Prescribing The Right - Exercises
Prescribing the right exercises for patients with sciatica is essential to their recovery. By delving into the underlying mechanisms of the injury, we can identify the most effective exercises to enhance healing while avoiding those that could potentially worsen the condition. This tailored approach ensures that each patient receives the most appropriate and beneficial treatment plan.
Article Index:
A few Fundamentals
What Not to Do
Renowned back pain expert, Professor Stuart McGill of Waterloo University, with over 240 peer-reviewed papers, offers crucial guidance on exercise selection for those dealing with back pain, including sciatica. He advises against certain movements, such as toe-touching stretches, which can exacerbate disc-related issues due to forward flexion intolerance. Additionally, exercises involving hyperextension, like the "superman," can place significant compressive forces—around 600 kilograms—on the spine, potentially worsening existing injuries.
Exercise Goals: No Pain, All Gain
For individuals suffering from sciatica, the primary focus of initial exercises should be improving neuromuscular control and endurance while avoiding pain. Performing exercises that trigger pain can lead to abnormal neuromuscular patterns and further injury, so recovery exercises must stay within a pain-free range.
Traditional rehabilitation methods may fall short, as they often overlook underlying neuromuscular dysfunctions and sometimes promote exercising through pain, as seen in work-hardening programs. These programs can reinforce or even create improper motor patterns, leading to persistent pain due to increased nervous system sensitivity. Moreover, the scientific support for the effectiveness of work-hardening programs is weak, emphasizing the importance of pain-free, targeted exercise in managing sciatica.
Central Sensitization - The Windup Phenomenon
Continuing to exercise despite pain from tissue injury can significantly increase the risk of central sensitization, a condition where the nervous system becomes overly reactive and hypersensitive to stimuli. This process, known as Wind-Up, lowers the pain threshold, causing even mild sensations to be perceived as painful long after the initial injury has healed.
When in a state of Wind-Up, the nervous system’s heightened sensitivity demands that exercise be performed within a pain-free range to break the cycle of chronic pain. Prioritizing pain-free exercises is essential to prevent further sensitization, contrasting with past exercise approaches that may have unintentionally worsened the condition.
Exercise Examples
The exercises below are examples that may be prescribed to patients dealing with sciatica. The choice of exercises will depend on the patient’s unique pain triggers and the root cause of their condition. Please keep in mind that these exercises are for demonstration purposes only and should not be considered personalized recommendations.
Cat Camel Stretch - Your Day's Opening Movement
The Cat-Camel Stretch is an ideal first movement of the day, especially for those with sciatica or back discomfort. It's important to avoid intense stretches or bending right after waking. Your spine needs time to warm up, as spinal discs take about an hour to release the extra fluid that builds up during sleep. This gentle stretch helps mobilize the spine without overloading it.
Nerve Gliding Exercises for the Spinal Cord and Sciatic Nerve
To help free the spinal cord and sciatic nerve, we recommend that patients perform gentle nerve gliding exercises 3 to 4 times a day, especially in the initial stages of treatment. The instructional video on nerve gliding demonstrates various techniques to effectively mobilize these trapped nerves, providing relief and promoting recovery.
Bird Dog from Quadruped Position
The Bird Dog exercise, performed from a quadruped position, is a powerful tool for training the nervous system, especially for those dealing with sciatica. This exercise is not only safe but also highly effective even in the early stages of recovery. It helps your body learn to transfer energy from the legs through the core to the arms, improving stability and motor control—key components in managing and alleviating sciatica symptoms.
The Wall Plank Exercise
The Wall Plank is a key exercise for restoring motor control over core muscles after a back injury, making it particularly beneficial for those with sciatica. This exercise helps rebuild strength and coordination in the core stabilizers, essential for spinal support and reducing sciatica symptoms. It lays the groundwork for more advanced core exercises, promoting a safer and stronger recovery.
