Back problems

[LCSULLA]

How's everyone doing? I am hoping to be pointed in the right direction inregard to my back problem. I have a sciatic nerve problem in my left lower back, right next to the spine. And I sometime get a tingling felling in my left leg if I sit wrong or if I lay on my right side. Second is that my lower back hurts when I wake up in the morning. This I think might be a muscle imbalance caused by a weak core. Oh and I have gotten the sciatic nerve checked out when it happened in 96-97 and my orthopedic said the x-ray and mri turned up nothing. I got cortisone shots in my nerve for about a month but it only relieved the pain slightly. And there is no loss of strength in the leg and I can do rack-pulls/Deads with no problem but not reverse-hypers. RHypers hurt the hell out of my left lower back. So what do you guys think......

[LCSULLA]

Anyone?

[rbibbs]

LC, sometimes it takes a while before the person with the best answer has time to get on the forum.

IMHO, lumbar function is entirely dependent upon full abdominal articulation. There are so many muscles there, big ones, overlaying organs instead of bones, so it's hard to find "the one" that may not be supporting properly. I have that problem too, and I'm not much better at defining it than you are. It can literally be anything, even trapped intestinal gas, making a muscle tensed/relaxed when it should be otherwise. Like yours, mine remisses and comes back, sometimes because of a strain, sometimes for no apparent reason, sometimes for a day, sometimes for 2 weeks.

I use exploratory differential motion between upper and lower body to try to restore full tonus and proprioceptive bandwidth to the abdominal set. If I had a more definitive answer I'd sure tell you. Perhaps one of our members does. Meanwhile, what's your overall articulation like, ht/wt/activity level now vs. historically, and any history of injury?

LC, please sign your posts with your full name... courtesy, so we know what to call each other, and forum policy.

[LCSULLA]

Sorry about not posting my sig, rbibbs. I am not active at all with grad school and full time work. I am about start training again using cals, swimming, running and sandbag drills. My height is 5'8 and weight about 215lbs. I don't look over 200 though...

Shane Vasquez

[James Boelter]

Keep in mind that I am just starting out in this field and am only recently licensed in massage therapy, so my advice should be taken with a shovel ful of salt.

I don't know how well this is known outside of the circles I've trained in, but I learned that one way to get the 'symptoms' of sciatica but still show nothing wrong on an x-ray is to have a problem with the piriformis muscles. The piriformis is one of the muscles (the big one) that sit under the glutes and is responsible for externally rotating the thigh - it runs from the base of the sacrum to the 'greater trochanter' (the 'big lump' ) of the thigh bone.

The sciatic nerve has to pass through/around/between this muscle as it courses down the back and hamstrings. There are three 'main' variations of this passage shown in most anatomy texts - some people actually have the nerves string through the muscle itself, some over, some under.

So, if the piriformis is in spasm or overtight for some reason, it can compress and entrap the sciatic nerve and cause a kind of 'false' sciatica.
Because it is a 'soft tissue' problem, an X-ray won't show anything, and because the problem isn't in the nerve root, a cortisone injection won't be of any benefit.

This should be very easy to confirm, and if this is the case, the treatment is the same as the diagnostic method. If you can get a good PT or massage therapist with a deep tissue or trigger point background to work on the deep muscles under your glutes and around the hip socket, one to three short (15-20 minute) sessions should bring about a marked improvement. Or some self applied therapy with corrective exercises aimed at loosening the external rotators of the femur (any good yoga therapy book will have these) or self therapy exercises demonstrated in the recently published books 'Ultimate Body-Rolling Workout' (Zake &Golden) or 'The Miracle Ball Method (Petrone)' would directly apply to this.

I hope this information proves to be of some help.

[MikeT]

James,
I have been seeing a chiropractor for a while for a hip problem, and he has recently started to think that this may be due in part to a spasming piriformis muscle.
For the last couple of years, my right hip has been giving me severe pain, to the point where I could barely walk. This was an on/off condition, and would be aggravated by certain activities before taking a few days to die down again.
An X-ray showed no abnormalities in the hip, but a physical examination by my chiroprator found that the right side of my pelvis was much lower than the left, which he believed was causing the hip pain and also some lower back pain on the left side. The treatment I had centred around realigning the pelvis so that it was straight, and this did seem to sort the problem out, at least for a while. At subsequent visits, the pelvis would slip back a bit and need realigning again, and the hip pains would come and go as before.
The last time I visited, my chiropractor took a different tact, and, beside the realignment, did some deep massage on the hip, as he mentioned the piriformis spasming as you have refered to. This hurt a bit afterwards, but, touch wood, I have not had much in the way of re-occurance since.
He also mentioned accupunture as a means of getting to this deep muscle, although I have no experience of this. I will try most things once, though - any thoughts on this?

I don't mean to hi-jack this post, but was just sharing my experiences of a problem with a similar (possible) cause

BTW - the exercices which most aggravated the pain (not during, usually the next day) were kettlebell work and bodyflow moves like the cossack squat and knee switch. I have stopped doing these movements! These body flow moves especially seem to particularly set the pain off. Does this sound like a result of a spasming piriformis? Is there anything I could specifically work on to loosen this area (I religiously follow WW/ FBD daily)
regards,

Mike Taylor

[rbibbs]

Don't worry about 'hijacking' Mike. Posting our collective experiences and knowledge is exactly what The Forum does best.

