Let’s Start With The Bad News…
Sciatica and Back Pain are the two most common complaints that I hear. When I ask patients, “What do you think would help resolve your pain?” I usually get a confused look in return or an annoyed look, which I completely understand. It is an annoying question. Most people will ask, “Isn’t that why I came here?”
The reason I ask this question is to get an idea of what they are expecting from the appointment and to see what preconceived notions they have about Sciatica or back pain. Shockingly, the answers are all over the map!
Answers are typically dependent on what your Doctor told you, advertisements on television, videos on Youtube and articles like the one you are reading right now. What’s unfortunate is that the message always seems to be a little different depending on your source. This obviously creates a great deal of uncertainty and frustration.
More often than not, I am seeing people that got less than thorough evaluations from their Physician during their speedy 15 minute session. The result of that is non-specific treatment recommendations that leave people with a poor understanding of WHY they have back pain or Sciatica in the first place.
You walk away thinking the issue is a “medicine deficiency” or that you are doomed because of arthritis or a less than perfect MRI or X-Ray. Instead of a treatment plan, you get some catch all recommendation like “try Yoga, Pilates or Water Aerobics.” And if that does not work you’re convinced that your pain is because of some extra pounds.
Let me start by saying, I feel your pain. I have been in your shoes and I understand how frustrating it is when you are getting conflicting advice from different medical providers, as well as different “health experts” on the internet. Especially when that advice is telling you to just deal with the fact that pain is your “new normal.” I am here to call bull crap on that one!
Now, The Good News…
Getting out of pain and back to an active lifestyle is easier than you think. I am always excited to share that with people at the start of our session. Regardless of your age, weight, medical IQ, what your MRI and X-Ray look like, or how busy you are… there is hope!
My own experience with Sciatica and Back Pain, and my experience treating people with Sciatica Pain and Back Pain has made me very attune to seeing what strategies work and which one’s fall short. Many people falsely assume that they need to start adding a bunch of things to fix their pain. They assume that their improvement is dependent on a new workout plan, lots of “corrective exercise,” Yoga, Pilates, Swimming, the perfect diet, meditation and so on…
In reality, finding relief from your pain requires SUBTRACTION.
Everyone mistakenly thinks that their pain is just going to vanish with one exercise, medication, cream or whatever. This is far from the truth. You need to understand the Aggregation of Marginal Gains. This a concept made famous by British cycling coach Dave Brailsford, who lead the British cycling team to 10 gold medals at the 2008 Beijing Olympics.
To quote James Clear, “In the beginning, there is basically no difference between making a choice that is 1 percent better or 1 percent worse. (In other words, it won’t impact you very much today.) But as time goes on, these small improvements or declines compound and you suddenly find a very big gap between people who make slightly better decisions on a daily basis and those who don’t. This is why small choices don’t make much of a difference at the time, but add up over the long-term.”
The first thing we have to do is Eliminate the things that are triggering your pain.
The list below will describe the most common mistakes people make that keep them in pain. Believe it or not, research has shown that most people are doing the very things that are causing their pain. Many of these activities will actually bring you a sense of relief in the moment, but end up delaying your progress.
6. “Flat” & Rounded Back Posture
The reason I put the word flat in quotations is because a flat back is technically a rounded back posture. Somewhere along your journey you were told that good posture meant a flat back. Maybe this cue was given to you with sitting or when exercising. For example, it is common for people to falsely think they should be flattening their back against the ground with exercise.
If you weren’t coached into this posture you gradually adopted a flat (rounded) lower back posture before or after your pain started. This is a compensatory posture that the body often adopts when in pain that can actually exacerbate your symptoms over time. This is a sure fire way to make your back and Sciatic nerve SUPER angry.
Some degree of curvature (hollow) is naturally built into your lower back. Respecting this posture will prevent back pain and keep your Sciatic nerve from being compressed by a herniated or bulging disc.
How much of a curvature (hollow) you adopt is based on your anatomy and preference. If you have ever used a lumbar roll or lumbar support in your car, you know that the Goldilocks Rule applies. You need to find the amount of hollow that is just right for you.
Words of Wisdom: In some cases a slightly rounded back posture is adopted by those with a condition called Spinal Stenosis, which typically happens later in life. Even though a slightly rounded back can be helpful for this population, I would still argue that it should not be extreme and you want to minimize it to avoid excessive stress at the lower back.
