Physical Therapy For Sciatica

27 Comments

  • bird.vera@yahoo.co.uk

    Reply Reply August 26, 2012

    Hello Dr Best
    I previously snet a message saying exercises were helping and that I was awaiting results of MRI scan. The result of the scan was that – Large left sided disc prolapse at L4-L5 compressing the descending left L5 nerve root.
    However the good news is that a week prior to getting this result from my doctor the pain, when sitting down, had gone. I had been doing three exercises a day, ie: 1) laying on tummy and pushing upper body up with my hands at shoulder height 2) laying on my back with one knee bent up and the other leg straight with a long rubber band round the toes and stretching my leg up and 3) knees bent and rolling them side to side. Each of these exercises I did ten times each, holding for a count of 10. I also walked each day for at least 45 minutes.
    When at the doctors I meant to ask if swimming is OK as I have not done so for a while and I only swim using breast stroke. Would this movement with my legs do any harm. Alternatively i could use the breast stroke with my arms and just flap my legs up and down. Over to you for your recommendations please. Incidentally my doctor told me to continue exercises for a couple more weeks, but I am still doing them each day and assume this is OK as I do not want a re-occurence.
    Thank you so much
    Vera Bird

    • Dr. George Best

      Reply Reply August 27, 2012

      Hello Vera,

      I’m glad to hear you are getting better.

      Breast stroke should be fine for you to do, but if you do have increased pain when doing it, it would be best to hold off on it for a little longer until your condition is a bit more stable.

      It is definitely alright to continue the exercises and in fact, I highly recommend continuing the exercises at least a few times per day from now on as a preventive measure. It is important to understand that just because the symptoms are gone, the disc prolapse is probably not completely gone, and most likely the disc will never be 100% normal again, so prevention is important.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

    • Craig

      Reply Reply July 31, 2014

      Hello DR. Best,
      My name is Craig. I am 34 and for the last month I have been experiencing extream debilitating nerve pain that starts at my right buttock down my rt. hamstring threw my calf into my heel. My calf is tight and numb. My toes are numb and tingly and I experience pain in my heel when walking. For the last week my foot has been weak at the ankle making it hard to push off from. I believe it to be the piriformis type because my rt. buttock is tight and knotted up. This all started after a long drive in a small Kia. Any movement is painfull and stretching seems to make it worse. I have seen a Dr. Who prescribe me some painkillers and some antinflairories, also I have gotten “medical messages” from few different individuals that only seems to temperarily releave pain. I am at a loss on what to do next…
      Thanks,
      Craig

      • Dr. George Best

        Reply Reply July 31, 2014

        Hello Craig,

        I think it’s more likely to be primarily a disc issue than the piriformis since you’re having weakness in addition to pain and the stretching seems to make it worse. The piriformis and other buttock muscles are innervated by some of the same nerve roots that form the sciatic nerve, so they can get tight as another symptom of nerve impingement as opposed to being the primary cause.

        Anyway, my suggestion is to treat based on the assumption that it’s a disc problem, which means start by using the McKenzie method and applying cold packs per the instructions in my free ebook. You can do the piriformis stretch as well, but you may want to hold off for a little while to see if you can get the disc-related issues calmed down a bit first (stretching a muscle that is tight due to irritation of the nerves supplying it is usually not very effective and does sometimes just increase soreness in the muscle). Be sure to follow the instructions closely for the McKenzie method and actually test the positions for the one that best centralizes the symptoms, and follow the recommendations for frequency of doing the exercise and applying cold for best results.

        If you do not already have the ebook you may download it here.

        If you don’t get significant improvement within 1 to 2 weeks, I’d strongly recommend talking to your doctor about having an MRI to evlauate things further.

        Good luck!

        Dr. Best

  • Ms Anderson

    Reply Reply August 30, 2012

    Hi Dr Best,

    I recently suffered my first episode of sciatica with progressive symptoms for over 4 months. And full blown extreme pain for the last five to six weeks. After treatment of different combinations and eventually double doses of pain killers and muscle relaxants taken several times a day my pain has subsided including at home exercises. The advice on your website seems to have been most beneficial on explanations, how to and what to do with home exercises. I was diagnosed by two physicians (two doctor visits) one diagnoses was spondylothesis and the other was back pain w/sciatica. Is there a difference?

