Health Detectives on Sciatica
Much has been written on the web regarding sciatica, but what is often less emphasized is how to prevent it. In the case of sciatica, the same strategies useful for prevention are also often the best way to treat flare-ups. Of course, if you already have sciatica symptoms you should first consult with your doctor before trying any of the exercises described in this post.
Prevention is the future of health care and requires learning about common conditions before we actually experience symptoms. It is estimated that 49% to 70% of people will experience lower-back pain at some point in their lives and 5% to 10% of these cases will be caused by sciatica (BMJ. 2007 Jun 23; 334(7607): 1313–1317). Based on these numbers, now is the best time to learn more about our lower backs.
The key to the prevention of sciatica is maintaining core strength, stability and flexibility. Exercises that strengthen the body’s core, provide lumbar stability keeping vertebra in proper alignment. Stretching exercises provide the movement needed to nourish and cleanse the intervertebral discs (i.e. shock-absorbers of the spine). This nourishment through movement helps to keep the spine flexible and thus prevents herniated and ruptured discs.
What exactly is Sciatica
Sciatica is lower-back pain that radiates through the buttocks, down the back of the thigh sometimes reaching the feet (JAMA – Patient Page). There can also be numbness or tingling associated with it. It can last for months and it should be no surprise that often there is recurrence or worsening of symptoms with time if the underlying cause is not found and treated.
The sciatic nerve is the largest and longest spinal nerve in the body. It originates in the from lumbar segments L4 and L5 and sacral segments S1-S3. The nerve then courses over the anterior portion of the hip and threads through the greater sciatic foramen and traveling deep into the buttocks and back of the thigh to the back of the knee where it splits into the common fibular and tibial nerves that continue to the feet.
Sciatica refers to a set of pain symptoms and not the nerve itself. The pain symptoms resulting from obstruction to nerves in the hip region are sometimes referred to other areas of the leg or feet. That is, the source of the pain is often not the same area where the pain is felt.
In his book “Sciatica Solutions, Dr. Loren Fishman lists the following seven causes of sciatica:
- Herniation of interverterbral discs.
- Spinal stenosis (narrowing of the spinal canal)
- Spondylosis (degenerative spinal osteoarthritis due to aging)
- Nerve entrapment (piriformis syndrome in which the buttock muscles press against the sciatic nerve)
- Inflamation caused by various factors such as infection, joint slippage (spondylolisthesis), etc.
- Vascular problems
- Central mechanisms
From the OnTierraHealth prevention perspective the seven causes to focus on are as follows:
- Lack of intervertebral disc flexibility and range of motion exercise
- Lack of proper lumbar stability strength training
- Lack of proper nutrition, hydration and oxygenation of vertebral column, joints and nervous system.
- Overweight and obesity
- Poor movement dynamics and posture at work, play or sleep
- Sedentary lifestyle or long period of inactivity
- Environmental exposure to toxins and radiation resulting in increased nerve sensitivity.
Exercises and Stretches to Prevent Sciatica
As I mentioned above many of the exercises used to prevent sciatica can also be used for recovery, however, if you have pain when doing any exercise it is best to seek advice from your doctor or allied health practitioner before proceeding.
Healthy movement is not only good for your health, it is also a source of joy and fulfillment because the body was designed for elaborate, detailed, luscious movement along a vast number of degrees of freedom. One of my yoga instructors would often describe certain movements as “delicious”. At first I thought, “how can a movement be delicious? ” However, as you regain the mobility of your hips, and vertebra through careful practice you will very likely agree that healthy movement can feel “delicious.”
A valuable resource for preventing back pain and sciatica or for restoration through yoga is provided by Adriene Mishler. The YouTube video below is good start for preventing sciatica.
Here are few more links to Adriene’s videos for lower back and spine health:
Personal Trainer John Chase provides instructions for performing 5 basic core stability and strength exercises in the video below:
Nutrition for the Spine
In general a good diet is one that is balanced for the needs of the entire body. Targeting individual body systems can lead to imbalance in another region. A healthy diet for the spine will also be a healthy diet for the brain, the heart and muscle. Healthy diet also varies from individual to individual because of genetic and individual differences. Therefore it is up to each individual to become an expert on their own body.
OnTierraHealth recommends the following approach for healthy eating:
- Balance the diet such as to achieve a BMI in the range between 18.5 and 24.9.
- Follow the Harvard Healthy Eating Plate recommendations.
- Consider including omega-3 rich foods such as fish, flax-seed, walnut, chia seeds several times a week.
- Consider including dark chocolate for its healthful flavonoids.
- Consider including pumpkin seeds as a healthy source of protein, fatty acids and zinc.
- Monitor urine color for proper hydration. Urine color for most people should be a very light tinge of yellow.
- Healthy bowel movements indicate the diet is being absorbed well by the body. Consider also natural postures for bowel movements that relieve pressure from the sciatic nerves. The natural position is squatting rather than sitting.
Other Factors for Spine Health
There is no way around this fact – health requires detective work. There are too many possible scenarios that could affect the health of your spine to number here so keep seeking new sources of health information and listen carefully to your own body.
In general increasing mindfulness through breathing meditation will allow you to become aware of your body’s communication. You will notice that the body requests movement after periods of inactivity longer than 10 minutes. So get up and stretch. Consider the use of a stability ball chair that allows you to gyrate your hips while sitting.
Also consider alternating positions by using an adjustable height desk for sitting or standing while at work. If possible given your physical ability, it is a good idea to spend time each day getting down on the ground. People often lose the ability to get down easily and stand up again due to lack of practice. Proper movement techniques should be used when getting down on the ground to avoid injuries.
Many lower-back injuries occur while driving. Consider adding addtional lumbar back support with a mesh type device to your car seat. I have found this type of device to be a back saver on long trips.
Good luck keeping your hips and lower-back happy, and let us know your secrets for lower-back and sciatica health!