Sciatica and disc herniation. Exercises and positions by Dr Andrea Furlan MD PhD

Sciatica is a pain caused by nerve pain. There are many nerves that originate in the lumbar spine. They exit the spinal cord through these small holes. Then they travel inside the buttock area and here one of them is called the sciatic nerve. Then the sciatic nerve travels down the back of the thigh and then it splits into two nerves. One that goes to the front of the leg or tibial nerve and the other branch that goes to the back of the leg, the peroneal nerve, also called the fubular nerve. When a nerve is inflamed or injured it causes a typical pain pattern that is more like burning, electrical shocks or a stabbing pain. If the nerve damage is severe it also causes muscle atrophy and sensation loss. Low back pain with nerve injury is relatively rare. The most common conditions that cause this is a lumbar disc herniation. In this video I'll show you three resting positions to alleviate sciatica pain, three exercises that you can do for pain relief and four activities that you should avoid. Sciatica is usually self-limiting and resolves within a few weeks. Therefore the purpose of this 3-3-4 method is to provide some pain relief while your body does the healing process. Let's talk about sciatica today. Last year I had sciatica caused by herpes zoster virus or shingles. I know how bad this pain can be. I started having a dull deep pain inside of my buttocks radiating down to the back of my thigh and leg. Two days after the skin rash erupted and it was confirmed that it was shingles. The pain was constant and I used the techniques that I will show you in this video to get some pain relief and avoid pain medications. The sciatica that I had lasted about four weeks and I don't have any pain anymore. I did another video where I tell the story of what happened with my varicella zoster disease. But the most common cause of sciatica is not shingles, it is actually disc herniation. First let me explain what disc herniation is. The disc is a cushion of water between the two vertebrae. Its function is to act like a shock absorber but the disc can degenerate and break up and the material that is supposed to stay inside the disc then gets out. If this extruded content compresses a nerve that is going to the leg then we call this disc herniation and the symptoms of pain going to the leg is known as sciatica. The pain from sciatica will be different from the pain from the degenerated disc. If it's just the degenerated disc, the pain will be referred to the lower back, the buttocks, hips or the inguinal area. Now the pain from sciatica is felt in the thigh and leg and it's because the disc is compressing the nerve that goes to the leg and foot. It usually affects only one side. The diagnosis of sciatica is easy to make. You need to see a doctor. The doctor will do some tests with you like raising your leg like this. This is called the straight leg raising test and it stretches the sciatic nerve causing a specific pattern of electrical shock sensation. That's why we avoid any exercise that stretches the sciatic nerve when it's inflamed. The doctor will also examine if the nerve is functioning normally like testing the reflexes with a hammer, checking if there is muscle atrophy and if the sensations are normal in the skin. If the doctor suspects that there is a sciatic nerve injury then they may order a CT scan or MRI and sometimes an electrodiagnostic test called electromyography. If you have low back pain caused by a disc problem without any pain radiating to the legs, you may watch my other video that I did for degenerative disc disease. Sometimes the disc herniation will affect the nerves that control the bladder or bowels and this is what we call cauda equina syndrome. This is a medical emergency and the person needs to go see a doctor immediately otherwise they may develop incontinence of bladder or bowels that may not be reversible. First I'll show you the three relieving positions for sciatica. So this is the z-line position. What you do is you find a comfortable position on the floor, grab a chair or it could be a couch. You're going to put your knees and legs on the top of the chair and pull until the knees are above your abdomen. Put a pillow under your head and now try to find a position where you're the small of your back here the lumbar spine is flat and you are not having the sciatic pain. You're not having the pain going down the back of your legs anymore. You are relaxed. If you can find this position of comfort, stay here for as long as you can. 5 minutes, 10 or even 20-30 minutes because this is almost like taking a painkiller. You will notice that this is the same position that I showed in the previous videos. If you have a disc problem, a lumbar degenerative disc disease and also if you have the facet joint diseases. Now if you have sciatica, this is an excellent position. That's why we recommend this z-like position a lot to our patients who have acute low back pain because it relieves the pressure in the vertebrae, in the discs, the nerve roots, the facet joints. If you stay here for about 30 minutes, the pain is alleviated a lot and then you can do a few more activities. Now this is the second resting position. If you want to alleviate the pressure on the disc and the herniated disc, you're going to raise your trunk on your elbows. Try to be 90 degrees here and if you can tolerate this position, you just find a comfortable position that you're not having the pressure going down to your legs and you stay here. Then you can be reading a book, watching a video and see if you can stay in this position for about 5, 10, 20, 30 minutes. Because when you do this, you are releasing the pressure on the nerve root that is exiting from your lumbar spine. And if you have a disc problem, this is excellent because this is going to help the disc to, if there's a disc prolapse, to heal faster. Now if you have facet joint pain, which I explained in a previous video, this is going to aggravate your pain. So don't do this. If your pain is aggravated, it may be because you also have facet joint osteoarthritis and this position will not relieve. But if you only have a sciatica from disc herniation or disc problem, you're going to feel a lot of relief from this position. The third position of comfort is the prone lying position. So you're going to lie down on your stomach with a pillow or cushion under your abdomen and you're going to try to relax here, lowering your head. And finding, the key is to relax and find a position that you don't have any pain. So try to move your legs, maybe put another two pillows or three and move your neck. And when you find that position, that you have zero pain, you don't have any sciatic pain, that's the position you can stay for 5, 10, 20 minutes. Because when you find that position, you know that you are relieving the pressure on the nerve root, the sciatic nerve. Now I'll show you the three exercises that you can do to alleviate your pain. The first and most important is to keep active. You should keep walking, preferably on a flat surface. Don't walk uphill or downhill. Walk within your limits. If you can only walk five minutes, then walk five minutes many times during the day. Try to increase the amount of time that you walk and also how