    Now the pain is less, more dull and I’m able to get out of bed within 15-20 minutes. But now I have more pronounced (especially at end of day) numbness in my foot and tingling sensations up the backside of the ankle. How long does it take for numbness to disappear? I’m in my mid fifties and wondering how could an elderly person cope and tolerate an episode of such great pain? Do seniors suffer this same type of pain and are they able to practice a regimen of exercise sufficient to minimize or eliminate sciatica pain? As this pain has subsided I don’t know how I can tolerate a recurrence of the ‘pull-cord – shock – vibration like’ pain I experienced in my hip traveling down my leg to my ankle.

    Ms Anderson

    • Dr. George Best

      Reply Reply August 31, 2012

      Hello Ms Anderson,

      Spondylolisthesis (I think that’s probably the diagnosis your question is about) is a condition in which one of the vertebrae is shifted forward on the one below it. There are two underlying causes for it. The first is a situation (which may be congenital or the result of trauma, usually in childhood) in which the front part of the vertebra is separated from the back part of the vertebra and the front part gradually shifts forward over time. This type of spondylolisthesis can vary considerably in severity and can produce instability in the spine, but usually is a mild problem that may or may not produce any symptoms. The other cause of spondylolisthesis is degenerative thickening of the bone on the surfaces of the spinal joints which essentially pushes the vertebra forward. This type is more stable than the other and the forward shift is usually minor. It may or may not produce any symptoms over and above what is typical with degenerative arthritis in the spine. My guess is that since only one of the doctors mentioned it, you probably have a degenerative type of spondylolistheis which may or may not be related to your symptoms. “Back pain and sciatica” is a non-specific diagnosis, as it is basically just a list of the symptoms you are having and does not suggest a cause.

      With the symptoms you described, my guess is that you have one or more bulging discs in the lower spine and/or degenerative bone and ligament thickening that is narrowing the openings around the components of the sciatic nerve. Bulging discs are cannot be reliably diagnosed with regular X-rays – an MRI or CT scan is needed to make that diagnosis. How well and how fast someone recovers is largely related to the severity of the problem. A mild disc bulge or case of degenerative narrowing around the nerves will typically resolve symptomatically within 2 to 6 weeks. With more severe cases, it can take several weeks to several months over which time the symptoms will gradually improve as an overall pattern, but often with periods of increased and decreased symptoms according to activity, stress level, etc.. With regards to numbness specifically, it may not always go away entirely. In many cases after the severe pain, there will be dullness of sensation that people may describe as numbness, but their basic sensation to touch is still active (in other words, if you can feel someone touching the area or sticking a pin in it, it’s usually a temporary issue). With complete numbness (loss of sensation to touch or pinprick), it is a sign of damage to the nerve, which can be temporary or permanent to varying degrees. With actual numbness, the sensation usually does improve over time, but it can take several months, and completely normal sensation may never return.

      As a general rule, I want to see an overall noticeable improvement in symptoms over every 2 week period unless there is some unusual event or cause for things not to improve (such as a fall, car accident, or other trauma occurring in that period of time). If things are not improving in that span of time, a change of treatment approach is usually warranted. While there are significant symptoms present, I recommend a fairly intensive program of self-care, using the exercises and cold packs per the instructions on my site up several times per day. Once the symptoms have subsided, then the treatments can be reduced, but the exercises should be continued a few times per day for prevention.

      Older individuals can and do experience these problems, but in most cases the underlying causes tend to be more from degenerative arthritis than from bulging discs. As we age, the gel inside the discs becomes less fluid, so the discs become stiffer and less likely to bulge. Exercises are not always as effective for treating symptoms caused by degeneration as with bulging discs, but still are helpful in most cases and are beneficial for prevention. It just takes longer to get results in most cases of degnerative spine conditions.

      If you have further questions, let me know.

      Good luck for continued improvement!

      Dr. Best

  • Fung Chow

    Reply Reply January 28, 2013

    Dear Dr Best,

    I suffered sciatica nerve pain for the first time in July 2010, I had received a treatment from a Osteopaths which taken me 2 months for fully recovered.

