There are very few areas in life where there is only one way to get the job done, especially when it comes to health. The experts themselves can rarely agree afterall. Even in far less complex areas of life there are many ways to skin a cat, so when it came to back pain & sciatica there was always going to be a few pathways to possible success.
In terms of how specifically to get rid of sciatic pain and back pain it is first important to understand that back pain and sciatic pain are not really ‘conditions’. Lower back pain and sciatica are symptoms that can be caused by a broad range of different underlying complaints. At the obvious end of that spectrum you can have a serious form of bone cancer be the cause of your back pain (don’t freak out just yet if you have back pain this isn’t very likely). At the less obvious end of that spectrum there are numerous different kinds of the common ‘mechanical’ lower back and sciatic pain.
So given that there are different kinds of back pain and sciatica there are also inevitably going to be different treatments and different approaches to their rehabilitation.
Here are a few of the major themes and approaches that have a track record of success in managing back pain and sciatic pain. I have separated them by ‘general theme’. Within each theme I have given specific examples of techniques and systems that fit within each that theme.
Body work for back pain and sciatic pain should really need no introductions. The earliest record we have of hands on treatment for back pain is recorded on thousand year old papyrus. Bone setters and similar hands on healers have done this kind of work down the ages as well as helping people with fractures and dislocations long before there were any hospitals when you got hurt. Going back more than 200 years it was quite normal for there to be a bone setter the same way there was a blacksmith and a baker. When the orthopaedic movement that gave rise to present day orthopaedic surgeons it’s founding father was a bone setter who did further training as a doctors and turned to the dark side… jokes.
Move to the present day and in the developed world the bone setters are extinct. As is the case with our suspicion that the dinosaurs might have just evolved into birds… it may be that bone setters have just evolved into something else closely related.
Today body work for back pain and sciatica is provided on a massive scale by physiotherapists, chiropractors and osteopaths and acupuncturists. These professions are now fully and independently regulated health professions with excellent standing across the developed world.
Body work for back pain and sciatica can be used in a number of different ways.
Some body work for sciatic pain and back pain is targeted at breaking up scar tissue. Many of us have scar tissue in our back and pelvic area. Scar tissue can come from significant injury or build up gradually over time.
Some body work for sciatic pain and back pain is designed to release deep tracts of muscle tension. Many cases of sciatic pain are caused by deep muscle spasm in the back of the hip.
Some body work for sciatic pain and back pain is designed to mobilise the vertebrae and bones of the pelvis. Many back pain sufferers have stiffness and locking in between their vertebrae.
Some body work for back pain and sciatic pain is designed to release patterns of tension that many back pain sufferers ‘hold’ in their bodies over time. These types of treatments are often very gentle and very effective.
Some types of body work for back pain and sciatic pain are designed to release deep muscle trigger points. Many back pain and sciatic pain sufferers have complex referred pain patterns from deep ‘pressure points’ in the muscle.
Body work for back pain and sciatic pain can come in many forms. Manual stretching, deep pressure like trigger point release, manual mobilisation, facial scraping with massage tools, acupuncture needles, suction cups, vibration tools… fun fun fun ! Most of these tools need to be applied repeatedly over time in order to resolve stubborn pain issues and they work best in combination with eachother.
Seeking help from a qualified practitioner like a chiropractor, acupuncturist, osteopath or physiotherapist is the way to go if you want to get body work done. Bear in mind that as is so often in life the most flexible approach will often win out over more rigid thinking. Whoever you see should be willing to entertain and try out different approaches.
Unlearning & Refining Movement Patterns
The patterns of movement that we adopt as we mature and develop into our fully fledged adult selves are complex and unique to each of us, in movement terms you are a snowflake. Some of the ‘individuality’ we adopt is not ideal. Consider the difference between the posture of the average toddler (pretty much perfect with the average office worker (hit and miss) and the posture of the average teenager (usually terrible). We can and we do pick up bad habits as we go!!!
Modern surveillance technology is moving away from facial recognition to identify individuals on CCTV and towards identifying people by their walk. A person’s walk is as individual as their facial features and a lot easier to pick up from a distance on cameras. These individual movement patterns that we develop can for a percentage of us become quite dysfunctional depending on what life throws at us, if they stray too far from the ideal they can over time lead to back pain and sciatic pain amongst other things .
