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Date Posted: 06:16:24 06/26/04 Sat
Author: J.R.Smith,c.f.t.,s.p.n.,s.s.c.
Subject: Sciatica problems

Sciatica problems

This information is not given to diagnose or treat any spinal or spinal medical problem. You will need to see an orthopedic surgeon, chiropractor or other medical professional.

Thanks.
J.R.Smith

Sciatica is a commonly used term for pain originating from the back that is felt along one of several nerve distributions in the buttock, hip, thigh, leg, ankle or foot. Generally the sacral plexus consists of nerves from the L4-L5 and S1-S2 which forms the sciatic nerve, which is actually two nerves from the same sheath, the common peroneal and tibial nerves. These nerves supply the posterior thigh, leg and foot as well as the anterior and lateral leg and the upper and posterior portion of the foot. Sciatica involves compression or irritation of one or more nerves exiting the lower spine that make up the sciatic nerve. The sciatic nerve branches off as it travels down the lower extremity, and thus pain can be experienced along this route.
The specific exercises recommended will depend on the cause of the sciatica which include:

Sciatica from a herniated disc /Sciatica from spinal stenosis /Sciatica from degenerative disc disease /Sciatica from isthmic spondylolisthesis

With regard to sciatica and herniated disc, which is most likely the cause in your client, consider the following plan for programming.

Exercises to treat this condition are recommended according to which positions will cause the symptoms to move up the lower extremity and into the low back.

For many clients this is accomplished by getting into a backwards bending position.

The low back is gently placed into extension by lying on the stomach (prone position) and propping the upper body up on the elbows, keeping hips on the floor (Figure 1). This should be started slowly, since some patients can not tolerate this position initially.

This position is typically held from five to 30 seconds per repetition, for 10 repetitions.

After practicing this exercise, the spine specialist may recommend a more advanced form of the extension:

From the prone position, press up on the hands while the pelvis remains in contact with the floor.

This position is typically held for 1 second, repeated 10 times.

A similar exercise can be done standing by arching backward slowly with hands on hips if the patient is unable to lie flat. However, the prone position is usually preferred.

These “extension” exercises are done regularly, about every two hours. More importantly, the spine specialist may recommend that the person with this condition should avoid getting into a forward flexed (bent over) position. This tends to counteract the effects of the extension exercises. The specialists may ask the patient to correct forward flexed positions immediately with an extension exercise.

As the pain works out of the lower extremity, the exercises typically are advanced to strengthen the low back and abdominal muscles to prevent recurrences of the condition. To strengthen the low back muscles:

In the prone position and hands clasped behind the lower back, raise the head and chest slightly against gravity while looking at the floor (stay low).

In the prone position with the head and chest lowered to the floor, lightly raise an arm and opposite leg slowly, with the knee locked, 2-3 inches from the floor.

To strengthen the abdominal muscles:

For the upper addominals, lay on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the floor. Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head.

For the lower abdominals, tighten the lower stomach muscles and slowly raise the straight leg 8 to 12 inches from the floor, keeping the low back held flat against the floor. Water exercises are also excellent, even just walking in waist-deep water.

Aerobic conditioning may also be encouraged for general body fitness. Walking is an excellent form of exercise for the low back, working up to three miles per day at a brisk pace if able.

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