    At the beginning of November 2012, I went to gym for the worked out, I execised leg curve for 12 times only one set the weight I was lifted total which means 3 bars light weight, then I went on do another exercise leg press 5 bars done for 12 times only for one set. A few days later I feel pains on my right hamstring, initially I thought I suffered Hamstring injuries, I went to see doctor ask for treatment and I was prescribed co-dryramo 500mg four time a day one or two tablets.

    My doctor referred me to see one of physiotherapy at local hospital, they told me that I had suffered hamstring injuries, but two weeks later I gone back to same hospital for second appointments, this time I was seen by a different physiotherapy he advised me that I am suffering sciatica nerve pains not Hamstring injuries.

    After I read your last email message, I am very concerned my symptoms would never get better you stated if a patient neglect things too long, this would never able to relieve the symptoms this could cost me a good quality of life (even surgery). Nevertheless, on 26/01/2013 I went to see same osteopath who treated me last time two years ago, he advised me to do a exercise regularly Mckenzie technique 3 set a day, each set which requires 5 times for 30 seconds.

    I am increasing concerned that I would never able to be fully recovered. Can you please advise me whether it is too late for me to relieve symptoms or full recovery because I delay to have a treatment from Osteopaths?

    At the moment I feel tingleys and pins and needles on my feet at the same time I feel pains on my right calf. It is my second time I suffered sciatica nerve pains which is worse than first time which is 2 years ago. But I do not feel pains when I walking, sometimes I feel pains on my calf when I sit down, but the pains gone away after 5 minutes.

    Your early reply would be greatly appreciated. Thank you

    Mr Fung Chow
    I

    • Dr. George Best

      Reply Reply January 28, 2013

      Hello Fung,

      From your description, I’d say you likely will be able to recover. Permanent damage to the nerve requires either severe nerve compression or several months of at least moderate compression. It does not sound like you’ve had neither sufficient severity nor duration of the problem to be too concerned about permanent nerve damage.

      Once you are feeling better, it is advisable to continue using the exercises on a preventive basis and perhaps see the osteopath periodically for preventive care as well. The better you take care of your back when you are not having symptoms, the less likely you are to have flare ups.

      Good luck!

      Dr. Best

  • Fung Chow

    Reply Reply January 29, 2013

    Hello Dr Best,

    Thank you very much for your reply. Do you think swimming is a good exercise for me? If it is, please advise me in which style ( breaststroke or backstroke) is the best for me to relieve symptoms in swimming. Thank you.

    Fung Chow

    • Dr. George Best

      Reply Reply January 29, 2013

      Either breaststroke or backstroke is fine, but you may get a little more benefit from the breaststroke.

      Dr. Best

  • Rose Selenge

    Reply Reply February 8, 2013

    I can’t open the video

    • Dr. George Best

      Reply Reply February 8, 2013

      The video is working properly on the site end, so chances are one of two issues is occuring on your end. If you have been able to open and view the other videos on the site, most likely the problem is there was some interruption in the data stream when you tried to open this one and your browser cached a damaged copy of one of the files needed to play the video. In this case, if you clear your browser cache (delete your browser history), you should be able to then reload the page and play the video. If you haven’t been able to play any of the videos on the site, most likely there is a compatibility issue with the device you are using. For example, the pre-installed web browsers on certain Android devices are not compatible with most of the streaming video players currently in use. This can be overcome by installing the Skyfire browser, which is available from Google Play (it is availableon a free trial basis, then it’s a few dollars to buy it once the trial ends).

  • Anthony Ahorttor

    Reply Reply March 26, 2013

    For over two years I have been suffering from sciatica. It became severe March 2012 and peaked June – July the same year. It disappeared in September. Doctors proposed surgery because I could not walk normally at the time. Later Doctors and myself decline on the surgery. March this year it came again and very resurgent that I can hardly be in standing position for 10 minutes. Do you think surgery in a good option in this situation?

    Kind Regards,
    Anthony.

    • Dr. George Best

      Reply Reply March 27, 2013

      Hello Anthony,

      In my opinion, surgery should only be considered when the symptoms can not be managed to a point where they are tolerable using other treatments. The severity of symptoms during an acute episode is not a reliable indicator of the need for surgery. The only times symptoms alone would indicate the need for surgery without delay is when there is loss of bowel and/or bladder control and/or the presence of “saddle anaesthesia”, which is a loss of sensation in the inner thighs and lower buttocks (the area that would contact a saddle when riding a horse), and/or extreme weakness in the legs (which needs to be distinguished from “giving out” of the legs due to pain).

