by Christina Abbott on July 27, 2010
When sciatica pain gets the better of you and nothing you do seems to help, here are some self-treatment tips you can use to get pain relief. Look at other suggestions in my Checklist Part 3. (There is a list of 17 corrective actions and treatments in three parts.)
Self-treat your muscles with pressure and massage, ice or heat (ice for pain and muscle spasm 1-5 minutes, moist heat for achiness and stiffness 1-5 minutes. (See my post on Ice or Heat)
The treatment protocol I use in my Neuromuscular Therapy practice near Boston is the following:
Use some kind of massage, vibration, short application of ice or heat first. This gets the blood flowing and starts the lymphatic system draining waste products from the fluids around the muscles.
Find a place where the muscle is tender and has a tight place or a knot. If you feel any referred symptoms (sensation other than where you are pressing), it indicates that you’ve found a Trigger Point, a more important place to treat than just a place of tension.
Apply pressure with your thumb (or fingers, elbow, knuckle, a ball or some kind of pressure tool like the Theracane shown above), increasing the pressure until you increase the pain to a level 6 on a scale of 1 to 10. (Too much pain turns on your body’s alarm systems which is not helpful when you’re trying to get your muscles to relax. Too little tenderness under pressure indicates a less than optimal treatment depth.)
Hold the pressure where it hurts and count for 8 - 12 seconds. You should feel either that the muscle is softening under your pressure or the pain is subsiding, indicating that the contraction is releasing. If nothing happens, hold the pressure for up to 20 seconds. If you still feel no change, keep your thumb in the same place and let up pressure to allow the blood to get to the muscle for maybe 10 seconds, then press in again and hold until you feel a release. I suggest repeating this procedure up to three times. If you aren’t getting anywhere, go on to another place and come back to this stubborn spot.
Finish your self-treatment with more “flushing” using massage or ice or stretching.
What is better, ice or heat? That depends on your symptoms. Think of a swollen ankle. The injury has stimulated inflammation. The appropriate application is ice, not heat. Heat will increase the inflammation and swelling. So if you have pain or swelling use ice. Also use ice when you have muscle spasms. With both conditions you want to turn off the nervous system temporarily. Ice increases blood flow through the capillary beds under the skin, increasing the removal of waste products that cause pain.
Heat is used for achiness and stiffness to increase blood volume in the larger vessels, warm the muscle, and bring oxygen and nutrients. Lack of oxygen causes muscle pain, nutrients are necessary to heal the tissue.
The next post is on treating medical conditions.
by Christina Abbott on July 22, 2010
When sciatica pain gets the better of you and nothing you do seems to help, here are some physical changes to check and correct to get relief from my Checklist Part 2 on corrective actions and treatments.
Make physical changes in posture, repetitive tasks involving affected muscles, sleeping position, and irritating activities. Alexander Technique and Feldenkreis are two reliable corrective therapies.
Posture is often a factor in relieving sciatica. If you are sitting with a slumped posture, you may be compressing nerves that perpetuate your symptoms. The piriformis muscle is right under your buttocks (gluteus maximus) and is an entrapper of the sciatic nerve. Sitting back with your pelvis tucked under puts you right on top of it.
This posture can also distort the lower back (lumbar spine) from it’s normal curve. It is meant to stack up in a curve, and not curve backward. With that reverse curve position, the front edges of the vertebrae press together and can squeeze disc material out toward the back of the spine where the nerves are located. If the pressure on the nerves is sufficient or the discs are leaking fluids containing irritating chemicals, it can hurt. The position also affects the muscles, compressing some and stretching others. Constant poor positioning can cause the muscles to contract and even go into spasm.
Sleeping positions can affect sciatica symptoms also, especially sleeping on your side. Side sleeping puts pressure on the deep muscle in the side of your hip called the gluteus minimus. That muscle has been nicknamed the “pseudosciatica” muscle. If the muscle is tight, then compressed during sleep, the blood flow slows down and can cause pain from depleting oxygen supply to the muscle. Compression can also activate Trigger Points in the gluteus muscle, causing sciatica symptoms.
Side sleeping also curves the spine so it “sags.” That causes compression on the sides of the vertebrae where the nerves are located. It also causes prolonged shortening of the muscles in the side of your waist. A little muscle there called the quadratus lumborum is responsible for a majority of low back pain of muscle origin.
