IOL Strength and Conditioning

I began my funky attempts at fitness in the late ‘70s, at the outset of the jogging craze (trudging is what I was doing), and from then until fairly recently, we fitness enthusiasts spread the rumor that sciatica was a runner’s problem, and bent-leg situps were the cure. Now that we’re past those ridiculous decades, we now know that’s not the case, neither the cause of the problem, nor the cure.

In fact, sciatica isn’t a diagnosis at all; it’s a symptom, and it means pain down the leg. If you went to a doctor or chiropractor and got that diagnosis, and the instructions were to rest or to take an anti-inflammatory — and was the extent of the instructions, nothing more — it’s time to get a new doc. Sometimes the inflammation will run its course and the pain will dissipate, but it won’t be from following those instructions, and it’s likely to flare up again in a few months if you don’t get to the underlying cause.

What’s happening is there is a nerve or perhaps nerves under pressure, sending pain running from the spine down the back of the legs, usually one leg, but  possibly both. Somehow, you have to figure out what’s causing the pressure: Is it at a disc, either inflammation or possibly a rupture or herniation, or perhaps the common reason of something pressing on the sciatic nerve as it travels through the glute region?

In Dave’s case, which you may remember from his back surgery a couple of summers ago, it was from severely degenerated discs. The surgery took the pressure off the nerves and the pain is gone, but that was one situation where holding off on surgery backfired; the nerves were damaged enough they were unable to repair — reinnervate is what that’s called — and he lost a bit of lower leg function.

The moral of Dave’s story is this: If the pain doesn’t change after a month, pursue specialized doctoring. I don’t mean to say you should get surgery if you have back pain for a month, but if there’s no change in symptoms after doing the techniques that follow, don’t be too stubborn to get help.

After having watched Dave’s process, I’d first try a neurologist to check for peripheral artery disease (PAD), and then I wouldn’t wait too terribly long before queuing up at the neurosurgeon’s for a MRI and possibly even surgery if the diagnosis was degenerative disc disease. If the diagnosis was PAD, I’d seriously consider EDTA IV chelation, which Dave did and which didn’t work, but that could be because he didn’t have PAD but wanted to avoid back surgery so he tried it anyway. Along the way, I’d start paying attention to cardiovascular issues, too, because PAD is unlikely to stand alone; those other arteries are probably getting into the action, or out of it, I guess is a better description.

If you make your way to a physical therapist or a chiropractor, look less for manipulation and more for soft tissue therapies to take down the inflammation. You might get some radiant heat, followed by a STIM treatment, which will probably give you some temporary relief. Once home, icing the low spine and glutes a couple of times a day will help. Those reusable fishermen ice sheets are real handy for chilling the whole back at once.

Let’s assume the pain isn’t debilitating and you’ve decided to forage around for answers on your own for a bit. Here are the easiest things to try:

Using a tennis ball, look for a trigger point in the piriformis

Now the next one could be a little controversial: McKenzie back extensions. The main reason for the hesitation is because if there’s a disc herniation, there’s a chance it could be an unusual bulge and the extension could make it worse. But the thing is, if you ease your way into these, should there be a problem, you’ll know it long before you can cause any trouble.

And I figure, if you’ve got back or sciatic pain, you’re not jumping whole-hog into any back exercises anyway, so I feel safe in throwing this out there. I have a good friend from the gym who had terrible back problems, was sidelined at his aggressive construction work, had a bunch of injections and was heading toward surgery. He started doing the McKenzie exercises, quickly left the medical funnel and has been doing great ever since. Now there’s a guy who’d be disappointed in me if I’m too chicken to write about press-ups in a bit about back pain. Here’s how, with an explanation from physical therapist, Dr. Mike Jones.

Practice back extensions using the McKenzie Press-up

Now some exercises. Start here: Cook Hip Lift for glute activation, to overcome too much sitting

Abduction exercises to strengthen the outside of the leg, offsetting too much front-to back action

If you had little success with your corrective work and are enjoying a bit of relief, it’s time to address the cause. Why did this happen in the first place? The most likely cause is a problem between the low back and the hips, and the easiest place to start is a hip mobility program. When the hips aren’t moving well, the low back moves too much, and that will get you into trouble. For most adults sitting at a desk reading this, if you aren’t working mobility, you’re probably losing it, and if your back isn’t hurting now, it will be. Here’s how to get started on a hip mobility program.

I leave you with two more suggestions. First, hop on over to Esther Gokhale’s site and order her book, 8 Steps to a Pain-Free Back, in which she’ll explain and demonstrate our faulty postures and what to do about them. While you’re waiting for the book to arrive (which you’ll faithfully read and practice instead of burying it under the TV stand), settle in for this one-hour video.