      The vast majority of cases can be effectively managed without surgery. If you have not already, I recommend you begin with the self-treatment methods in my free ebook, which can be downloaded at: http://www.sciaticatreatmentathome.com/sciatica-treatment-exercises/ . As it discusses in the ebook, an initial period of up to a week to ten days of intensive use of the McKenzie exercise and cold packs (see the ebook for details) will usually substantially reduce symptoms and then you can gradually reduce the frequency and use the exercises a few times a day for prevention. Management of the underlying causes of sciatica really should be considered as a lifelong thing – not something you only do when you have symptoms. Although sometimes presented as a once and for all “cure”, surgery rarely is a permanent fix, and often people who have surgery on one disc subsequently have to have surgeries on other discs down the line. Surgery may be the only option in a few cases, but it’s generally best to avoid it if possible.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • P.WYNNE

    Reply Reply September 1, 2013

    I started a sciatica episode six days ago. It did not start as back or buttock pain but as a searing pain from the top of my thigh and down the full length of my right leg, with numbness. I expedited an exercise that had been given to me from a previous sciatica episode in May this year (which incidentally had a small amount of back pain but included buttock and leg pain) and the numbness and pain subsided. I felt I had caught the incident just in time but still attended my GP who diagnosed a sciatica attack and prescribed naproxen. The following day I developed the same symptoms with searing pain mainly in my right thigh travelling to my foot. I cannot move more that ten paces without having to fall to the floor and lay on a hard surface to relieve the symptoms. Sanitary issues are a nightmare. The medication gives no relief to the pain. Is it likely the symptoms will subside or is this a situation that will require hospitalisation

    • Dr. George Best

      Reply Reply September 1, 2013

      Hello,

      Given the recurring nature of the problem and the severity, most likely you are getting sciatica due to nerve impingement in the lumbar spine, most likely due to a disc protrusion. While most disc-related sciatica comes from a combination of direct disc pressure on the nerve and pressure from inflammatory swelling, since the anti-inflammatory medication is not working, it’s likely that in your case direct pressure from the disc is the more significant issue. I suggest using the relatively intensive treatment protocol discussed in my ebook for the McKenzie exercise in the position that best centralizes symptoms (discussed in detail in the ebook). If you do not already have it, you can download it from the link on the right sidebar of:

      The vast majority of cases will get good symptom resolution with the self treatment methods in the ebook. Once symptoms are gone, continued use of exercises on a daily basis (on a less intensive schedule than during major symptoms) is strongly recommended to help prevent recurrences. There are cases in which the underlying causes of the sciatica are more severe and require more aggressive treatment such as injections (for aggressive treatment of inflammation) or possibly surgery to remove disc or other tissue that is constricting the nerves, but these are rare. If you are not improving significantly within a week or so, I’d recommend talking to your doctor about getting an MRI to evaluate the situation further.

      Good luck!

      Dr. Best

  • Chris Dorgan

    Reply Reply October 21, 2013

    Dr I have sciatica as a result of inflammation of the (nerve/piriformis) due to over training for a Triathlon
    How long do the nerves take to repair themselves so I can get back to training?
    I have not ran or biked for 4+ months and am getting my 3rd epidural WED which have really helped w/ the pain.
    I really appreciate everything you do sir
    Great and helpful website

    • Dr. George Best

      Reply Reply October 21, 2013

      Hello Chris,

      The fact that you’re receiving epidurals and that they are helping suggests to me that the problem is most likely a disc protrusion and associated inflammatory swelling and not the piriformis muscle. The piriformis may be tightening up as well, but if so, it’s most likely a secondary effect of the nerve compression/irritation rather than the primary cause of your symptoms. So, it’s not really a matter of the nerves repairing themselves as reducing and/or stabilizing the disc protrusion and controlling inflammation. While epidurals do a good job of reducing inflammation, they also inhibit normal tissue regeneration and healing, so they’re definitely not ideal as a long-term management strategy.