Repetitive movements, misuse and overuse of muscles irritate them. Think about the muscles you are using in your daily tasks. Hours of computer use, lifting heavy objects and shoveling in the garden are typical irritants, also lifting children and laundry and furniture. Lifting from a twisted position and twisting to pick up something from the floor are the most dangerous activities.
Your sport may contribute to low back tension that can lead to sciatica symptoms. Running causes repeated concussions on the spine, golf and racquet sports cause momentary stress every time the ball is hit in a twisted position. Sports that require changing direction a lot like basketball and soccer put strain on that little “pseudosciatica” muscle.
Proper stretching is necessary for maintaining healthy muscles. The Active Isolated Stretching protocol can be used for all stretches. In my opinion, and that of the many athletes who practice it, AIS is the most effective and least harmful of all the stretching methods.
Alexander Technique and Feldenkreis therapy are both excellent corrective therapies. Alexander Technique helps you feel where your spine should be in space. It teaches you how to make those corrections and gives you easier ways to perform daily movements. Feldenkreis corrects movement patterns, sometimes going back to infancy. Retraining poor movement patterns corrects irritating repetitive use of the muscles. Both therapies balance the muscles and allows them to get the R&R they need.
The next post is on self-treatment.
by Christina Abbott on July 21, 2010
When sciatica pain gets the better of you and nothing you do seems to help, here are some minimally invasive medical treatments you can try to get relief from my Checklist Part 2 on corrective actions and treatments.
Nerve blocks, radiofrequency treatments, facet blocks etc. can be performed in out-patient pain clinics and hospitals. Doctors with a Pain Management specialty are the ones performing these minimally invasive procedures.
Live x-ray technology (fluoroscopy) is often used to precisely target the area that is causing your pain. In most cases you can walk out of the office and resume your normal daily activities immediately.
Nerve injections of all types are performed to block the nerve signals causing pain. Most of the injections are on the spinal nerves. These medications serve to make the nerve numb to pain.
Radiofrequency treatments “burn” nerve endings to deaden them. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, preventing it from sending pain signals.The nerves will eventually regenerate and will need to be treated again.
Facet blocks target the nerves in the facet joints that restrict twisting motions in the spine. A facet block is an injection of local anesthetic and steroid into the facet joint. More than one block may be needed depending on how many joints are involved.
Other procedures include cortisone or steroid injections for inflammation. These chemicals are very powerful and effective, but since they also kill cells, they can only be used a few times in the same spot. The source of the inflammation needs to be identified and corrected to prevent multiple anti-inflammatory injections.
Before trying these, make sure you have addressed Trigger Points with Neuromuscular Therapy and researched all other factors that may be causing your pain. See my previous checklists for reasons and explanations.
by Christina Abbott on July 20, 2010
When sciatica pain gets the better of you and nothing you do seems to help, here is a medical treatment you can try to get relief from my Checklist Part 2 on corrective actions and treatments.
Have Trigger Point injections when appropriate (see a physiatrist usually, also medical pain specialists, neurologists and anethesiologists) Dry needling is a good option that doesn’t use an anesthetic.
To determine if you have Trigger Points, go to this previous post “Treat Trigger Points,” that shows those that cause sciatica symptoms. Manual treatment with a Trigger Point therapy like Neuromuscular Therapy usually helps. My NMT center is near Boston.
A Physiatrist is an MD, a Doctor of Physical Medicine (like a Physical Therapist with an MD). They are the ones in the rehabilitation centers that treat neuromuscular disease, chronic illness and conditions needing rehab. Physiatrists usually know about Trigger Points because it has most likely been taught in their specialty courses. Remember that Trigger Point information on sciatica pain has only been around since 1991! Other doctors who have learned about this source of pain are those who specialize in Pain Management, and sometimes anesthesiologists and neurologists. Some forward thinking PCPs have enough information to guide you to the right specialist.
Trigger Point injections are used when non-invasive treatment hasn’t helped enough. Drs. Travell and Simons in their medical text Myofascial Pain and Dysfunction: The Trigger Point Manual recommend using an “ice and stretch” treatment protocol first. When a Trigger Point is found in a taut band eliciting a “local twitch response.” the skin is cooled with ice in the direction of the muscle fibers of the taut band to turn off the nerve response. The muscle is then passively stretched.
The injection procedure involves inserting a needle in an area where TrPs are located and searching until one is found, indicated by a “jump sign.” (The muscle jumps when contacted by the needle.) A combination of a local anesthetic and saline are then injected, the anesthetic to stop the muscle from firing and the saline to flush the tissue of pain-causing elements. When this works it can stop the pain temporarily or permanently depending on several factors.