Beginner's 3-Minute Plank Series
Once initial improvements are made, this 3-minute plank series becomes part of the core routine for sciatica recovery. Designed for beginners, each set lasts just over a minute, with a goal of completing 3 to 5 cycles and a minute of rest between. For those new to planking, starting on your knees and holding for ten seconds helps build endurance in the slow-twitch muscle fibers, essential for strengthening the core and supporting a resilient spine.
Activities of Daily Living
Managing your daily activities is as crucial as exercising within a pain-free range, especially for those with sciatica and low back pain. Here are some key strategies to help reduce pain, speed healing, and reduce re-injury risk.
Identify Your Pain Triggers
Understanding how your pain responds to movements like flexion, extension, lateral flexion, or rotation is vital. Once you've identified what triggers your pain, adjust your posture and avoid those movements to aid in your recovery.
Start Your Day Gently
In the morning, your spinal discs are swollen, which can increase discomfort. Avoid stretching during the first hour after waking. Instead, take a hot shower to warm up your body before easing into exercises like the cat/camel stretch.
Mix Up Your Movements
Staying in one position for too long can aggravate sciatica. Make a habit of changing your position every 20-25 minutes. If you've been sitting for a while, stand up, stretch, and walk around to keep your muscles engaged and reduce stiffness.
Prioritize Movement Over Ergonomics
While a well-set-up workstation is important, it’s even more crucial to keep moving. Adjust your chair, change your seating position, or use a physioball intermittently to encourage movement and prevent prolonged static positions.
Managing Back Pain During Daily Activities (ADL)
This video offers key strategies for managing sciatica through everyday activities. Properly handling daily tasks can make the difference between quick pain relief and the risk of chronic back issues.
Why Choose Our Approach for Sciatica Treatment
Our comprehensive approach to treating sciatica boasts a success rate of over 90% in reducing pain and improving function. Here's why our method is effective:
Established Expertise: Developed by Dr. Brian Abelson, the Motion Specific Release (MSR) methodology draws from over 30 years of clinical experience and the successful treatment of more than 25,000 patients. This ensures you receive the highest standard of care tailored to your specific needs.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including nerve compressions and musculoskeletal imbalances, often at the root of sciatica.
Advanced MSR Procedures: Our MSR techniques precisely target areas of fascial restrictions, joint dysfunctions, and nerve entrapments, providing targeted and effective relief from sciatic pain.
Customized Exercise Programs: We create individualized exercise plans that improve nerve mobility, strengthen core and back muscles, and restore overall function, facilitating recovery and long-term well-being.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive strategies, ensuring a holistic and lasting solution to sciatica.
Choose our proven, patient-centred approach for effective, long-term relief from sciatica. Take the first step toward your recovery with confidence.
References - Part 4
Flor, H., Braun, C., Elbert, T., & Birbaumer, N. (1997). Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters, 224, 5-8.
O’Neill, S., Manniche, C., Graven-Nielsen, T., & Arendt-Nielsen, L. (2007). Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. European Journal of Pain, 11, 415-420.
McGill, S.M. (2009). Ultimate back fitness and performance (4th ed.). Waterloo, Canada: Backfitpro Inc. ISBN 0-9736018-0-4.
McGill, S.M. (2007). Low back disorders: Evidence-based prevention and rehabilitation (2nd ed.). Champaign, IL: Human Kinetics Publishers. ISBN 0-7360-4241-5.
McGill, S.M. (2015). Back Mechanic: The Step-by-step McGill Method to fix back pain. Waterloo, ON: Backfitpro Inc.
McGill, S.M., & Kavcic, N. (2005). Transfer of loads between lumbar tissues during the flexion-relaxation phenomenon. Spine, 30(17), 1996-2004.
Disclaimer:
The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.
This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.
By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies on this website.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.
Join Us at Motion Specific Release
Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.
Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:
Protocols: Over 250 clinical procedures with detailed video productions.
Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.
Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.
Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.
Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.
Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.