back, Gluteal, Nerve Pain, Physiotherapy, Sciatica

The Secret to Sciatic Pain

Sciatica is a complex problem that many of us have either experienced, or know someone that has.  “Sciatic pain” however, is not just one problem but an umbrella term used to describe many sciatic-nervedifferent problems that cause the sensation of nerve pain in the area of the body controlled by the sciatic nerve.

Nerve pain can be caused by any irritation of a nerve either through compression, excessive or prolonged stretching, damage due to trauma, local chemical changes or even interference from scar tissue.

Nerve pain can feel different to different people and can be in different areas for different people, with either hot or cold feelings, pins and needles or numbness, sharp or shooting pains or even loss of power to muscles.  These differences are dependent sciatic painon which nerve has been affected and how significantly it has been affected.

The reason why sciatic pain can be caused by so many different problems is because the path of the sciatic nerve can be affected by multiple structures.
The four structures that are mostly responsible for sciatic pain are:

The Spine
When our nerves travel from the spinal cord and leave the spine, they must pass through small holes between vertebrae.  These holes (foramen) can be narrowed by different variables such as repetitive poor movement patterns, degeneration of joints, dehydration of spinal discs or disc protrusion.

The Pelvis
The lowest segment of the spine, the sacrum, also has small holes through which nerves emerge to service our legs.  If the sacrum is not gliding correctly through movement or there is poor alignment of the pelvis, these nerves can be affected.

The Buttockspiriformis syndrome
Within the buttock muscles, there is a singular muscle called the piriformis.  In most of the population, the sciatic nerve passes underneath this muscle, but 17% of people have this nerve pass through the piriformis.  Incorrect length or function of the piriformis muscle can aggravate the sciatic nerve in both populations but is more likely among the 17%.

The Muscles of the Leg
Scar tissue and a history of damage to muscles close to the sciatic nerve can cause adherence to the nerve itself and lead to pain.

Due to these multiple causes, there are multiple solutions to what seems as though it is the same problem.  What may be beneficial for your relative or friend with sciatica, may not be as effective, or may even be detrimental to your own situation.  This is why it is important to consult your physiotherapist, who will perform a thorough examination, to determine which problem is attributing to your nerve pain and create a program tailored specifically for you.

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abdominals, back, Core stability, Daily Exercises, Gymn Dangers, Hips, Improving Movement, Injuries, Physio's Personal Tips, Physiotherapy, Pilates, Stability

How stable is your core?? Here’s how to check!

personaltrainerOften, people spend hours doing “core training” in the gym such as sit-ups, planks and the like only to find that they still experience symptoms of instability such as low back pain during training or, they get injured regularly doing exercise. The problem? This kind of “core training” addresses the strength of your abdominal and oblique muscles which are responsible for providing movement but does not train the deeper, stabilising muscles that are responsible for maintaining good alignment of the spine.

Here is a little exercise to introduce the feeling and the essence of stability in you torso. The true “core”:

1. Lie on your back, knees up, feet flat on the ground.

2. Breath, and feel how your ribs move and the shape of your spine changes.

3. Place your index fingers on the bones at the top of your pelvis at the front.

4. Feel what happens when you lift one foot from the floor REALLY SLOWLY!!! No jumping it up!!!

5. Try again and try to not allow any movement in your pelvis or lumbar spine.

Did you hold your breath? Did your pelvis roll toward the side you lifted? Did your back arch away from the floor? Did you get a “ping” of back  pain?

If YES was an answer to any of these questions you have room for improvement in you core stabilisation.

Practicing this exercise is actually a great way to begin the reactivation of your deeper, stabilising muscles.  Breathing as you move and load the spine is essential to prevent rigidity. Our bodies are designed to be fluid and coordinated when moving and breath holding can stifle this and cause us to become to stiff when moving! If you don’t breath while you do anything you won’t do it for very long!!

Mullumbimby-Pilates

For detailed explanation of core stability refer to our previous blog “What is core stability?”. You can find it here: https://northernbeachesphysio.com/2014/03/28/what-is-core-stability/.

Also, watch this video of one of physiotherapists, Angus, walking through the above exercise and explaining how to activate your core!

abdominals, back, Core stability, Feet, Gymn Dangers, Physiotherapy, Pilates, Shoulder

What is Core Stability?

Power and Strength are useless without Stability and Control

muscles

Big flashy muscles might be attractive but as any physio will tell you, they are next to useless without core stability.

Thankfully the health and fitness industry has now started to embrace the need for core stability, but still few people really understand the concept and what it means.

Essentially our bodies have hundreds of different muscles that all perform important tasks and the very conspicuous Abs, Glutes, Pecs, Delts and Biceps (amongst others) are there to provide strength but they are supported by a plethora of smaller, less conspicuous muscles that provide stability.

shock absorbersThese are generically referred to as the ‘Core Muscles’ and the best comparison we can think of is with automotive suspension systems.

If the ‘Strength’ muscles are the springs then the ‘Core’ muscles would be the shock absorbers.  They are usually less conspicuous, sometimes even hidden within the springs but without them your car would fall apart in no time.

The same goes for humans.  Good strength muscles alone won’t keep you running smoothly. Without good core stability you’ll be in for lube and servicing (physio) all too often and eventually you’ll be off to the scrap yard before your time!

inner_core_musclesWhen it comes to spinal stability, the most important muscles are the multifidus, pelvic floor and transversus abdominis. As shown in the image to the right, these muscles form a supportive cylinder around the spine. The transversus abdominis is like a corset around your abdomen and it sits deep underneath all the “six-pack” muscles.  It attaches the lower ribs, diaphragm and lumbar spine to the pelvis.

This ‘core’ stabilises the spine and allows the load of movement to be evenly distributed between all the intricate joints of the spine. Just like a car suspension system, it reduces the shock through the joints and thus reduces wear and tear which would, over time, lead to conditions such as arthritis or bulging discs.

personaltrainerDoing exercises like sit ups is useful to strengthen the big “six-pack” muscles, but doing this exercise without good core stability will lead to excessive load through the joints of the spine and can lead to injury of the spine.

So in that respect it is important to activate and strengthen the core before you start on a regime of strength building.

 

Muscles of the posterior shoulderAnother example is the shoulder. The “delts”, “lats”, “pecs” and “biceps” look fabulous but they are not the stabilisers of the shoulder.

Over training of these without attention to the deeper, core stabilisers of the shoulder can result in injury as a result of an increased load being put through the system without the appropriate “suspension”, so to speak.

See our blog on ‘Shoulder Stability’ for a series of simple exercises to build core shoulder stability.

Each area of the body  has a “core” component.

Feet have intrinsic muscles that operate in balancing.

Ankles rely on hip and foot stabilisers for control.

Knees similarly need good hips and feet to be protected.

and even Necks have a deep system of muscles that control movement.

In essence, the core muscles play a crucial a role in overall well being and strength. Without the stability and control provided by the deeper core muscles, the power and strength gained from training is useless!!

Stay tuned as our series of CORE STABILITY blogs will introduce the specifics of core training for different parts of the body and the common areas of overloading we see in fitness regimes!

Post by Catherine Stephens (B.App.Sc Physio) and Angus Tadman (B.App.Sc Physio Hons I)