If you have sciatica or sciatic nerve pain in Toronto, you’ll know it’s one of the worst pains you could ever have, it can be absolutely crippling!
You bend down to pick up your shoes, or something you’ve dropped, or lift something, and you have the WORST pain you’ve ever felt in your life, like a lightning bolt, shooting through your low back, into your butt, and sometimes partially or all the way down your leg.
It can be horrible, and bring you to your knees, literally!
So why does this happen?
To explain that, it’s important to understand some of the anatomy of your low back and the sciatic nerve.
Your low back, or lumbar spine, is composed of 5 bones, or vertebra. They are separated by discs, called intervertebral discs, and the function of these discs is to partially cushion, to direct some of the movement in your low back, but mainly to function as spacers between the bones, to give space for your spinal nerves.
In more than 90% of cases, the cause of sciatica pain in Toronto is related to the discs in your low back.
Sciatica refers to the sciatic nerve, which is the largest nerve in your whole body, and is responsible for the sensation for your leg (including pain!), and also for muscle strength and function for your leg. Pretty important!
The confusing thing about sciatica is that you often feel it down your leg, but the ORIGIN of the problem is your low back, because that’s where the sciatic nerve branches from your spinal cord.
The sciatic nerve branches off from multiple points in your low back, but mainly from the bottom vertebra, L4/5 and L5/S1, and also from your sacrum.
When the sciatic nerve is compressed or irritated, it will cause SEVERE SCIATICA PAIN in the areas the sciatic nerve controls: in your low back, into your gluts, into your hip, and down your leg as far as your feet.
Along with pain, sciatica can also cause NUMBNESS, or PINS and NEEDLES or altered sensations.
Because the sciatic nerve is also responsible for controlling the leg muscles, providing strength, you may also feel WEAKNESS in your leg, have DIFFICULTY WALKING, and feel like your leg may GIVE OUT on you.
These are all characteristic symptoms of sciatica, or sciatic nerve pain in Toronto.
If you’ve had previous issues with low back pain, or had x-rays or MRIs taken of your low back in the past, there is a good chance that you may have been told that there is disc degeneration or spinal arthritis with these vertebra and discs, likely at L4/5 or L5/S1.
Sciatica is most often the progression of a chronic low back problem, from chronic disc degeneration, disc herniations, or arthritis in your low back over years and years.
However, sciatica may also occur from an acute condition, with virtually no previous low back pain or warning. This can be caused by lifting something excessively heavy, poor lifting technique, bending improperly, or poor exercise form, causing a disc bulge or even disc herniation in your low back, resulting in instantaneous compression and sciatic nerve pain.
To start with, we have to consider what caused your sciatica pain in the first place.
For the vast majority of sciatica nerve pain sufferers, it’s very likely that compression from either sitting or forward bending played a significant role in the development of your sciatica pain.
The other less common occurrence is that you suffered from a catastrophic trauma…from lifting something far too heavy, or using poor form while bending or lifting, and in that instant you bulged or herniated a disc
Without doing a proper assessment and taking x-rays, it’s impossible to know specifically what happened in your case to cause your sciatica, but your first step would be to minimize whatever caused it in the first place!
For most people, this means avoiding prolonged sitting, and avoiding any forward bending.
The problem with sitting is that you probably start the day out with the best intentions to maintain proper posture. But as the day progresses, and you get more and more fatigued and tired, your start to slouch, more and more.
As you start to slouch, or from bending forwards all the time, you start to LOSE THE NATURAL CURVE IN YOUR LOW BACK.
The curve in your low back, called a lordosis, is designed to absorb stress, basically functioning like a giant spring, to absorb all the compression from gravity.
As you start to LOSE this normal curve, your low back is no longer able to properly absorb the gravitational stress and compression.
Instead of your curve absorbing it, that compressive loading is transmitted onto your vertebra, and most significantly, onto your lumbar discs, which were never designed for that purpose.
As this loading continues for months and years, compressing the front portion of the disc, the central gel-like material of the disc, termed the nucleus pulposus, starts to slowly get pushed backwards, migrating towards the outer fibrous ring, termed the annulus fibrosus.
As this gradually goes on for months or years, it slowly forces its way through this outer fibrous ring like layer, until eventually, one day, you do somethings, like bend down to pick up your shoe, and the gel-like material suddenly bulges through the disc, or worse yet, herniates, causing a lightning bolt of pain, and you’re down on your knees.
This is by far the most common presentation we see with patients.
This sciatic nerve pressure can cause severe pain, muscle spasm, almost complete lack of movement, and in some cases numbness or tingling, into the back, butt, or even down to your leg and foot. It can be crippling.
Seems simple enough, but unless you do, you’ll continue to aggravate your sciatica pain, and not only won’t get better, but will likely continue to worsen.
For most people, avoiding any increased compression or flexion (forward bending) of your low back is crucial.
You want to AVOID prolonged sitting, especially on any soft surfaces, like soft couches, reclining chairs…anything that is really soft and doesn’t provide proper support.
You want to avoid compression of your low back, and any hunched or slouched posture.
So if you have to sit, sit on something that is firm and provides good support for your low back and the normal low back curve.
Better yet, try to AVOID PROLONGED SITTING. The best is to be upright and MOVING AROUND. In most cases, walking is best for anyone with sciatica pain.
Even if it’s a slow walk, that’s fine, but being up and moving around is almost always better than prolonged sitting.
The best option for laying down for sciatica relief in Toronto is on your back, with a small pillow under your knees to decrease the tension in your hamstrings, and take stress off your low back.
If it’s more comfortable to lie on your side, you want to place a small pillow between your knees, to stabilize your pelvis, and take pressure off your low back.
That means tying up your shoes, putting your socks on…you want to minimize any further forward bending, which can further irritate the discs and nerves in your low back, and worsen your sciatica pain.
