Month: August 2010

What is Sciatica?

Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve or by compression or irritation of the sciatic nerve itself.

Generally speaking it is pain in the lower back, glutes, leg and foot. The pain may be in one of those places or all of them and can be mild or very severe. Someone with Sciatica may also feel numbness, and may experience muscular weakness causing difficulty moving or controlling the leg. Typically the symptoms are on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

What are the causes of Sciatica?
The number one cause of Sciatica is a disc herniation – A condition where two vertebrae’s are compressed together forcing the jelly like cushioning to bulge out from in between the vertebrae’s. There are others causes though, such as:

  • Spinal Stenosis – A condition due to narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity.
  • Spondylolisthesis refers to the forward slip of a vertebra over the one beneath. There is different grades of this, which explains why some people don’t have pain with this condition.
  • Pregnancy – Weight gain, uterus growth, ligaments and joints relaxing due to hormonal changes, cause shift in the pelvis, which can in turn cause compression on the sciatic nerve.
  • Sacroiliac (SI) Joint Dysfunction – SI Joint becomes inflamed; the portion of the sciatic nerve running in front of the joint will become irritated.
  • Piriformis Syndrome – is a condition due to an over active Piriformis causing compression on the Sciatic nerve.
  • Daily Habits and Activity – Daily activities can cause overuse of the Piriformis muscle or place more stress on the joints, which can cause added compression or irritation to the sciatic nerve.

Can sciatica be cured?
There is no cure for sciatica. You can relieve the symptoms to the point you don’t have any more pain or discomfort though a series of stretching and exercises. However, these symptoms may come back depending on the cause of sciatica. The best thing to do is, once the symptoms are relieved continue with the stretching exercises prescribed by your doctor or physical therapist. This will help in future prevention of the symptoms of sciatica to come back.

What can I do to relieve the symptoms?
Depending on what is causing sciatica depends on the treatment. There are many different forms of treatment that your doctor will prescribe to you depending on the cause of sciatica. Below are different approaches that may help to relieve symptoms. In most cases many of these will help. Always ask your doctor before beginning any form of treatment though.

Below is a list of treatments and description of each, try the least evasive forms of treatment first.

  • Stretching Exercises – Though a series of stretches for the hips and back you may relieve the symptoms of sciatica. This will help to relax the over active muscles compressing on the sciatic nerve.
  • Physical Therapy – Will rehabilitate the herniated disc or the over active muscles as well as give you a program to follow to prevent recurrent flare-ups and compression on the sciatic nerve. This program will help you to strengthen the muscles supporting your back, stretch the over active muscles, and improve the posture, which can cause the compression on the nerve roots.
  • Massage Therapy – Massage therapy along with trigger point therapy is a great way to help alleviate the symptoms of sciatica by getting the muscles around the area to relax releasing the compression on the nerves.

If these forms of treatment do not relieve the sciatica symptoms, then trying these more aggressive forms of treatment.

  • Non-Surgical spinal decompression – this technique is great for those with herniated or bulging disc that are causing the sciatic symptoms. It gently separates the vertebrae from each other, creating a vacuum inside the discs that we are targeting. This moves the herniated or bulging disc into the inside of the disc, off the nerve root. Eliminating the symptoms of sciatica.
  • Medications – you may be prescribed anti-inflammatory medicine to reduce the inflammation of the muscles that are creating sciatica along with a muscle relaxer to allow the muscle to relax. If you have a lot of pain a pain killer (narcotic) may be used for short term relief. In some instances your doctor may inject a corticosteroid medication into the affected area to help relieve pain.
  • Surgery – in some severe cases, this is an option when the compression is causing excessive weakness, loss of bowel or bladder control, and when the pain is progressively getting worse, even following all other treatment options.

What are some Exercises and Stretches I can do at home?