Dry needling is done by doctors but also by nurses and acupuncturists. The procedure involves inserting a needle repeatedly into a Trigger Point to break it up and is usually effective when a specific TrP is targeted. Both TrP injections and dry needling are uncomfortable, as would be expected.
The next post is about other procedures.
by Christina Abbott on July 14, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is some things you can check from my list for corrective actions and treatments Part 2.
Check for systemic conditions, vitamin and mineral inadequacies, food sensitivities, allergies, anemia, infections and parasites, yeast infections, toxic blood conditions, thyroid hypoactivity, circulatory disorders, acidic pH level. Limit intake of carbohydrates and other muscle stimulants like caffeine.
This is a big list, but when medical intervention and other treatments don’t give you enough pain relief from sciatica, use this checklist to be sure there is no systemic factor that is perpetuating your symptoms.
Vitamins and minerals are getting more attention now from the medical world. Essential for neuromuscular health are the Calcium complex, Vitamin C complex, and the B-complex.
Food sensitivities stimulate a full body response against the substance and allergies stimulate a full-body histamine response clogging your body’s self-cleaning organs. Anemia prevents the delivery of oxygen to your muscles, causing pain and spasm. Infections and parasites turn on the alarm systems to fight what’s wrong. Yeast organisms have 70 waste products of their own that your body has to clear before taking care of itself. Toxic blood affects everything negatively that the blood goes to. Thyroid hypoactivity (body temperature below 97.6 degrees) is common and usually causes pain. Hyperactivity rarely causes pain. Circulatory disorders mean that not enough blood is being delivered to the muscles. Acidic pH levels irritate your nerves. Carbohydrates and stimulants make your muscles tense.
Perpetuating factors are important in understanding pain. Whenever a patient in my Neuromuscular Therapy center near Boston doesn’t respond as well to treatment as I think they should, I start checking these systemic factors.
by Christina Abbott on July 13, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is something you can do for pain relief every day from my checklist for corrective actions and treatments Part 2.
Keep hydrated. Water is essential to healthy muscles and joints. Every process in your body requires water. In my Neuromuscular Therapy center near Boston, I have seen patients recover from pain complaints with a few appointments to manually release muscle tension and Trigger Points and then simply an increase in their water intake.
To understand why, here are a few images. Think of a juice concentrate. It’s really strong tasting as a concentrate. The more water you add the less of the juice you taste. Now think of a strong acid. If you put it on your skin straight, it can “burn,” causing damage. If you dilute an acid, it can be safe, even edible. Now think of those acids inside your body bathing your nerves and muscles. Undiluted acids in the fluids of your body can be irritating. Drinking fluids dilutes those fluids.
Another image is a car engine. If it doesn’t have enough oil, the parts rub together creating friction and heat. Eventually the heat causes damage. In your body, water acts as a lubricant, preventing inflammation from tissues rubbing together. Inflammation equals heat. Heat causes pain. Water cools the heat.
Now think of a boat transporting essential products into a port. Water is the means of transport in the body, feeding the soft tissues of the body with the essentials for healthy tissue and removing waste products that cause pain. If it doesn’t dissolve in water, then it is carried by water.
Almost all of the chemical reactions in our bodies take place in the presence of water. Without it we cannot live. Metabolism, temperature control, elimination, blood volume and pressure, and the health of every cell depend on water. The muscles are 70-75% water, blood is 82% water, even your bones are 25% water and those figures are just a start in understanding it’s importance, especially in relieving pain. Chronic muscle aches and pains are one of the symptoms of a lack of water.
The formula I use for a general guideline is: Your weight divided by two equals the number of ounces of water you should consume each. Some factors like medications and alcohol increase that requirement. A passionate plea for the medical community to understand it’s curative powers is presented in The Body’s Many Cries for Water by Dr. Batmanghelidj. Some think it is an extreme view, but it will open your eyes.
by Christina Abbott on July 12, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is something you can do for pain relief every day from my checklist for corrective actions and treatments Part 2.
Keep moving to keep the muscles limber and the blood and lymph flowing. Prolonged tension or inactivity can produce pain. Tai Chi is a gentle movement therapy to explore. I love the phrase “Rest is Rust.”
Remember when going to the hospital meant days of bed rest? Those days are over! They get you up and moving the same day as your surgery. That’s because your body heals better when you move. The formula for injury recovery used to be RICE Rest, Ice, Compress, Elevate. It’s now MICE: Move Ice Compress Elevate .
