Don’t Wait 4 Years To Find Out Why You Have Sciatica!

Hi, I'm Dr. Molly with Your Goals Physical Therapy. Let's talk about Sciatica. So sciatica is kind of a general term. A lot of people get diagnosed with sciatica, in general, what they're talking about is that they have low back pain that runs down their leg. So they may always have back pain. Like there's a little bit of ache in their low back, then with certain motions or in some cases all the time, they have a burning sensation that runs down one of their legs. When somebody gets diagnosed with sciatica, that can mean that that burning sensation is running from their hip to their knee, or could even go all the way down to their foot. Today I wanted to talk about why it is so important, not to wait years to find the reason for that pain.

That might sound weird. Why would anybody wait any length of time to find out why they have burning pain? But really, honestly, it happens more often than we might think. If you're just sitting and it's like a mild ache down your leg, and it doesn't really interfere with too many things people tend to just justify stuff. You'll hear people tell you, it only really hurts when I sit for a really long time. So I just get up and move around and then it would go away. So it was just basically easy for me to ignore. “I sort of pushed through things”. “During one of my physicals, I went to the doctor, they did an x-ray, they didn't find anything. So I just sort of figured that the pain would eventually go away on its own.”

Over time if you start to really talk to people, you find out that when that pain started, they just started limiting what they did. They would think “I can’t sit for long periods” so they wouldn't sit as long. They figured out that going on long walks in some cases helped, but then there would be a distance that was just too much, and they couldn't go that far. So they just stopped going that far, because why would you have pain? You just don't walk that far. I can walk a mile with no pain, then I'm walking a mile. Right? I mean, that makes perfect sense. Instead of bending over for things, they start getting creative with how they're going to pick things up off the floor. They just slowly make these changes over time because they're avoiding pain. And in some cases, this is completely subconscious. You and your body just know that these activities are going to hurt. So you simply stopped doing them. 

My plea to you is that if you are aware that you're having some kind of back pain, specially something that is burning down your leg, even if your x-ray or your MRI come out and they're completely fine, I strongly urge you to seek help to figure out what is causing that.

You might ask, “How do you figure out what's causing that if it doesn't show up on an x-ray and MRI?” That is ultimately what physical therapists do we live in a gray area? You know, it'd be nice if I always got people that came in and they have this nice, pretty picture that says, this is where my pain is, and this is how you're going to get rid of it but that's not how it works. That's because that's not how people are. 

That's not how everybody’s body is. Everyone’s life is different. Everybody's physiology is different. So I live in the gray area and it is super fun because it means no day is the same. People who come in with sciatic pain, you first have to figure out what positions are comfortable, what positions make things worse? Is there a certain muscle that every time that muscle activates you fire up, or is it a position that changes all these things.

When I see people that have sciatic pain or any other kind of nerve pain, these are the kinds of things that we go through.  I try to ask what happens when this happens? What happens when that happens? I watch people move. I find out what things they have decided to just opt out of.  Because like I said, some people don't even think about it. They either don't drive for long distances. Like I don't go on road trips anymore. I don't do anything that requires balance because I know that I'm not going to feel stable. So I go through and I ask a whole lot of questions and we physically touch you. Asking does this hurt? Does that hurt? Does this make it better? Does this make it worse? By the end of the treatment, we know definitively things to avoid and definitive things to keep doing because they may make things hurt less. You avoid the things that make it hurt. Then you just build the stability and the strength and the range of motion off of all the things that reduce your pain.

No matter what your MRI or your x-ray show, we do a treatment, the two of us with what you tell me makes you feel better, and what makes it easier for you to walk, what makes it easier for you to get up and down from the chair. Then ultimately the goal is to not only stop things from hurting more while you're doing them, it's to get rid of the pain all together, it's to stop having your leg burn all the way down to your ankle or your foot.  Is to have it first only to be in your low back. And then once it's just staying in your low back it's to just get it to leave altogether. The nice thing is that the whole way, because everything's kind of slow, and this is a process, you get used to how to move differently, how to breathe through motions.  You get more in touch with how you're moving your own body and how to know when you're doing something that's causing damage versus how you're doing something that is just making your muscles sore.  
Honestly, that is a big trick, right? Especially if you're already in pain, how do you discern the difference between muscle soreness, (which in my world is a good pain), and the pain that your body is telling you, “Whoa, hold up. That is causing a lot of damage. We need to stop this behavior right now.” 

That is the gray area that I live in. I live in, how do we take this burning sensation that's going down somebody's leg and in their low back, how do we get that pain to come up towards their spine? And then eventually just go away. How do we get them from avoiding so many activities in their life to getting them back to bike riding, running, walking with their kids, getting up and down off the floor, going on long road trips? My plea is that if you have any kind of nerve pain, even if you're able to kind of ignore it, because a lot of people can, it's very impressive how much people are willing to deal with.  Even if it's something that you can kind of ignore that you're trying to push off, the earlier you help those nerves not be compressed, the less nerve damage you'll have. What does that mean? What is nerve damage? That can mean that you're losing sensation. That can mean that you're losing muscle strength since your muscles are controlled by your nerves. The sooner you find out what is causing that nerve pain and that burning sensation, even if it's not showing up on an MRI, if you're having that burning sensation, it means something is pinching on a nerve. And the sooner you figure that out, the easier it is to change your movement patterns and the faster you get back to doing everything you want to do without limitation. So that is my final plea. I hope that everybody's having a wonderful day. Please share this information with anybody who might need to hear it.

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