Sometimes the experience can be 'spot-on' relating to the original question. Your post was closer than mine in that regard. What I experience as 'lower back pain' is not sciatica, it's fatigue in the lumbar inter-vertebrals. I'm subject to an overtension-induced irritation of the brachial nerve that shuts down my R shoulder (RC, I think) intermittently, so I know the phenomenon in another location, but I didn't relate it to Shane's problem until you and James posted.

In relating our own experiences, reading others', and observing the process by which we resolve these MS anomalies, everyone's database expands. Great synergy!

Broadly Shane, I'd offer that acquisition of mass and strength come naturally to you, and less-so relaxation, so that's what you'll be working harder on to keep this condition in remission. Not 'relaxation' as in wearing out batteries in a remote control... but the motor neurology of relaxation that permits range-of-motion to occur. If I'm reading James' anatomy correctly, I can feel my piriformis contract when I turn my knee outward (to its own side). The corresponding motion that forces the piriformis to relax is turning the knee toward its opposite side, a motion nobody uses regularly. WW intermediate uses such a motion.

Flex 30 degrees at the knee and 'draw' (sideways) figure-8s on the ground, leading with your toes. Your raised knee and foot will alternately face their own side then the opposite side. This may restore tension-balance between the piriformis and its opposor. A variation on this exercise is to lead with your heel instead of your toes. This might 'solve' the problem, but again it might not since the problem dates back several years and you could need therapeutic intervention along the lines James suggests. Once the 'core' of the problem is solved, use the WW exercise for maintenance.

All bearing in mind that I'm an unemployed computer engineer, not a doctor, kinesiologist, or PT.

[James Boelter]

Mike, as Rick pointed out, we are all here to learn and to contribute. If my post connected to anyone in any way, then it is all good.
I think that acupuncture is a worthwhile healing modality, but if this is a soft tissue problem, then perhaps a soft tissue solution is the place to start. At the risk of seeming simplistic, if deep massage helped the problem, then deep massage might be a good ongoing modality to manage it and keep it from coming back. In fact, a little self-applied daily preventative massage with a ball against a wall or on the floor might go a long way.

The two books I mentioned (and the balls which can be ordered to accompany the exercises recommended) both contain routines and corrective exercises to work directly on the piriformis and the related hip rotators, and the balls (especially the 'Miracle Method' balls) are of the ideal firmness and consistency to practice self pressure. In several books I have seen a recommended exercise where you insert the MM balls between your butt at the floor on each side of the sacrum (about where your hip pockets would be) and 'V'-ing your legs up in the air to each side, then breathing into the area where the body contacts the ball. This places a deep pressure directly on the piriformis while it is shortened and is a great help in getting it to release.

Check in your area to see if there is a massage therapist who is trained in (hopefully this means completed a course or workshop in) trigger point therapy, neuromuscular therapy or general 'deep tissue' therapy. They should know exactly where to go and what to do. This isn't the same as general Swedish massage (as valuable as that can be) or relaxation massage - it should only take 10-12 minutes for each side and 2-3 sessions to get a noticeable reduction in pain and discomfort. The therapist may want to work on reducing tension overall or in other parts of the kinetic chain, and it's up to you whether you want to spend the time.

[LCSULLA]

Thanks for the advice James. Do you know a site that would list these therapists?
Shane Vasquez

[bob_stra]

So what do you guys think......


... in regards to what? Exercise program or treatment methods? Be very specific in what you want to know. My mind reading powers are at a low ebb these days ;-)

Oh and BTW - the presentation of sciatic pain you have is a little unusual. Most normally feel it originates in the buttock, not the low back. Might be discogenic in origin, not piriformis? Also - what treatment/s are you following? Your exercise routine?

[MikeT]

James, Rick,
thanks for your replies!
Mike

[LCSULLA]

Sorry I haven't been here in the last few days but I have had some personal stuff to deal with. bob_stra i don't know what discogneic and piriformis mean...can you please explain? And what i wanted to know was treatment options and/or any of Coach S's stuff could help ie: Warrior Wellnes, Maximology or anything else. Also i want to thank everyone who helped with my problem.

Shane Vasquez

[Jarlo Ilano]

Rick,

Good stuff as always! Are you sure you are just an engineer? :wink: Maybe the North Shore waves gave you some Mana for healthcare!

James,

You have some good technical expertise, and do more than me to explain alot of the specifics of soft tissue work. I would advise, and you can take it or leave it as you wish :wink: , that you as you grow more technical that you begin to shed a "tissue specific" style, and seek to find what are called "clinical patterns". I know you have found, as have I, success in treating specific areas, but you will soon find that there will recalcritant symptoms that may be similar to what has worked in the past, but require more indepth analysis. But with that being said, I know that it is hard to "diagnose" over the internet, and your advice is well founded. You'll be a fine massage therapist.

Shane,

Not to speak too much for Bob S. But, the gist of what he is saying, is the need to be more specific about your symptoms and aggravations. And also you habits, routines, and treatment trials. For more of what I mean please refer to Jonas' success in treating his knee in this thread http://www.circularstrengthmag.com/forum/viewtopic.php?t=1425
Though it his knee, not back, the general principles of finding successful resolution are the same. And also you might want to read my little essay here. http://www.circularstrengthmag.com/forum/viewtopic.php?t=1378
It may helpful to understanding more about your options.

And, you really can't go wrong with working on Warrior Wellness. Rick outlined the approach very well if you want to just start there.

Good luck to you.