The way we sit and stand is also unique to each of us as individuals. Along with the way we move sitting and standing can be a major factor in determining whether we get back pain and sciatica. Sitting all day every day at work tends to amplify the scope for harm to be done by faulty sitting habits.
There are numerous disciplines that target our patterns of habitual movement and alignment. It is possible to unlearn faulty patterns that we have picked up along the way if you have the help of clever people. Faulty and inefficient patterns of movement can be unravelled and reconnected over time for those of us who are willing to do the work. If you have suffered with back pain and/or sciatic pain for a long period of time you should seriously consider looking deeper into this topic.
Disciplines and systems that are worth investigating if you wish to do some ‘unlearning’ include Feldenkrais Method, Alexander Technique, Chek Method and Postural Patterning. Also recieving careful coaching in any and all sports that you are consistently engaged can be of great value in reducing strain on the body.
Strength / Core Training
It is a pretty well known that the core has a role to play in the prevention of back pain and sciatic pain. The rumours are accurate too, the core has a major role to play in preventing pain and injury in the back and sciatic region.
The deep muscles of trunk which form the true core have broad and complex attachments to the spinal bones. These attachments enable them to prevent injury by exerting force on the bones and preventing excessive compression, twisting and flexion when it becomes necessary for the protection of the spinal structures.
So the good news is that the core does help prevent pain and injury to the back and sciatic area. The bad news is that doing sit-ups is not going to cut it. Sit-ups and planks do not ‘target’ the core and they do not work for people who have a specific need to resolve or prevent back pain and sciatic pain. In fact there is good evidence to suggest these exercises can make back pain and sciatica worse for a percentage of sufferers.
Activating the core in a way that reliably impacts a significant history of back or sciatic pain is far more involved than anything you are going to do in a gym class. For those of us who have properly lost our core strength (if you back pain or sciatic pain that’s you) the work involved in restoring it properly in the long term is a specialised as it is effective. The answer is 1 on 1 coaching which teaches you to isolate your multifidus and transverse abdominus muscles.
The only way we can recommend you do this is with a practitioner who is experienced with facilitating rehabilitation of the deepest part of the core. We do this type of work at Featherston St. Pain Clinic. Group exercise classes are wonderful for your general strength and mobility… but they won’t cut it for your core if you have a history of back pain or sciatic pain.
There is a good reason why Cognitive Behavioural Therapy now features on international guidelines for managing back pain. Stress is a major aggravator of all stubborn pain conditions, back pain and sciatic pain are no exception to this universal rule.
The majority of people having a bad episode of back pain or sciatic pain have either been under sustained stress or have just come to the end of a stressful period, either in their relationships or at work. Even those who have suffered an ‘injury’ type onset of their back pain will often have had more than their usual amount of stress in the lead up to the ‘injury’ event. The ‘injury’ is more like a pain trigger or the straw that broke the humans back than a true injury in these instances.
It is not easy to say exactly how stress, back pain and sciatic pain are all connected, but the fact is they are. We are very early in our scientific understanding of how stress relates to chronic pain, but that need not get in the way of good outcomes for you the patient.
To say that there are many possible ways to manage stress could very well be the understatement of 2019 by yours truly. There are a virtual constellation of ways you might be able to reduce you stress in ways that could positively impact your back pain and sciatic pain. Some are less practical than others, selling your kids in the pets section on trademe or leaving your boss in a shallow grave on the Miramar pensinsular for example are both fairly impractical mechanisms.
One of the most common ways that people manage their stress is though intense exercise, this is an excellent way as long as you have an exercise form that doesn’t irritate your back. We recommend float tanks, yoga classes, time in nature and therapy with someone who you really like and trust. The most important tool for managing stress however may be patience, unravelling patterns of thought and action that cause stress takes time.
Pain is a complex old thing, it both hurts us an in some complex way nourishes us. Our suffering can most definitely grow us. Humans without pain are somewhat like food without seasoning. Suffering long and hard with stubborn intractable sciatic pain and back pain is self improvement most of us could do without. Balance is the thing, its okay to get sick, its okay to be sore, these are parts of life. Being stuck with chronic pain is not natural though, which is why I believe there are so many solutions that actually turn out to work in our search for relief.