      How long it takes to recover varies considerably depending on the severity of the disc protrusion and other contributing factors such as arthritic changes in the spine, congenital factors, and the activities you’re involved in. Training for a triathlon is of course very rigorous and distance running and long periods bent forward on a bicycle are going to tend to cause problems with disc protrusions. Some people with disc problems can recover to a point where such activities can be tolerated and some do not. That being said, your best chance for recovery to where you can attempt that type of training is going to require treatment that actually reduces the disc bulging and counters the damaging effects of those activities, rather than simply suppresses the inflammation like the epidurals do. As I alluded to earlier, while the epidurals have helped the pain, they may actually delay your recovery, so my suggestion would be to go to other anti-inflammatory measures that don’t inhibit healing (such as using cold packs as directed in my ebook and taking natural anti-inflammatories like Turmeric / Curcumin, Omega 3 fatty acids, etc.). If you are seeing a physical therapist, they also have electrical stimulation modalities that lower inflammation without delaying healing. It will also be very important to use the McKenzie exercise in the position that best centralizes symptoms as frequently as possible at first (per the instructions in my ebook) and once the symptoms are much improved or gone you should continue the exercises at least a few times per day. Assuming that you do get out of pain and are able to resume triathlon training, it will be especially important to do the exercise on a preventive basis.

      Rather than looking at things in terms of a time frame for recovery, I suggest looking at it from the perspective of what you can do. As the symptoms improve, try adding in activities a little bit at a time and see how things go. For example, if you want to try doing some running, start with maybe 10 minutes at an easy pace the first few times and if you don’t have any major flare ups, gradually increase the time.

      Good luck!

      Dr. Best

  • Sneesmom@yahoo.com

    Reply Reply November 19, 2013

    Dr Best, I have had pain in my buttocks and down my righ leg for 8 weeks now. I also have Fibromyalgia that is under control with lots of stretching and exercise but not over doing. All my activity to try and stretch the pain away made it worse so saw a 2 drs that said bulging disk maybe, an MRI was ordered but insurance will not pay until PT is tried. I do not respond well to PT due the Fibromyalgia and electrical stim is the worst for me. My son who is an osteopath says no ultrasound just ice and the Mckenzie, ultrasound would not be good for inflammation of the nerve (is this right?) he says MRI first to see what the cause is then therapy that I can tolerate cannot take meds for inflammation or pain either. Hurts most when standing, excruciating pain, a little when sitting and most of the time none when laying. How do I convince my doc to skip the therapy..insurance wants a letter from her why PT is not a first option for me. She does not quite understand the pain of Fibromyalgia and that PT in the past has been very painful. I cannot be on my feet for any length of time so can’ t get a lot done and walking is out now too. I have done your test for piriformis and it does not seem to be that. Any advice would be appreciated…I am 64 and garden ,bake,cook and can’ t do it right now or play with my new granddaughter!

    • Dr. George Best

      Reply Reply November 19, 2013

      Hello,

      I agree with your son that ultrasound would tend to increase inflammation and that an MRI would be clinically indicated before therapy in a case like yours. Convincing your doctor to send a letter to the insurance company may not be that easy though. Many doctors area afraid to “buck the system” because there have been instances where insurance companies will drop doctors who don’t play along with their arbitrary rules and this can be quite devastating to the doctor’s business if they have a lot of patients with that insurance. The only suggestion I have in that regard is to perhaps get the records from the last time you had physical therapy and have your doctor review them. Armed with that information, your doctor might then be more confident in overriding the PT first rule and get the MRI approved.

      In addition to using the McKenzie exercise and ice, I have recently found that the herb turmeric is quite effective as an anti-inflammatory and is well-tolerated by most people. If that’s something you would like to try, I suggest the Himalaya Herb brand, which I think is among the best for the price.

      If you have further questions, let me know.

      Good luck,

      Dr. Best

  • Cj

    Reply Reply November 25, 2013

    Dr. Best, thank you for your fast reply, I contacted the dr’s office for a letter to be told I needed PT ,but in the meantime the hospital called to schedule the MRI so I did. (Seems the insurance company has not implemented the PT rule yet) and since the docs office had called to schedule it previously they did. So waiting results…doing the one stretch you recommended and ice and trying not to bend or do too much that aggravates it. I think just not doing things like hamstring stretching and tennis balls, and downward facing dog is making a bit of difference so thanks for the info. I keep rereading stuff here incase I missed something important.

