Welcome to Rehab Renegade! This exercise program outlines the initial exercises we commonly give to our patients that we suspect have Sciatica caused by a “pinched nerve” at the lower back. If you want something more detailed with video explanation please check out our Courses.Â
The first thing we have to do, before implementing long term solutions is to STOP doing the things that are likely triggering the pain in the first place. Believe it or not, research has shown that most people are doing the very things that are causing the pain. They might think it’s helping, but those activities are actually prolonging the pain.
In this article, 6 Things You Should Not Do When You Have Sciatica or Back Pain, we go into more detail on things that should be avoided.Â
If you have pain in sitting it is important that you learn how to modify your alignment to reduce tension at the lower back.
Find a position where you feel comfortable. Next place your hands on your lower back without adjusting your alignment. Feel the back muscles to see if they are hard or soft.
From here, lean slightly back until you feel the muscles soften and then slightly forward until you feel the muscles engage. You want to adopt a position with SOFTNESS in the back musculature and NO PAIN.
Correct for rounded shoulders and forward head. I like to tell people to GENTLY open up their palms to find a relaxed neutral upper back position.
If you place your hands on your lower back while poking your chin forward you can sense how a forward head position engages the back muscles. (good alignment – ears, shoulders, hips, ankle).
Use a small lumbar roll in chairs you sit at frequently. Place the roll at the lower curve of your back. This will help you maintain better posture.
Purchase here:
https://www.amazon.com/Original-McKenzie-Lumbar-Roll-OPTP/dp/B000H48WYA
Understanding how to adopt a spine sparring position is critical.
Start out by feeling your lower back muscles. Are these muscles working hard or relaxed?
While still feeling your back muscles move into a slightly slouched posture, notice how the muscles stiffen. Now lean back to a point where you feel the muscles soften. Continue to lean forward and backward until you feel most comfortable with the least amount of tension in the back muscles.
Next, notice how poking your chin forward as most of us do while working on the computer causes the back muscles to stiffen. And then notice how bringing the head back into alignment (ears over shoulders) softens the back muscles.
Lastly, be mindful of how you position your arms. Holding the arms in front of your body can also cause over active back muscles. Rather, keep the arms by your sides or behind you to help promote a relaxed standing posture.
While using your electronic devices such as a tablet or smart phone, do not slouch and do not allow your head to protrude forward.
Hold the electronic device up so that you can see it better and maintain good posture at your back and neck. This will also help reduce excessive tension in the low back musculature.
When pain is related to the disc, we work on finding positions of extension at the spine. This helps centralize disc matter that may be protruding. Rounded or flexed positions actually increase the severity of disc protrusion, which is why we avoid slouched or rounded lower back positions.
Below, the positions of extension progress from less loaded to more loaded positions. You can incorporate all of these extensions postures or stick with EXTENSION IN PRONE if the back is more irritable.
We also incorporated multiple options for traction (aka decompression of the spine) to take pressure off the disc and nerve roots.
Start by lying flat on your stomach. Do your best to relax. With each breath try to let your back and hips sink toward the floor, feeling as if your muscles soften. Spend 20 to 30 seconds in this position to ensure that it does not increase pain.
If you find relief with this position you can try transitioning to resting on your forearms. Take 20 seconds to assess how you feel.
Spend 2 to 3 minutes in the most comfortable position.
Once again make sure you are relaxing your back muscles by breathing softly. Use this position as often as needed to find relief.
Perform this exercise as often as needed to resolve pain. Minimizing pain early on is crucial to seeing long term improvement.
Standing back extensions are optional.
In some cases patients will report an immediate sense of relief with this exercise.
If this worsens your pain please discontinue the exercise and continue through to the next module in this course.
Place your hands on you sides and gently bend backward holding for 1-2 seconds. A positive sign is a reduction in pain or centralization of pain.
Centralization-Not all pain is bad. With Centralization, your pain may become more focal to the lower back but NO LONGER going down your leg or felt at your leg (or foot). This is a good sign. It means the exercise is working.
Peripheralization- This would be the opposite response. This is when symptoms actually radiate further away from your spine and down your leg. If this occurs please STOP this exercise and rely on other methods that we provide for relief.
Prescription: Perform 8-10 repetitions as often as needed to get yourself out of pain.
In the cat cow exercise start on your hands and your knees. The hands should be directly below the shoulders and the knees should be directly below the hips. Perform gentle motions here.
The goal is to reduce stiffness at the spine, NOT to create a strong muscle stretch.
Only 8 to 10 repetitions are necessary, any more than this may actually start to increase symptoms especially if done forcefully. If it helps, inhale quietly as you arch your back and breath out quietly and slowly as you round your back.
Use a mirror so you can see if what you feel is actually real. Many people have trouble creating full movement at the spine and hips.
Being able to do this well will help you adopt better posture and perform other exercises with better control.
Find a surface that is about waist height. Push your hands down into the table as you move your weight over your arms.
Feel as if your weight is moving down through your arms and that your shoulder blades are moving downward into your back pockets.
From here you can let your hips move forward toward the table letting your lower back extend as much as tolerable.
You should feel as if your spine is elongating, similar to an inversion or traction table. Try to relax the back and hips as much as possible.
Prescription: As often as needed for pain relief. Even if this does not change your pain it may be beneficial to perform this exercise 3x per day to help decompress the nerve and reduce sensitivity at the lower back (do it before each meal).
Reps: 3
Time: 30-45 seconds
