How to Tackle Low Back Pain and Sciatica

Waking up with low back pain and pain shooting down your leg can be a rude wake-up call that you may need to stretch more, but do you know what to do? 

As a physical therapist, I am frequently asked what I do to keep aches and pain away. When I say that I stretch almost every morning I get a look that says, "yeah... I don't have the time or energy for that". BUT, I do all my stretches in bed. 

Rather than trying to get myself out of bed, change into stretching clothes, and then start my routine, I like to stay in bed where it's warm and comfortable. 

Below is a list of exercises to keep your back healthy and happy.

Double Knees to Chest: To start, bringing both knees towards your chest allows stretching of the glute muscles but also opens up your spine allowing for an increase in space between each vertebral bone. Hold this position for about 30 seconds and repeat 3 times.

Lower Trunk Rotations: With your arms out to the side and your legs bent to about 90 degrees you'll allow your knees to fall to the side. Remember to scoot your hips to the opposite side when your knees land and look away from your knees to increase the twist. In the example above, the knees fall to the right, so I scooted my hips to the left and I am looking to the left. Hold here for about 30 seconds and repeat 3 times to each side. 

Sciatic Nerve Glide: Holding on to the back of your leg you will then point your toes up to the sky, this will slacken the tension from your Sciatic nerve. 

You will point and flex your toe while on your back repeatedly. When your toes are pointing towards your nose, you will increase the tension on your Sciatic nerve. Repeat pointing and flexing your foot 10-20 times (as tolerated), and perform 3 times on each leg. 

Advanced Sciatic Nerve Glide: if you performed the above sequence a few times and did not feel a flare up of the sciatica symptoms then you can progress to a more aggressive way to move the sciatic nerve. The difference now will be that you are holding your head up the entire time as you point and flex your foot. By lifting your head up you will pull your nerves from the opposite end and will increase the tension felt, this is a good progression after you've practiced 

Getting out of bed from a resting position without warming up is like jumping into a soccer game without stretching, your muscles will be stiff and sore and you may not be able to reach peak performance. Starting your day with these exercises will help relieve your low back pain and decrease shooting pain from sciatica. 

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Hypertonic Pelvic Floor Muscles

 Hypertonic Pelvic Floor Muscles

The pelvic floor is a group of muscles located inside the pelvis. These muscles help hold the weight of your organs and they are the gatekeepers for bowel movements and urination.

Female pelvic floor model

The pelvic floor muscles are positioned in a way that they counter the pressure coming from above when the abdominal muscles are activated. Having strong pelvic floor muscles helps create core muscle stability. The bladder, the sex organs, and the rectum are all located inside the pelvis, surrounded by the pelvic floor muscles. The pelvic floor and the bladder work opposite of each other - as the bladder is filled it relaxes and expands to contain more fluid; simultaneously, the pelvic floor muscles will contract to prevent any liquid from escaping. Once you decide to urinate, the pelvic floor muscles relax and the bladder gently contracts to allow passage of liquid. A similar process occurs with bowel movements. The rectum is the location where feces is stored until ready to be expelled, when having a bowel movement the pelvic floor muscles will relax to allow passage of feces. This is a simplified way of thinking about how the body controls our bowel and bladder, however, it allows us to explore the complications that can happen which may lead to urinary incontinence, diarrhea, constipation, pain during sex, and painful bladder, amongst other issues.

Hypertonic pelvic floor muscles occurs as result of the pelvic floor muscles being contracted and having a hard time relaxing. Hypertonic pelvic floor muscles can cause pain with sex, constipation, urinary urgency, pelvic pain, and tightness of the surrounding muscles of the hip (like the hamstrings and piriformis). Hypertonic pelvic floor muscles can occur for many reasons such as trauma to the muscles from childbirth, continued breath-holding (like with exercising or with stress), or prolonged “tummy sucking”, according to the Pelvic Floor First website, a leader in pelvic health awareness. This can also happen from holding your bladder for long periods of time. Some people who have developed hypertonic pelvic floor muscles reported holding their urine because of a busy work schedule not allowing them bathroom breaks (ie. school teachers, nurses, commercial drivers, etc.) or those who wait to use their private bathroom rather than public bathrooms. 

Hypertonic pelvic floor muscles symptoms may also present as: 

• Sciatic nerve pain

• Pelvic pressure

• Hip pain

• Low back pain

• Pain with menstruation 

• Difficulty with urination and/or bowel movements

According to the International Journal of Sports Physical Therapy, physical therapists are considered the movement experts in the medical field. Physical therapists analyze movements and positions that can help or could be worsening your pelvic floor hypertonicity, allowing for a better understanding of what is going on,  which is crucial for addressing the problem. Speaking with a pelvic health therapist is helpful to receive a personalized plan to address your symptoms, understand the root cause, provide helpful bowel and bladder advice, and guide you to the level of activity you want to have. Treatment might include a combination of stretching, teaching proper diaphragmatic breathing, contraction of the core muscles (this includes the pelvic floor and diaphragm) with lifting, return to sport training, and pelvic floor relaxation techniques. Pelvic health therapists provide education about the function of the pelvic floor muscles to help you gain a deeper understanding.

The following are the top 3 stretches I recommend for hypertonic pelvic floor muscles, they are meant to be completed gently. These stretches are not intended to replace speaking with a pelvic health therapist.

1. Bent Leg Modified Downward Facing Dog

2. Straight Leg Modified Downward Facing Dog

3. Glute and Hip Flexor Combination 

Bend both knees, point your toes and knees in, push your hips back and arch your back. Hold this position for 15 seconds for 3 repetitions. You should expect to feel a gentle pressure across your sit bones. Slowly increase the amount of time you hold until you are able to perform this stretch for 30 seconds, after that try to repeat 5 times. 

poin

Keep your knees straight and point your toes in, push your hips back, and arch your back. Hold this position for 20-30 seconds and repeat 3-5 times. You should expect to feel a gentle pressure across your sit bones. As previously mentioned, slowly increase the hold time and repetitions with the goal being to hold for 30 seconds 5 times. 

Keep your tailbone tucked in, don’t allow your back to arch. Hold this position for 20-30 seconds and repeat 3-5 times. You should expect to feel a gentle pull along the front of hip of the standing leg and a along the buttock of the leg on the chair. Slowly increase the hold time and repetitions with the goal being to hold for 30 seconds 5 times. 

Also, pelvic health therapists often refer to these yoga poses that encourage pelvic floor muscle awareness, activation, and relaxation. 

• Happy Baby

• Pelvic Tilts  

According to the Mayo Clinic Proceedings Journal, other non-therapy-related treatments include neuropathic modulating medication such as amitriptyline, nortriptyline, gabapentin, and pregabalin. Tricyclic antidepressants are also prescribed, but should not be the first step towards managing the symptoms as it can lead to an increase in bladder/bowel symptoms. Trigger point injections with the use of Botulinum Toxin Type A, corticosteroids, or anesthetic medication also may help with symptoms. 

Contact your doctor if you are feeling symptoms that may lead you to believe you have hypertonic pelvic floor muscles to get started on your path to recovery and wellness. Feel free to contact me regarding questions you may have and to see if pelvic floor rehabilitation is right for you.