I’m no stranger to injuries of the athletic variety; I call these “the easy ones” because I can point to EXACTLY where it hurts. No guessing. Mine are in the knee, ankle, and occasionally, the wrist/hand. Not so this winter!
Let’s backtrack a bit: Winter 2015 was not kind to me. It felt like I was coming down with some illness every other week. As such, I make a very poor patient, with very poor patience.
This last go-around left me with a nasty chest plague. Intense coughing fits really did a number on my body, and at one point I was even consulting The Google with a “Lumbar pain AND coughing” query. This is a real thing, as evidenced by a large amount of articles provided. I found myself doubled over with low back pain with each spasm, needing to support my upper body weight on my knees to keep my back from feeling like it was going to break. I’ve even had numbness and a feeling of heaviness in my leg after sleeping in certain positions.
Pain down the leg, commonly called Sciatica by many, comes in many shapes and sizes.
I’d like to take some time right now and clear up some of the mystique about this often-proclaimed condition.
Sciatica is merely a bucket diagnosis, meaning it is a generalization to explain a set of symptoms ranging from low back pain, pain in the buttock, thigh, leg and foot. It isn’t really a diagnosis, per se. Sciatica means, in Greek, “pain down the leg”. Most people confuse these generalized symptoms with an issue with the sciatic nerve. Everyone has a sciatic nerve, two actually, one on the right and a match on the left. Originating from the L4/L5 vertebrae, the sciatic nerve shoots through the muscles of the back part of the hip, down the thigh, branches off into different segments just north of the knee, and ends in the foot.
Pain can shoot down the leg from a variety of different conditions and structures, other than actual sciatic nerve injury, and knowing the Why can increase the odds of improvement and recovery.
If your back hurts, it’s also not uncommon to have more than one issue going on at a time.
The traditional medical treatment of sciatica is usually muscle relaxers and oral steroids to treat inflammation. The goal is palliative in nature, meaning the symptoms are suppressed, but the condition isn’t addressed. This treatment sometimes works, but not always, and many a client of mine have complained how their back pain feels worse after the prescriptions expire. Sure, the muscle relaxers relaxed the tight muscles in the low back, which were there to prevent further injury.
Muscular splinting, like a fever, is not something to be afraid of, and is quite useful and protective. We shouldn’t be so hasty to eliminate it.
Of course the steroids did their work to reduce the inflammation, thus decreasing pain, but inflammation is the chemical process our body uses in which to heal itself. I’m going to throw, “poor patients; poor patience” back out there. Interpret that at your own pace.
From a physical medicine standpoint, assessing sciatica is of the utmost importance. Different reasons for pain down the leg require incredibly different methods of therapy.
A treatment protocol for one reason could be absolutely catastrophic for another, causing more pain, injury, and loss of function.
Successful recovery requires pairing the proper treatment plan with the correct reason for the pain. It’s proactive. There is work to be done. This is easily done with skilled hands-on assessment techniques. Many of the causes of sciatica can’t be seen with the eye, and don’t necessarily and definitively show up on imaging, especially via X-ray.
Without a proper hands-on assessment, we’re guessing at best, and getting in the way of recovery at worst.
As an Orthopedic Massage Therapist, it is not my duty to diagnose. In fact, it is prohibited. I can, however, assess for the purpose of informed decisions toward effective treatment protocols. I’ve studied assessment technique at great length, as well as the differences between many of the injuries we can experience in our body. I assess so I don’t make you worse. My first question is always, “have you seen a Physician recently for this issue?” Sometimes the answer is yes, and the diagnosis given is sciatica (big help there), and sometimes it is no, in which case I always encourage the client to consider doing to establish a history. Whether the client has seen a physician or not, I still do my own assessment; I don’t rely on what others tell me, and who says my perspective and skill-set isn’t incredibly useful in these situations? That’s a rhetorical question [grin]. If the client is game for an in-depth assessment, we do it, if they just want to veg on my table for an hour or so, we do that instead, just don’t expect high mileage therapy. If you want me to do my job, let me do my job.
Some of the most common reasons for “sciatica” are: dysfunctional and destabilized sacroiliac joint; pelvic imbalances and distortions; sacroiliac/sacrotuberous ligament injury; facet joint dysfunction; spondylolisthesis; herniated nucleus pulposus (disk)/lumbar radiculopathy; piriformis syndrome; lumbar ligament injury; and generalized neuromuscular dysfunction.
As you can see, many different situations cause “pain down the leg”. When we assess an injury or a pain, we utilize a variety of range of motion tests. Some are active, some passive, and others are resisted; basically, you do some of the moving, I move you, and we work together as a team to flesh out the information we need to guide us in the correct direction. We then can properly plan the best treatment protocol to ensure your safety and optimal recovery. Sometimes referrals are made to see an appropriate medical professional based off of our findings.
We can’t know what we don’t know, and I don’t like to guess when people are hurt. It’s a waste of time and money when we guess. It can be dangerous to guess, as sometimes some pretty big issues cause the pain. I want happy, raving-fan clients who enjoy a healthy life without pain and injury.
I didn’t get the nickname “Magic Hands” for nothing.
Nothing says “Good Morning” like waking up to use the Necessary in the middle of the night and having to drag my leg behind me. I admit to a slight freak out; my Mom had a stroke a few years ago that showed up as a loss of function in her right foot. The doctors kept telling her she had a “pinched nerve” in her low back. Using my assessment skills, I encouraged her to consult a neurologist, and it was very good she did; she had a blocked artery in her neck, which caused the stroke. So here I am, 2:33am, running through some assessments in my sleep addled mind, making sure I could go back to bed or if I needed to wake my husband and call an ambulance. I’m prone to melodramatics, so I give myself a gold star for keeping my cool while half asleep and half numb. I rationalized what was going on and decided more beauty sleep would do me good, just change my sleeping position. I awoke the next morning with pain and stiffness. I did the appropriate stretches and exercises and now, 48 hours later, am completely fine.
No numbness. No tingling. No pain. Good movement. Back to normal. Not even an ache when I cough.
It’s important to take a look at any discomfort you may experience in your body. Pain is a messenger. Let it tell you what it needs to tell you before you silence it with prescriptions and procedures. There is always a reason for pain. If you have low back pain and haven’t had it thoroughly addressed, not only with imaging, but also with a thorough movement and postural analysis, consider yourself only marginally informed of what is going on. It’s easy to fall into the trap of trying to squash symptoms; no one, not even me, likes to feel pain or discomfort, but successful recovery is difficult if we don’t address why the pain is present in the first place.
Is it time for your assessment?
If you are experiencing low back pain, either new or old, and would like to explore some options on how to alleviate your discomfort, I welcome you to email me at firstname.lastname@example.org, or call my receptionist at (847)249-7960 with any questions. If you are ready and proactive, I encourage you to also click the Book Now button above.
**the information contained above is not meant to diagnose illness or injury, but is meant as education, as self-inquiry, and to inspire greater dialogue between you and your health care team.**