5. Stretching Your Hamstrings
This may feel good in the moment, but it is really stressing your Sciatic nerve in a way that is going to exacerbate the pain in the long run. An already angry nerve doesn’t like to be tugged on! If stretching were the secret formula for getting better you would not be here. And honestly, I’ve met almost no one who has contributed stretching to relief from Sciatica pain. Interestingly, some of the most flexible people are the ones coming in complaining of back pain and Sciatica most frequently.
If you are thinking, “Well I don’t have Sciatica, only back pain,” my recommendation is the same. Localized back pain can have a muscular component, but pain at the back is more often related to irritation at some structure local to the spine (i.e. disc). Your stretching actually tends to put the body in positions that irritate these already irritated structures.
4. Self Back “Cracking”
Sciatica is often triggered by an injury to a disc in your back. In many cases back pain is also triggered by an injury to a disc in your back. With disc injury comes a little bit of instability in the lower back. This instability is often to blame for your back “locking up” or muscle spasms with even the most subtle movements.
The remedy for a painful lower back is usually enhancement of postural awareness, movement quality and strengthening at the back and hips, NOT stretching. Your back “cracking” (manipulation) might feel good for a second, but it is only a temporary solution that leads to more instability and chronic pain over time.
Words of Wisdom: Back manipulations have a time and place, especially in the first 4 weeks after an injury. After that they show little help for long term improvement. Stopping back pain and preventing back pain require you to understand how to maintain good “Back Hygiene.”
3. Stretching Your Lower Back
Many think their “tight back” is causing their Sciatica or Back Pain, and take steps to become more flexible in that area. In reality your tight back is often a symptom not the cause of your pain. Stiffness in the hamstrings, back and butt muscles are often because of an irritated disc and/or Sciatic nerve. You are not going to stretch the pain away. Think of your lower back more like the foundation of your house. You want it to be strong, stable and secure! When you start adopting this mindset, and learn the proper way to move and exercise you will finally get the relief you have been looking for.
Words of Wisdom: Certain stretches can actually be beneficial for back pain, but the focus is more on adopting positions that help reduce a disc bulge or take pressure off the Sciatic nerve. For instance, we will often prescribe simply lying flat or propped up on your forearms while on your stomach.
Rounding your back while stretching might bring some temporary relief because of a stretch reflex, but the increased pressure placed on the disc and nerve actually cause more harm than good.
2. “No Pain, No Gain” Mindset
This is a great way to build mental toughness, but a TERRIBLE way to rehabilitate your lower back. You need to learn how to pace yourself appropriately when returning from a back injury. You need to think of yourself like a marathon runner rather than a sprinter. If you come off the starting line at a 4-minute mile pace you are going to crash and burn before you know it.
Healing and pain are NOT the same thing. Asking, “how long will it take to heal?” is a totally different question than “how long will it take for the pain to go away?” You can be Pain Free with a back that is still healing if you learn how to pace appropriately. Avoiding painful postures can help desensitize angry nerves. Allowing you to do more activity with less pain over time.
Words of Wisdom: Understanding that “hurt does does equal harm” is just as important. A little bit of pain here and there is ok, but keep it to a minimum. If you can only tolerate walking, shopping, house work, etc. for a short period of time you need to do shorter, more frequent bouts of activity. This strategy over time will lead to steady progress without set backs.
1. Crunches and Twists
I saved this one for last because I think it has become more common knowledge that these are a “no, no.” Though it is subtle, he is bending into a rounded spine posture in the picture above, which is placing increased stress on the spine. You know not to lift with a rounded back so why are we tricked into thinking that any exercise with a rounded back is acceptable?
It has taken years for the Army to remove them from their Physical Fitness Test, but it finally happened. Exercises like crunches, side crunches and russian twists are an excellent way to injure your lower back. The lower back (lumbar spine) is meant to RESIST not create motion. One of the biggest mistakes I see in the gym is poor lower back posture with lower back strengthening (Core Exercise), general strengthening and cardiovascular exercise.
Stoping the pain, or “putting out the fire” requires you to stop doing the very things that are starting the fire in the first place. Resolving pain is more about subtraction than addition when you are just getting started. This doesn’t always mean doing less. It means you stop doing the things that are surprisingly contributing to your pain.
Being active is important for healing and pain reduction, but you need to be more calculated. Remember the Goldilocks Rule. We need to pace appropriately during the day. Too much, and we trigger a flare up in pain that keeps us sidelined for days, if not weeks. Not enough, and we’ll never see any progress.
If you need a little extra help check out our free online course for Sciatica and Back Pain.