When you move, your muscles work, and as they work they pump blood through those soft tissues, carrying precious nutrients, rebuilding cells and energy molecules: healthy tissue! The movement also pumps waste products out through the circulatory and lymphatic systems as well as through your breath and your skin, relieving pain by restoring a healthy environment. Movement also lines up the healing tissue in the direction it moves. If you don’t move, your body forms irregular scar tissue areas that prevent restoration of normal movement patterns.
Even random movements will help, so move whatever you can in any way you can and it will be good. Other gentle exercises you might consider are swimming and Tai Chi. When I say swimming, I don’t mean you have to swim laps, but moving about with the support of the water will be comfortable and should be pleasant. Tai Chi is an Asian exercise routine practiced by young and old. It is more of a movement therapy than exercise, getting your body and your energy (chi) moving to remove areas of “stagnation.” It shouldn’t take much looking to find a Tai Chi class somewhere nearby. Walking is another good way to keep moving. You don’t have to walk fast, just amble along if that’s all you can do. Moving is the important thing. Try moving your hips as you walk, or do a little dancing in your livingroom. Put on some good music and have some fun! Enjoying your exercise has been shown to increase it’s benefits.
I subscribe to a saying I heard years ago, “Don’t sit if you can stand. Don’t stand if you can walk. Don’t walk if you can run.” Keep moving!
…from my Neuromuscular Therapy center near Boston.
by Christina Abbott on July 11, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is something you can do to relieve pain every day from my checklist for corrective actions and treatments Part 1.
Stretching is a big key to pain relief of “sciatica” pains. Use the Active Isolated Stretching method: Actively stretch, assist at the end range for 2 seconds max and repeat 10x. Find out which muscles are tight and use specific stretches to lengthen them. (See my post on AIS protocol.)
Stretching serves at least two purposes. The first is that it lengthens and relaxes your muscles, allowing them to work more efficiently when you need them. Muscles contract in the middle (like Popeye) shortening the muscle length and forming an area where the tissue is thicker from the doubled-up muscle cells. As they contract in the middle, they shorten the muscle, pulling on the ends where they attach to bones. If the muscles can’t relax and form muscle contraction knots, they stay in that doubled-up state and can’t move well because they are shorter than normal. When they lengthen they can relax. Stretching lengthens and relaxes muscles when it is done correctly.
The second purpose is to get fresh blood pumped into the muscle to bring energy cells, nutrients and oxygen which are necessary for it’s health and ability to do work. Almost as important is that stretching increases lymph flow. The lymph is what is collected by lymph vessels from the fluids that surround all the tissues (interstitial fluids). The content includes waste products of various kinds. When waste is allowed to accumulate and decompose, it forms acids that irritate the nerves and cause pain. Without the lymphatic system, we would die in 48 hours (reference Dr. Bruno Chickley). As the muscles work, contracting and relaxing, blood and lymph are pumped through. Active Isolated Stretching, as the name implies, is active rather than passive stretching. The activity does the pumping. Passive stretching with the stretch held for a long time does no pumping, in fact it reduces fluid flow by narrowing the blood and lymph vessels.
Stretching has also been found to help release Trigger Points (reference Travel and Simons), those areas of hyperactivity that work a muscle constantly and that refer pain. In my Neuromuscular Therapy center near Boston, I stress the use of AIS for patients with TrP activity. If you pull on a muscle that is actively contracting, it is counterproductive, even harmful. AIS prevents the protective action of the muscles to threatening activity and helps release those hyper muscles.
For sciatic symptoms there are specific AIS stretches that help the low back muscles, the glutes, piriformis and hamstring muscles. To see those stretches, buying Stretching for Everyone by Aaron Mattes is a sound investment of $15 . Go to our sidebar store or directly to his web site.
by Christina Abbott on July 10, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is a tip for pain relief to investigate from my checklist for corrective actions and treatments Part 1.
Restore balance to muscles and joints with manual muscle therapy, appropriate daily stretching and a careful corrective exercise. Swimming is one of the best general exercises for back and hip problems. It takes away the effects of gravity. Do everything you can do without pain to stimulate your body’s wellness response.
Your joints have nerves within their protective tissues that alert the nervous system when there is a condition that is threatening. Tension or imbalance in a joint that causes the bones to rub together will fire off those nerves. The rubbing causes friction, heat, inflammation and pain, in that order.
