Top 10 Burning Questions for Low Back Pain and Sciatica
by Dr. Alice Holland, DPT, Stride Strong Physical Therapy
Following this article you’ll find information about our Free Low Back Pain Workshop. In this workshop, we’ll discuss causes and demonstrate treatments for low back pain and sciatica. I’m confident that we can get you back to pain free!
Hope to see you there – Alice
- How long before I can see improvements in my pain?
A: Most patients who come to us will start to feel better in 2-3 visits, or 1-2 weeks of therapy. If this does not happen and there is no reduction in pain, you may be wrong about the cause of your sciatica regardless what your X-Ray or MRI shows.
- Will I be completely healed after physical therapy or will this sciatica pain come back again?
A: Most patients who complete all the 3 phases of healing (i.e. they no longer have pain, motion and strength has returned to normal and they’ve returned to all of their activities) will have a minimal chance that their sciatica will return again.
Maintenance plays a big role in keeping sciatica away. The body Is much like a car: if you take care of it, regularly change it oil, keep it running and keeping aware of how it is running, there will be little chance of a catastrophic breakdown. However if you ignore a problem and not care for it, your ‘car’ will likely breakdown and be in need of repair.
- Will I need special equipment?
A: The short answer is no. Though we might use special equipment at our PT gym, we will show you exercises and ways you can get the same benefit from exercising at home with minimal to no equipment. Occasionally, we encounter a patient who responds very well to traction therapy, in which case would be the only exception for equipment needs.
- Should I use heat or ice on my leg?
The cause of most sciatica originates in the low back and spine, so ice or heat on the lower extremity will not change that.
Heat calms down muscle spasms but exacerbates inflammation. Ice calms down inflammation but does not help with muscle spasms. Your physical therapist may recommend you use either for your low back, but it is best to get their advice on your particular situation first. You can get more advice from our blog here.
- Which exercises should I do?
The best exercises for you depend on what the cause of your sciatica is. There are 3 main causes for sciatica:
- Herniated discs
- Stenosis, arthritis
- SI Joint problem
Each cause has a series of different exercises that suits it best, so picking the right exercise involves knowing the cause of your sciatica.
- How do I know the cause of my pain?
People with sciatica from a herniated disc usually have pain with bending forward, twisting, coughing or sneezing. The sciatica symptoms they experience is usually sharp and travels down the back of the leg and possibly into the foot. Patients whose cause of sciatica is from herniated discs are usually 35 years or younger.
People suffering from sciatica from a stenosis or arthritis issue are usually 50 years old or older, has pain with walking or standing, and gets relief from sitting.
Conversely, people suffering from sciatica who have an SI joint origin have a low-grade pain from sitting for long periods of time. The sciatica pain they experience usually reside on the buttocks and/or outside of the thigh. Symptoms may also include heaviness in one leg or feeling like the leg is “off”.
- How often should I do the exercises, and do I have to do them forever?
A: Most of our patients in the clinic do our prescribed exercises everyday. Some do them 3 times a day and usually there is no harm in doing them more times a day, even.
However, your body will sooner or later adapt to these exercises and in order to progress to greater vitality and ability, the body needs to be challenged. For example, one of the best programs you can move on to once you complete the 3 phases of healing for your sciatica is a walking program or a Tai Chi program.
People who walk every day have less risk of reinjuring their back.
- What does physical therapy entail? What do I need to do for complete care? Am I going to relapse?
The best thing to do for your sciatica, if you are worried about it coming back again in the future, is to complete all 3 phases of healing that your PT will help you through. They are outlined here:
Phase 1: We focus on getting dramatically reducing your pain, numbness and tingling.
Phase 2: We focus on restoring normal movement of your spine and hips and return you back to full strength.
Phase 3: We gradually let you return to all of your usual activities, including recreational activities, while monitoring you for increased symptoms, advise you on avoiding faulty postures within your activities.
Phase 3 is typically where we see patients flare back up with some symptoms because they have returned to their usual activities and may have lost some self-awareness with bad habits and bad postures. However, with a little bit of guidance from their PT, they get back on the right track and continue on getting stronger and stronger so they can withstand all the loads and forces that daily life brings them. Usually it takes only 1-2 visits to get these patients on the right track again.
- What sleeping position is best?
The best position is sleep in is your back. Next is in a fetal position on your side. The least favorable is on your stomach. The most important point to note about spinal positions in sleeping is to keep your spine in “neutral”. This means it is not bent or twisted into ranges outside of its natural curve.
Pillows, folded towels/blankets, bolsters places under your knees have been shown to decrease spinal pressure in sleeping. Pillows can also be places under your waist if you are sleeping on your side to help you find the least pain position of sleep.
- How long is this going to take to go away?
A: It depends a lot on YOU.
The first 2 phases of healing involves gaining range and movement back, returning your strength in your back and lower extremities back to normal. This process itself takes anywhere from 4- 8 weeks.
The final and third phase of healing involves gradually returning back to the recreational activities you want to do, and depending on how active you are this process can take 1-4 months.
‘Why the range in time?’ you might ask. Here’s why:
- Overall health differs from person to person. Healthier and younger people heal faster.
- Health issues like diabetes, heart disease, high blood pressure, tobacco use, alcohol abuse and body weight with influence healing time and will prolong the process of healing.
- Nutrition plays an important factor in that those who consume a large variety of nutrients in their diet will heal faster than one who consumes a lot of ‘empty’ calories.
- Everyone varies on their rest time. It is vital in physical therapy that patients allow time and rest for the body to heal – don’t be confused, this doesn’t mean have a sedentary day-life, it means adequate SLEEP. A lack of sleep slows healing time.
- Cortisol levels from stress plays a factor in healing. Those who have high levels of stress tends to heal more slowly.
- A key ingredient in physical therapy and healing is to stay moderately active with gradated movement. Living a sedentary lifestyle and sitting on the couch/chair all day does not promote blood circulation in the body, and a much needed component to healing is blood profusion!
- People who follow advice and instruction from top level healthcare professional heal more quickly than those who do not follow through with sage health advice.
- A lot of this advice coming from physical therapists is about posture and those who are more aware of their daily postures and habits heal more quickly. They can adjust habits such as sleep and sitting positions that help in the process of healing.
- Self-education matters a lot. We love patients who ask questions and are interactive and involved with their well-being. Those who read constantly about how to improve their health always do well with physical therapy.
- Sounds cheesy, but positivity also plays a definitive role in their healing. Where there is hope, there is persistence and this is how all the above comes together.
Do you …. suffer from back or leg pain when you stand or walk?
… have pain when you sit for long periods or drive?
… experience pain, numbness or tingling into your butt,
groin or down your leg?
Does your back ever “go out” if you move the wrong way?
Come to our workshop event for answers on your back pain!
Saturday April 28th, 10:00am
Stride Strong Physical Therapy Beaverton
12849 NW Cornell Rd
Portland, OR 97229