  • Low Back Stretch – Start by lying on your back pulling one or both knees to your chest holding for 30 seconds
  • Lumbar Rotation – Lie on your back with both knees bent, hands and arms making a “T” shape, drop your knees to the side, keeping your feet flat on the ground the whole time. Hold for 30 seconds and repeat on the other side.
  • Kneeling Hip Flexor Stretch – Start by kneeling on the floor, place left foot in front creating a 90degree angle. Press hips forward while engaging the left glute to help the left hip flexor relax. Hold 30 seconds and repeat on the right side.
  • Piriformis Stretch – Lie on your back cross the left knee over the right, raising the knees and pulling across the midline of the body. Hold for 30 seconds and repeat on the other side.
  • Lat Stretch – Start by sitting on your heels. Keeping the hips on the heels, walk the hands out in front stretching though the back only as far as out as you can go while maintaining hips on heels. Hold for 30 seconds.
  • Marching – Start by lying on your back, placing your heels on the floor at a 90degree angle from your hips. Holding that angle as if in a cast, raise your knee up slightly past perpendicular to your hips maintaining that 90degree angle, lower and repeat 10-15 reps.
  • Clam Shells – Start by lying on your side in a fetal position, knees bent to almost 90degrees. Roll your hips forward so that the top hip and knee is slightly in front of your bottom hip and knee. With out rocking your hips backward and keeping your heels together, raise your top knee only as far up as you can with out changing the position of your hips.
  • Quadruped – Start out on your hands and knees by placing your hands directly below your shoulders and your knees directly below your hips. Raise your left leg straight back pushing your heel toward the wall, while raising your right arm straight out keeping it as close to the ear as possible. Hold this for 5 seconds, lower and repeat on the other side, 8-12 reps on each side.
  • Swimming – Start by lying on your stomach placing hands out in front of you. Raise your left leg and right arm, and lifting chest off the ground, keeping the neck in neutral position, hold for 3 seconds, lower and repeat on the other side, 8-12 reps on each side. REMEMBER do not jerk your body into position only as far as you can controllably raise your chest, arm, and leg.
  • Bridge – Start by lying on your back, knees bent at a 90degree angle, feet flat on the ground. Squeeze the glute muscles, keeping the abs engaged, lift the hips up off the ground. Hold for 5 seconds, lower and repeat for 10-15 reps.
  • Pelvic Tilts – Start by lying on your back, knees bent at a 90 degree angle, feet flat on the ground. Place your hands on your hips and tilt hips forward, (think about taking your hip bones and moving them to touch your leg bones). It is important to remember to not use your back muscles to create an arch in your bag, but instead using your deep core muscles to move your hips. Then tilt your hips backward (think about taking your hip bones and moving them to touch your rib cage.) It is important again to remember to use your deep core muscles to move your hips rather then squeezing your glutes to move your hips.

For a more detailed view of the Sciatic Nerve see the below pictures.

Pathophysiology

Testimonial:
A couple of years ago I injured my back while training for a marathon. Initially I thought rest and ice would take care of it – it didn’t. I tried going to a chiropractor with no relief. Eventually, my doctor sent me to physical therapy where I received ultrasound treatments and was taught various stretching and strengthening exercises. The PT provided some relief, but I was still frustrated at my lack of progress as I had a nearly constant nagging pain, especially when I sat for long periods.

I spent a lot of time self-diagnosing. An article in a running magazine suggested that one common cause of lower back pain in runners was an injury to the piriformus muscle in the lower back and buttocks. It quite literally is described as a “pain in the butt.” I decided this must be it. At the end of 2009, I started working with Katrina Yniguez at SAC. I explained to her my desire to get back to running, and my belief that my piriformus was causing my back pain.

Katrina conducted an assessment of my biomechanics and immediately prescribed some corrective exercises for my leg and back muscles. She also started me foam-rolling (deep tissue massage) my piriformus muscle and other muscle groups. At first I thought she was crazy as the exercises she had me doing were very easy and seemingly unrelated to my back. Katrina explained, however, that strengthening these muscle groups would improve my biomechanics and ultimately reduce the risk for future injury. I persisted.

Eventually, Katrina stopped being crazy and started being just plain mean. Although always pleasant and upbeat, she had obviously decided at some point that the corrective exercises were not needed anymore, and it was time to start the hard stuff. Now, twice a week, she puts me through my paces with core-focused exercises that primarily work my back, legs and chest. I never look forward to the tough workouts, but I always am glad that I did them after they are through. The good news? My back pain is almost completely gone and, when it occasionally returns, I know exactly what to do to get rid of it. I’m now back to regular running, pain-free.

I appreciate Katrina’s ability to listen to what I thought was happening to my body and to design a program that would target the needed areas. It has been great working with her. She is great to work with an always has a positive attitude, and I’ve discovered she’s not really that mean (well, she kind of is).

Matthew D. Latimer

If you would like to begin developing a training program to assist with your specific situation, please contact Katrina Yniguez.

Debunking Pilates Myths

It’s expensive
A one-on-one session is a great way to start your Pilates training, but when you learn your routine, you can work out with a partner or small group to cut costs.

It’s only for women
Joseph Pilates was a man, and he created a system of exercise meant for every body, male or female. Pilates requires concentration, focus, coordination and agility.