To relieve joint pain, release the tension on all the muscles that cross the joint to allow freedom of movement without friction. In the case of sciatica symptoms, the joints that need attention are the joints between the vertebrae in the small of your back (lumbar), between the lumbar spine and hip (iliolumbar), and between the bone at the base of your spine and it’s adjoining hip bone (sacroiliac).
Muscles work together in groups to produce fluid movement. If one muscle isn’t working well, it causes the body to compensate. Compensation causes muscle imbalance. Those muscles that are required to do more work get tight and tired causing greater compensation. Eventually the overworked muscles become painful. Additionally, the joint movement is altered when muscles are not balanced, which causes friction where the bones are pulled too closely together on one side and produce the condition I just described.
Manual therapy, especially a specific and deep one like Neuromuscular Therapy, will relieve muscle tension and Trigger Points that shorten a muscle and tighten the joints. Lengthening and relaxing the muscle allows greater blood flow to bring the essentials (energy, nutrients and oxygen) for healthy tissue, and it removes waste products that cause pain.
Appropriate stretching (see Active Isolated Stretching) helps to decrease muscle and joint tension every day and increases the gains achieved with good manual therapy. Additionally, using AIS stretching techniques increases blood and lymph flow by pumping healthy fluids in and unhealthy fluids out of the tissues.
Careful corrective exercise strengthens the muscles that cross the joints, allowing balanced and flowing movement and good support. Increasing exercise gradually will help the muscles rebuild and prevent stressing the joints. Making sure that the muscles are working equally and together prevents the joint tension and imbalance that leads to pain. For low back and sciatica symptoms, exercise that takes the effects of gravity off the low back and butt are preferable.
Your body has what is called a “wellness response.” If you act as if you are well, your body will respond in kind. Try to focus on the parts of your body that feel good rather than on the parts that hurt.
Sciatic pains are one of the most common complaints that I treat in my Neuromuscular Therapy center near Boston.
by Christina Abbott on July 9, 2010
When sciatica type symptoms get the better of you and nothing you do seems to make it better, here is something you can do from my checklist for corrective actions and treatments Part 1.
Treat Trigger Points in affected muscles with neuromuscular techniques.
This is my favorite subject as a Neuromuscular Therapist.
Trigger Points are specific hyperactive and hypersensitive places in your body’s soft tissue that refer symptoms to another place from that spot. Because they are working 24/7, they never get a rest. Consequently, they use up all the nutrients and oxygen necessary for work which causes muscle spasms (and pain), and they give off waste products that accumulate, decompose and irritate the nerves (more pain). Trigger Points must be deactivated using Neuromuscular Techniques to reduce the local and referred pain.
With “sciatica” symptoms, I look at three muscles.
The first, the quadratus lumborum, is often the original problem. “Quadratus” means four-sided in Latin and “lumborum” indicates that the muscle in located in the lumbar region of the spine, at your waist between your ribs and your hip bone. The QL refers pain into the buttock from the sacroiliac (SI) joint across to the lower butt and down into the upper part of the back of the thigh. It also refers into the hip joint and above that into the top side of the hip. Sometimes it even refers into the abdomen, groin and down the front of the thigh. The part of the muscle closest to the spine is actually a ligament (iliolumbar), but it has the same referrals.
The second muscle I check is the scallop shaped gluteus minimus located in the side of your hip above the hip joint. It has been nicknamed the “pseudosciatica” muscle because it’s Trigger Points exactly mimic sciatica symptoms. One set of TrPs refers into the lower buttock and down the back of the thigh to the calf. The other set refers to the side of the butt and down the side of the thigh, knee and lower leg to the ankle. The muscle is underneath it’s partner gluteus medius and requires deep sustained pressure to release it.
The third major cause is the piriformis muscle. Doctors are paying more attention to it lately. It is a little muscle located deep to the much bigger and thicker gluteus maximus. TrPs refer from the SI joint across the buttock and hip and down the back of the thigh almost to the knee. Just as important is the fact that when it’s tight it can press on the sciatic nerve and cause big problems that include weakness and loss of function. The overlying gluteus maximus will be treated along with the piriformis. It causes mostly buttock pain.
While these muscles are being examined and treated, it is advisable for a therapist to check the hamstrings in the back of the thigh since all of the above muscles refer there and can irritate them.
After twenty years in practice, I find this complaint to be one of the most common. Consequently I treat these muscles every week in my Neuromuscular Therapy center near Boston.