many times you walk during the day. So this exercise is the sloppy push-up. You're going to get a mat or your carpet and you're going to start putting your arms in front of you and you're going to raise your trunk. And if this doesn't cause any pain, then what you're going to do is raise and do this. Keep your hands in front of your body. If this is okay, you can increase to 12 repetitions, 20 repetitions and you can do this once a day or two or three times a day. Because this exercise should not be causing pain. So if you do this exercise and cause pain, stop doing it. But if you do the sloppy push-ups and you feel that your pain is alleviated, then you can continue doing this exercise for your sciatic pain. So this exercise is similar to the one that we just did on the floor, but when you start getting better, then you can do this exercise standing up. So if you are in line waiting for something or at home or at work and you can't always find a floor to do the sloppy push-up exercise, what you do is you put your hands on your buttock areas and just keep doing this. You don't need to look up at the ceiling. If you have neck pain, you can look in front. So you do one, two, three, four, and you do this eight repetitions, 12, 20. If this aggravates your pain, you don't need to do it. But when you do these back extensions, if you feel pain relief, then it means that it's helping your pain and you can continue doing this exercise. There is no need to start a specific routine of exercises like going to the gym or stretching or strengthening until the sciatic leg pain gets resolved. Gentle stretching can be done, but it should not increase the pain. Now I'll show you the four activities that you should avoid. So this is important to learn how to get up from a chair or a couch or sofa because if you just simply do this, then it's going to put a lot of pressure on your lumbar spine and aggravate your pain. So what you need to do is there is a right way of getting up and this means that, so assuming that you are sitting upright and sitting correctly here, when you get up you have to get close to the edge of the couch or the chair or even your bed in the morning when you're getting up from the bed and even turning to the side a little bit and using your quadriceps and your hips. So pay attention to my lumbar spine. I'm not going to bend forward or backwards. I'm going to use my quadriceps. So this is how you get up. So this is important if you are doing the dishes or ironing or doing anything that you have to do standing up because when you are doing the dishes, if you are like this, you're bending your trunk all the time or ironing, that you are ironing all the time like this. What we tell the patients to do is get a box or a little stool, put on the floor and one of your feet will be on the top of the box. So when you do this, you're keeping your lumbar spine straight and it's hard for you to be bending. So then you remember that by keeping the foot on the stool, you have to be ironing or doing the dishes without bending forward. So the higher this, the better. But if you don't have anything higher than this, a box, a shoe box or two shoe boxes should be okay. Just be careful that they don't slip and you don't fall. Or you can get a stool, size 31 and you can do this and live in the countertop or live close to the sink where you are doing most of your activities that you have to stand up and do activities standing up like this. And the other important thing is to use some sort of lumbar support. If you are sitting, if you work with a computer, get something that you can put to support your lumbar spine. I got this for my car. So I use this in my car. I bought this 10 years ago when I had my episode of a cute little back pain and I still love it. I use it in the car. So this is how it works. You put in there and then it creates this support here for the lumbar spine. But there are, if you don't have one of this, you can have a towel, make a roll of a towel or you can just get a piece of foam. But you see, it creates this nice curvature that supports the lumbar spine and then you can relax. But you can use this especially for people who spend many hours in the car. It's really important that they have a support for the lumbar spine if they have this pain, lumbar disc pain. And they can use this also for computer work, for desk work, or even when they are watching TV. It's always nice to have a lumbar support that will give this curvature of the lumbar spine. And the depth of the lumbar spine really depends on your size, how much curvature you have. So you really need to try a couple of different sizes and depends on your body size. But for me, this one, I really like to use this in the car. And I'll put a link for this, which you'll find in the description of this video below. Number four, avoid stretching your hamstrings for the first weeks. The nerve is inflamed and if you keep doing this, you will have more pain. Give a few weeks, maybe six to eight, since the start of the sciatic pain. Then you can start doing some hamstring stretches. Here is an example of hamstring stretching. So if the person tries to do this or stretching the hamstring, it's going to stretch the sciatic nerve here and it's going to shoot the pain. So don't do this if you have sciatic pain. Now that you know what to do in the first four to 12 weeks, we call this the acute phase. I'll tell you what to do if your pain lingers beyond three months. In most cases of chronic low back pain, I find that muscle pain or myofascial pain syndrome is a very important factor that perpetuates the pain. Well, what happens is that during the acute phase, the muscles were all tense and tight to protect the lumbar discs. So after three months, the disc herniation or disaster is resolved and your body healed that acute problem. However, what may still be aching are the muscles. We call this myofascial pain syndrome and I have another video about myofascial pain syndrome exercise for the lumbar spine that you can watch. Smoking accelerates the process of disc degeneration and weakens the bones. So if you smoke and have low back pain, this can be a good reason for you to think seriously about quitting. Watch my other video about smoking and pain. Take a look at this other video to find out if you have predisposition to develop chronic pain. There are some factors that put a person at higher risk to develop fibromyalgia. Check here. If you know someone with sciatic pain, press the share button below and send this video to them. In the comments box below, write down if you have sciatica and which positions and exercises from this video worked best for you. Go to the description of this video below. You may find a summary of these positions and exercises that you can download and print at home. There is a link to all products that I mentioned in this video if you want to purchase them. Please don't forget that this video is for educational purposes only. If you have a condition that needs medical advice, please talk to your doctor and if there is an emergency, go to the nearest emergency department. If you like this video, give a thumbs up here, turn on the notifications and don't forget to subscribe to this channel. You can also find me on Twitter, Facebook and Instagram. Thank you for watching! Goodbye!