Dear Sciatica, We Need to Break Up: a letter to the afflicted, Part One
SCIATICA (noun): pain along the course of a sciatic nerve especially in the back of the thigh. broadly: pain in the lower back, buttocks, hips, or adjacent parts (M-W Dictionary).
Reading the insane number of direct messages, website submissions, and emails from people suffering with sciatica gives me a mild case of myocarditis. Followers: my heart honestly hurts for you. As someone who dealt with sciatica for 2 years without much relief, I understand your plight. However, this is my profession. I studied for many years about the human body, I continue to learn and study today, I played sports and have always been in the gym, I have a fairly good awareness of my body and how it moves/should move. I have easy access to healthcare and friends within my profession to help me when in need... and it was still a literal pain in the ass for me to manage. That alone makes me patently aware that those who do not understand the human body deeply, and additionally do not understand their own body, are fighting an unbelievably difficult battle.
If you do not understand the problem, how can you solve it?
If you do not understand your own body, how can you change it?
If you feel lost, how can you ever be optimistic you will recover?
When you receive advice that doesn´t work, how do you maintain hope?
A 2017 study from the U.K. showed that even with physiotherapy and family doctor care, only 55% of study participants showed any meaningful improvement after 12 months.¹ The obvious follow-up question: why do some recover and others do not?
A simple way to explain this predicament is an associative analogy...
We can associate the nuance of an injury with the simplicity of a cut to our skin. After we have a cut into our skin and it begins to heal immediately. If it is quite superficial the cut will heal within 3-7 days....in a vacuum. In other words...assuming the person is healthy with normal clotting factors, and no perturbations...the cut will heal like clockwork...in 3 to 7 days.
But back pain and sciatica are immensely different. Back pain is the boxer in the ring with a bad cut over his eye, still in the storm, trying to weather continuous blows from an opponents fist. And when the bell rings, the boxer must walk home through a thick forest of trees and brush. He also needs to move his eyebrow to speak and gesture, and sleep on the pillow, and deal with his toddler climbing on top of his face during playtime...and then fight again in the ring the next night and the one after that...all the while hoping to avoid any more "punches" to the zygomatic bone.
Will an ointment and Band-Aids work against a flush right hand jab?
Will the platelets congeal quick enough to tolerate a tree branch sliding across the face?
Will the swelling go down if there is continual trauma to the cut and the eye?
In reality, it is even more complicated for the low-back patient. There is the person´s previous injury history, anthropometry, age, sex, fitness level, activities of daily living, occupation, nutrition, mental state, motivation level, body awareness, hormone situation, home environment, access to health care, variation in disc shape, variation in disc injury, variation in nerve compression... The list is seemingly endless.
So where do you begin? How do you start to heal? Who do you trust? Which exercise will work? When do you go for medical intervention?
Honestly, nobody knows these answers with 100% accuracy. But there are some simple truths hidden within the extremely pessimistic complexities of low-back pain. Here they are:
1) You know yourself better than any doctor or therapist does. You are with yourself every second of every day. Therefore, you must be accountable to one person, your self. Learn to make self-awareness a priority...even self-experimentation.
2) Avoid painful triggers. If you constantly rub the cut above your eye, it will bleed again and the healing cycle starts over. Most people are causing small traumas to the area over and over again...restarting the healing cycle every day. This explains why one year is not enough to heal...if you constantly force the cut to bleed every day. No therapy will work if you constantly irritate the problem via simple daily tasks, such as sitting. Everyone is different, but the most common triggers for disc related sciatica are: sitting too long, bending the low back to move and lift things, sneezing, being too long in the same position, going to the bathroom, vacuuming, picking up awkward or uneven objects, walking uphill, getting out of the car/chair/bed, slow walking, etc... there are many more but these are just the most common I hear on a daily basis. So you MUST find ways to do these daily tasks without creating pain or increasing sciatic symptoms! More on this in PART TWO.
3) Train pain-free movements. If walking is pain free, walk. If swimming causes more sciatic-like symptoms, stop swimming. If hiking relieves the pain, you MUST hike. If sitting on the sofa to watch Netflix for hours increases the leg pain, you MUST STOP sitting long periods. If changing positions regularly and learning to sneeze in a pain free way avoids causing leg-pain...it is non-negotiable to do that!
4) Pain is not equal to damage! If you get a bit of jalapeno juice in your eye, you might think your life is about to end. Yet, asymptomatic people can unfortunately receive a shocking terminal diagnosis of cancer with just a few shorts weeks to live. A heart attack can hurt less than a set of 10 leg extensions at your local gym. People with hypothermia can perceive being overly hot and then take off all their clothes in freezing conditions... My point? Experience of pain and real injury is non-linear. Can it be linear? Yes. Is it typically? Most likely not. People will run until their leg breaks, but a paper-cut sends you swearing at all the Gods and your mother. Takeaway: We are resilient, we adapt, see # 5.
5) We only adapt and grow via stress. Without gravity we wouldn´t have a skeleton dense enough to stand. We wouldn´t have a force with which for mass to accrue period. It is because we experience the force of gravity, that we have a structure. Haven´t you ever heard that trees cannot grow tall but with the experience of wind, a stress that creates adaptation within the tree. Or that an Orca´s (Killer Whale) dorsal fin always folds over in captivity because it doesn´t receive the stresses that a high-speed, rarely surfacing, wild whale would.
"Force is the language of cells." - Dr. Andreo Spina
Need more examples? Play guitar? No? Try today and see how long you can play before your fingers are in extreme pain or even begin to bleed. So how do the pros play for hours every day? They´ve earned it. Why can an African bushman run barefooted over stones and brush with ease? They´ve never worn cushy running shoes. Why did Arnold Schwarzenegger have huge biceps? He trained them...a lot. Even with amazing genetics and drugs can you have his arms without training? Never.
Takeaway: How on earth can you assume to rehabilitate cellular tissue without stress, without force? With a hot-pack and a glass of wine? Sounds fun, but unfortunately...no.
6) Seek medical help when sciatica continually regresses. If pain began in the low back, then became butt pain, then it goes down into the foot, then you are feeling numbness and start to walk differently or trip (foot drop) it is time to go in for medical assistance. If you lose bowel or bladder function you must go in immediately.
**However, if your symptoms are these, but in reverse order, then things are looking up and you should be very optimistic. Pain that becomes less in the foot and leg and more in the back is called centralization, and is a good thing generally.
TO BE CONTINUED...in Part Two we show triggers and solutions as well as home based exercises to hopefully help you increase your pain-free capacity. But as much as everyone wants to see the "exercise for sciatica"...realize most of the answers are in what you just read...think deeply on this and start applying what you can.