    A question, you mentioned a back brace at amazon but I cannot find the link now, can you please post your recommendation for me to check it out..I have the dr ho one..do not like it.

    • Dr. George Best

      Reply Reply November 25, 2013

      Hello,

      The specific back brace link I have in the members area is currently out of stock, but there are several suppliers for the same brace. If you go to Amazon and do a search for “quick draw rap back brace” you’ll get several options. Since I don’t know what your size is or what your color preference would be, I can’t give a specific link (unlike the link I have in the member’s area that had all the sizes on one listing, most of the listings are for a single size).

      Dr. Best

  • Martha

    Reply Reply May 18, 2014

    I’ve had sciatica pain in my right buttock only when I walk uphill but not downhill for 2 months ago. I’ve stop exercising for 2 weeks now but I need to start walking again. If I just walk downhill after stretching, will I be OK to do that without causing more nerve damage. It also hurts when I drive for a long time.

    • Dr. George Best

      Reply Reply May 18, 2014

      Hello Martha,

      If the only time you get the sciatica symptoms is when walking uphill and when driving for long periods, you most likely have piriformis syndrome rather than true sciatica from nerve compression. In any case, walking is not likely to cause significant nerve damage even though it provokes the symptoms. My suggestion is to work on stretching the piriformis muscle a little more frequently. If that doesn’t resolve the issue, there may be an underlying joint dysfunction in the sacroiliac and/or hip joint which a chiropractor or osteopath who does joint manipulation can help you with.

      Good luck!

      Dr. Best

  • nancycook6666@comcast.net

    Reply Reply September 12, 2014

    I am a 70 year old woman. I started having having sciatica and piriformis syndrome after repetitive dancing on a rebounder!
    That was 3 yes ago!
    I also had an X-ray this week, and it showed my rt hip is lower than my lft. So after 3 years of treatment of all kinds, I have no clue who to go to or where to get help!
    After that length of time , it feels chronic!
    I cannot cross my rt leg over my knee. The pain in my butt is never ending at this point.
    Also my rt hip and hip joint, sit bone and inner groin pain.
    I want to cry all the time from the frustration of trying to fix the problem!
    I am a tennis player and LOVE to be active! But no matter what I try , it doesn’t help.
    I keep doing the Mckenzie an piriformis exercises, but eventually it exascerbates the problem!

    • Dr. George Best

      Reply Reply September 12, 2014

      Hello Nancy,

      I’m going to reiterate what I said in my response to your last post because your description of the symptoms really sound more and more like it’s primarily a hip joint issue to me:

      If the only time you have pain is when doing the piriformis stretch and when standing, and the symptoms are only in the butt and hip, chances are there is a problem in the hip joint itself. SI joint dysfunction may also be a factor, but I definitely would be looking at the hip (the ball and socket joint). I don’t know what imaging has been done, but in my experience it is a good idea to do an MRI on the hip when the symptoms are not improving even if x-rays did not show any problems. I have seen cases where X-rays of the hip were completely normal but the MRI showed major degeneration. It is also possible that the hip joint is not moving properly, and few practitioners evaluate the joint motion of the hip, so the problem goes undetected. In my experience, the most common hip joint dysfunction is a jamming in external rotation, and this does tend to result in chronic tightness in the piriformis, as well as compensatory issues in the sacroiliac joint (if the SI is compensating, it’s not going to get fixed until the hip problem it’s compensating for is corrected). A chiropractor or possibly a P.T. who who has a good foundation in extraspinal/extremity manipulation is your best bet for getting the hip checked out, but it may take some searching to find someone with that expertise. In the meantime, I would recommend having the MRI on the hip to make sure there’s not a serious issue that is going undetected.

      Again, I strongly recommend you have an MRI on the hip even if all the X-rays showed was the right hip lower than the left. My guess is that there is a degenerative issue in the joint that is just not visible on the X-rays and if that’s the case, an MRI will be necessary to diagnose it and for you to get effective treatment.

      Good luck!

      Dr. Best

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