If Only I Knew...
About Sciatica, Part II
By Marie-Catherine Bruno, BScPT, Cped(C).
In the last publication, we went over the anatomy of the back, the structures that can be involved in back problems and how they can be damaged. Let us now look at ways of avoiding the problems, or at least getting rid of them if they are already existent.
The first thing to do is to take care of the inflammation. The easiest way is still the ice (refer to ONA April 2001 ). There also are other alternatives, like anti-inflammatory medications and natural products. Ask your doctor, your pharmacist or your naturopath about them. The machines used in physiotherapy (LASER, ultrasound, interferential currents…) are usually not very effective as your back joints lie fairly deep into the structure, plus are covered by very thick layers of muscle. Those machines lose a lot of their efficiency at depths greater than 2,5 cm (about an inch ).
The next thing to do is to take care of the joints that are not moving, the stiff ones. They are the ones responsible for all of the problems you are having. So unless you make those better, your problems will tend to counterattack! Stiff joints can be mobilised (technique used by health professionals to gently help a joint to move) by osteopaths, chiropractors and in Canada, by physiotherapists as well. Once you get them moving, it is not over yet! You still have to take care of the ones that were taking the load and were moving too much. If your problem has not been in place for too many years, strengthening the deep stabilising muscles may be good enough (see your personal trainer at the gym of your physical therapist). If not, you may have to re-educate your body and teach your body how to work properly (it is like limping even when your ankle is healed – your brain registers patterns of movement and sometimes you have to make conscious efforts to get rid of them). Your physical therapist can help you do that, using proprioceptive neuro facilitation patterns (commonly called PNF).
The most important thing for your disc is without any doubt: keep them healthy. That involves using proper body mechanics to lift heavy objects (or light ones repeatedly) and watching your posture all day. Refer to the next paragraph on that topic.
If you have been bad (or unfortunate) and already have a disc problem, then let see what you can do to alleviate the pain. Your disc is either out of place or herniated. As we mentioned in the previous article, a herniated disc is a busted jelly doughnut, and besides surgically taking it out of your body, there isn’t much that can be done. But if it is still healthy, but just unstable, then your physical therapist can help you by using traction. A traction can be done by the P.T. himself (manual traction), or by a machine (mechanical traction). What it does is that it separates your vertebrae (opens up the space between them), and by suction, your discs will go back in place. Now once that has worked, remember: if your disc got displaced, it is unstable. You must strengthen the deep muscles around it to protect it AND learn proper body mechanics. Otherwise, get yourself a lifetime membership card at your nearest physical therapist!!!
Bad posture creates a lot of problems. Keep in mind that posture does not only mean when you are standing up. It also means sitting at your work desk, watching television and also, sleeping. Your back should have nice constant smooth curves in it (when looked from the side). If one of your natural curves seems deeper or sticking out more than everybody else’s, you may want to receive some advice on it.
When you sit at a desk, make sure that your feet are supported and that your knees are higher or same height as your hips. Keep your shoulders back and down, and have your elbows or wrists supported if you are using a keyboard. Also make sure that you are not poking your chin out and sliding your head forward. At night, sleep on your side with a pillow between your knees, or on your back with a thin pillow under your knees. Make sure your pillow is of the appropriate size (it should support your natural neck curve, so if you sleep on your side, you need a much thicker pillow that covers the width of your shoulder, otherwise your head is bent to the side).
When lifting objects, bend the knees and do not rotate your back, move your feet around instead if you need to pivot. Hold the object as close to you as possible, using both arms. I know it seems a bit slower, but hey, how slow do you get when your back is sore?!
If you have muscle spasms or just a lot of tension, make sure that you know why it is there. It is important to get rid of the cause first. Then, think of releasing that tension!
The 2 most effective ways of reducing muscle spasms are stretching and icing. They both have an effect on the muscle spindles (small receptors in your muscle that trigger muscle contraction) and help reduce the tension (because muscle tension is a reflex to protect your body). Massage also has great results as it has a general calming effect, plus it stretches the fibers of the affected muscles. Heat may make you feel good, but keep in mind that its effect will stop the minute you remove the heat source. Also be careful of not using heat if there is any sign of inflammation – it will only make it worse.
A good sequence is a hot bath to warm up the muscle, then a massage and/or stretching, and then deep ice. Even better, apply your ice on a stretched muscle (in a stretching position). It will freeze the fibers in that position and reduce the chance of them going back in spasm mode.
If you have pulled a nerve, all you can do is wait patiently. Nerves grow a millimetre a day, so let them do their work. If on the other hand you have an entrapped nerve, the only thing that will make you feel better is to take the pressure off it. That is the tricky part though : figuring out where the nerve is trapped. In 85% of the cases, it is not in the area where you feel the pain or the pins and needles. In fact, it is usually not even close! So for that one, you will have to find a great GP with good diagnostic skills, or a good osteopath. Once they have found where the problem is, they will release the nerve (manually, or surgically if really bad), and then you will start feeling better. A good thing to remember is that once you take the pressure off, it may take a while before you feel the relief. The longest there have been pressure on a nerve, the longer it will take for the sensation to be normal again. So be patient, but also pay attention to what you are feeling (your brain has an amazing capacity of telling you where the problem is, so don’t be afraid of speaking your mind).
Not too many health professionals work the fascia. It is a relatively new technique, and there still is not too much research on it. But yet, the results are amazing. If you experience chronic pain that does not seem to go away, even after treatments and medications, maybe the fascia has been overlooked. The symptoms can be pain, pins and needles, tightness and even nausea.
If the fascia is what your pain source is, then you need some myofascial realease (MFR). Some registered massage therapists (RMT), physical therapists (PT), osteopaths and chiropractors may help you.
Although relatively rare, your back ligaments may be damaged. When freshly sprained, you need to reduce the inflammation (see The joints above) and the muscle spasms as quickly as possible. Then you have to protect them by limiting the amount of strain you put on them. For many of you, it may mean rest and no work. In some cases, a back support may do the job. But whatever you do, you have to give your ligaments as much stability and support as possible (you don’t go running on a sprained ankle, do you?). It takes 3-4 weeks for the ligament’s fibers to heal, so that is for at least how long you want to protect them. Then, you will have to strengthen your back muscles, especially the deep ones since your ligaments lie fairly deep, before you can safely start using your back again. If you skip a few steps of that process, your ligaments will still heal, but they will be loose and unstable for the rest of your life (unfortunately, ligaments do not have good elastic properties), and you will develop an instability. Instability is irreversible, and leads to the joint problems mentioned previously (refer to The joints, ONA January 2002).
So there really are many things that can go wrong with your back. Being aware of all of the possibilities does not make you heal faster, but may at least direct you to the right health professional, and hopefully take you along the healing road. Remain hopeful, because back problems only stay when not properly taken care of.