This is important throughout the entire day, but especially first thing in the morning, when there is more disc pressure, and you are more susceptible to further disc injury and disc herniation.
When you get out of bed, instead of bending yourself forward at the waist and flexing your low back, roll onto your side, slowly lower your legs over the side of the bed, and gently push yourself up to sitting with your arms. Try to keep your low back as straight as possible during this process.
Try to avoid bending at the waist if at all possible: to pick up the soap in the shower, to get clothes, to put on your socks, etc. Better to squat if necessary, or have someone help you, but try to avoid bending forward excessively with your low back.
Try to avoid sitting first thing in the morning, for at least the first hour after getting out of bed, when there is more pressure in your discs.
Consider making breakfast, and eating breakfast, while standing. Try to do as much as possible standing or walking around, it can make a significant difference.
As with any injury, the goal of sciatica exercises and sciatica stretches is NOT “no pain, no gain”.
In fact, with injuries, causing more pain means you are further irritating and damaging the sciatic nerve tissues, meaning your recovery will take longer.
Please start out gently, and only to your pain tolerance. Understand that sciatica pain will take time to reverse and correct, please be patient, and do NOT be overly aggressive with your sciatica stretches or sciatica exercises.
Also note that although these sciatica exercises and stretches are well researched and valid, everyone is different, including you!
Your symptoms may be different, and the cause of your sciatica may be different. For best results with any sciatica treatment in Toronto, consulting with a sciatica specialist in Toronto will always get you the best results, the fastest.
This exercise was developed and popularized by Dr. Stuart McGill out of the university of Waterloo. The idea is to “floss” the sciatic nerve, basically loosening or removing any adhesions to it, sort of like how dental flossing removes adhesions to your teeth.
To do this, sit on a hard chair or bench. Intentionally slouch, so that your head drops down and slightly forwards, to take stress off your sciatic nerve.
With your legs hanging, and your head slightly hanging, slowly look up to the sky with your head, while also slowly raising one of your legs at the knee, so that your leg is gradually straightening. Try to move your head and leg at roughly the same time and pace.
Then slowly lower your head back down, as you slowly lower your leg back down.
Then repeat on the opposite side. Do 5-10 repetitions on each side. 1-2 sets per side.
Do one side at a time. Even if you have sciatica on only one side, it’s best to do both sides.
Please stay within the pain free range of motion. This exercise should not hurt. If you can’t do the full range of motion to start with, that’s fine. Gradually over time, you’ll be able to increase the range of motion.
The piriformis muscle is one of the most common muscles involved in sciatica pain. It crosses over the sciatic nerve in the gluteal area, and if it is chronically shortened and inflamed, can compress the sciatic nerve.
There are several techniques to stretch your piriformis, but we want to emphasize being GENTLE when you have sciatica. This is not a case of no, no gain.
Better to start out gently, without further irritating your sciatic nerve pain, than to be too aggressive, and aggravate your sciatica.
To stretch your piriformis, sit on a supportive or hard chair or bench, with your legs bent hanging to the floor. Slowly raise you leg up, and pivot at your hip, so that you are sitting with one of your legs across the other.
This position will start to stretch your piriformis muscle on the bent leg side. To further stretch it, place GENTLE pressure down on your bent knee with your hand, so that you can feel a gentle stretch of your piriformis muscle. This should not be painful. As the muscle stretches further, you can gradually use more pressure down on your knee.
As we’ve discussed previously, any forward bending should generally be avoided with sciatica pain, as this puts more tension on your sciatica nerve, and may further aggravate any disc bulge or disc herniation in your spine.
Avoid any aggressive hamstring stretches, done by other trying to bend down and touch your toes while standing, while laying down, or by stretching your hamstring by putting your foot up on a chair and leaning forwards.
All of these stretches are OVERLY AGGRESSIVE for anyone with sciatica nerve pain, and will likely irritate your sciatic nerve, and cause more sciatica pain over time.
In some cases, if your sciatica becomes severe enough, there can be actual compression of the spinal cord, from narrowing of the spinal canal, a condition termed spinal stenosis.
This requires special attention, and in many cases can be managed conservatively, but if chronic and severe enough, in some cases, may require surgery.
In rare cases, if the sciatica progresses and becomes severe enough, it can lead to certain complications which are considered medical emergencies.
If you are experiencing any numbness in the butt or groin (called saddle anesthesia), combined with any bowel or bladder problems (having difficulties urinating or having a bowel movement), this potentially indicates a medical emergency (called cauda equina syndrome), and warrants an immediate trip to your local emergency room.
If you’re unsure, but are experiencing the symptoms I described above for cauda equina syndrome, please go immediately to your ER and have it assessed properly.
The information above is helpful and accurate for the majority of people with sciatica, but the reality is not everyone is the same, including you!
Before proceeding with any treatment approach, it is advisable to consult with a qualified sciatica specialist to determine what the exact cause is for YOU, so you can get the best and fastest results possible.
Before we do anything with a patient with sciatica pain, it is highly recommended to do a thorough history to find out exactly what happened, and what may have caused it, and a comprehensive assessment, including digital structural x-rays, to pinpoint any disc degeneration or disc herniations.
A sciatica treatment plan is then begun, to first help you to start feeling better, slow down any further damage, get you back on your feet, and then work to ensure your spine is stabilized, so your sciatica pain doesn’t continue to occur and get worse.
If you’re experiencing any sciatica symptoms like this, we highly advise you to consult with a corrective chiropractor who has training as a sciatica specialist, who will properly assess you, but also has the knowledge and techniques to correct any underlying structural issues.
If we can be of service, or you have any specific questions, please don’t hesitate to contact our office.
All the best,
Dr. Byron Mackay