it centralizing, meaning it comes from the center. The pain is originating from the disc which is in the center of the low back and eventually, the pain goes away. That’s the progression we’re looking for. From ankle up, not getting rid of it at the back and making it worse, or staying down the leg. I hope I made that clear, Mike.

Mike: Clear as mud.

Mike: Is it better or worse to walk with sciatica?

Brad: Good question Mike. Typically it’s better. You want to walk. So what you want to do, there are a few things you have to keep in mind. You’re not going to go out for a two-mile walk and hope it’s going to get better. You’re going to walk as tolerated. You may start walking maybe 100 or 200 yards at first and then progress. When you walk, you want to walk on a very even surface. In other words, not in the woods, in the grass, or on a crowned road where you’re walking, and essentially one leg is longer because the road is crowned so the water runs off. So, sidewalks are preferable. Keep those things in mind. Again, start out with 100 yards out and back so that you can come home and sit down. Each day see if you can go a little bit longer. Walking is, we’ll call it, nature’s balm. Is that right, Bob, from Doctor Stewart McGill, the back expert? That’s where we found that, from his expertise, we found it to work well.

Mike: If you have one-sided sciatica pain, is it better or worse to stretch that one side?

Brad: Good question, Mike. Now, sciatica is almost always on one side. So the side that hurts, we’re going to try to stretch and yes you want to try it. A good way to start is if my right is my sore side, I’m going to take this arm up, like I’m reaching for an apple in a tree, feeling the stretch through that right side. If that feels good, you could actually walk around like that. And if that makes walking more comfortable, you’re right on.

Brad: Then, you can do it a little more aggressively. If you have a pull-up bar at home or anything that you can use for a handle, I know my sister’s doing this now with a door that she opened up. She’s light, so she’s not going to wreck the door. You can see how Mike is stretching that tissue on the right side. How’s it feel, Mike?

Mike: Oh, it’s stretching.

Brad: Good. Obviously, you have to have this set up and you have to have shoulder and enough strength to do this. So, use good judgment.

Mike: Is it better or worse to stretch your hips with sciatica?

Brad: Alright, here we go. Let’s talk about that. The hips are obviously connected to the low back, where typically the sciatica is from. If your hips and pelvis are actually causing your back to arch too much, that can irritate sciatica, and make it worse. So we’re actually going to do a stretch to lessen that arch and take the stress off of that. Typically from tight hip flexor muscles. Alright, the stretch for that hip flexor or the hip problem that we just talked about, Mike is going to demonstrate. But again, with all of these treatments or exercises, keep in mind the centralization. If the pain or symptoms are moving up toward your back, you’re right on, continue that stretch.

Mike: So I’m going to stretch my left hip flexor here. So I’m going to lay down on my back. I’m going to bring my right knee to my chest and I’m going to bend my left knee to about a 90-degree angle. And I’m going to hold this here. Try to keep my leg straight. You don’t want to go too far out, or too far in. And if you want to get more of a stretch, if you’re flexible, just scoot closer to the edge of the bed. Make sure your bed is firm here. If you have a soft edge, you don’t want to fall off. You can also use a firm table for this. You’re going to hold this for 30 seconds and then you’re going to bring the other knee up here. This should feel good and you’re going to stretch your other side. Make sure to do 2 or 3 sets of 30-second holds.

Brad: Your right’s a little tighter than your left I think Mike.

Mike: You’re very observant. Is it better or worse to place your back into extension if you’re having sciatica pain?

Brad: Right now, if you just did the stretch that Mike showed and it wasn’t showing progress, it may be good to actually extend your back like this. In passive, he was talking about pushing his arms up, keeping his pelvis or waist down on the bed or the floor, and getting this. So, if you’re going to do this, the way you’re going to start out is in a prone position, lying down, probably on the carpeted floor, not a soft bed. We’re going to start with a little lumbar extension on the forearms. You can see we’re starting to extend this. If things start to get better, and we centralize that pain, it’s coming up the leg, then you may go to mini-press-ups. There we go. And you’re going to do 10 of them, not more. And at that point, you’re going to again monitor, are you getting centralization of the pain? If it continues to feel better, you may want to do 10, rest a little bit, and then try to do a full extension. Now this may not happen in a matter of 20 minutes, it may be a few days. Each day you get up a little higher. Things centralize a little bit more, and it feels good while you’re doing it. That’s a green light for this exercise for you versus the previous one.

Mike: Another good option is called the cat/camel. So this one, as long as you get in this position and it’s not causing back pain, you get on all fours. And it’s an old yoga pose that has many different names, but cat/camel is what we’re calling it now. So you bring your head up and your butt up, this is the camel, and then you’re like a cat when it’s mad and hissing and arching your back, bring your head down. Just go each way, hold it for like five seconds or so, and do 10 repetitions.

Brad: Again, if it feels good, centralizes the pain, this could very well be the exercise for you. Do the one that works for you, stick with it, and you’ll see good improvement over time. Alright, I think we’re there.

Mike: Be happy, healthy, and helpful.

Brad: There ya go. Good luck with that sciatica.

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