It’s repetitive
Pilates builds a foundation of core strength, and that requires some deep, precise, consistent work. Only after your core is established and muscles correctly firing can you move on to the more complicated, advanced Pilates exercises. So yes, Pilates can seem repetitive in the beginning. But be patient! Your repertoire will expand as you become stronger and are able to demonstrate control in your body.

It’s only for dancers
Joseph Pilates was not a dancer; he was a boxer and wrestler, studied yoga and gymnastics. When Joseph and his wife Clara set up shop in New York City, George Balanchine sent many dancers to Pilates to rehabilitate their ballet injuries. The news of a workout that promoted strength with stretch spread quickly through the dance community, and has been popular ever since. However, Pilates is beneficial for all populations.

It’s easy
Pilates can be modified to accommodate nearly any injury, but true Pilates, once the basic concepts are understood, is challenging to the most fit person.

Downward Facing Dog

Adho=Downward
Muka=Face
Svana=Dog

Let’s all breathe in together… and sigh out a big exhale and relax. Usually that’s the sound made when coming into your first Downward Dog of the day. Of course if your hamstrings and hips or shoulders are tight, you’ll let out a few grunts, but like most forward bends, the function of relaxation and total body stretching out ways the groans.

Downward Dog is an extremely popular pose in most Yoga sequences. Ashtanga, Hatha, Vinyasa, Power, Anusara, Hot Vinyasa all use this excellent pose to warm the big muscle groups and strengthen the arms and shoulders for the rigors of a more strength building practice. Downward Dog focuses on stretching the shoulders, mid back, hamstrings, calves, arches of the feet, hips and hands. The “yoga buzz” you might feel at the end of class, when mind, body and breath are in alignment are often directly related to downward dog. Yoga Therapists have known for along time the benefits of forward bending and stretching to calm the mind, ease mild depression and anxiety.

DIG IT
Ok, let’s examine this pose more closely and practice.

  1. Set your mat, and come to hands and knees (Cat/Cow) from there tuck your toes under, ground the palms and first finger and thumb toward the floor and come to Downward Dog. Set your feet hip width apart and lift up on your tipy toes. Once on your toes, you’ll take the pressure off your hamstrings so you can roll your shoulders back, straighten your spine, lift your sit bones to the ceiling.
  2. As you’re lifting everything up, LENGTHEN, your heels to the floor, without rounding back and shoulders. Remember when you were in eight grade, chewing gum, if you clenched 1/2 the gum in your teeth and pulled the other half out like string, THAT’S lengthening. If your shoulders hunch, put a bend in your knees, grind your palms more firmly and press your chest closer to your legs.
  3. While holding Downward Dog for 5-10 breaths, engage your core and lift your kneecaps, keep micro adjusting shoulders and lengthening. Rest, by coming down to Child’s pose or Cat/Cow.

MODIFY THIS!

  • If you have shoulder, wrist or acute hamstring, eye injury, please do yourself a favor and HEAL before coming into a full on Downward Dog. You can get the benefits of a hamstring stretch by lying on your back, and strapping up a lifted leg and gently pulling it toward you. Go slow.
  • If you can’t yet comfortably ground your palms, grab two blocks as support props under your hands and come into the pose. You can also use a strap around your upper arms for more stability if your elbows poke out.
  • Like any yoga pose or practice, please consult your instructor before continuing if you have an injury or contraindication. I work with a lot of athletes, and often they work with incredible pain to stay on the field. Coaches have different theories on this, but my feeling, as a Yoga Coach is if you are in acute pain, stop and examine what’s going on. I like to push people to there limit, not drive them into pain.

    That being said, enjoy. Downward Facing Dog is one of my favorite poses and this combined with stretching hips, neck and a slight back bend, and sitting in silence for 5 minutes, can be your whole practice routine to re focus and energize your body daily.

    Pilates and Pregnancy

    Most women wonder if Pilates is recommended during a pregnancy, and fortunately the answer in most situations is yes! Pilates is a great way to tone abdominal and pelvic floor muscles, which can support an ever-changing pregnant body. Also, Pilates is very adaptable. Most Pilates exercises can be modified as your body and abilities change. The modifications keep the original goal of the exercise, while altering the form to work for your body. Exercise during pregnancy may support an easier labor, a speedy recovery postpartum, a quicker return to your pre-pregnancy weight, not to mention a comfortable pregnancy.

    Sounds great, right? Well, there are a few basic guidelines to follow before you jump right in.

    First, and most importantly, if you have never done Pilates before and just found out you are pregnant; this is not the time to start. Wait until the birth, and then find a qualified Pilates instructor to lead you through the exercises. Generally this will be about four to six weeks postpartum for a vaginal birth and six to eight weeks for a surgical birth.

    Second, as with any exercise routine, check with your doctor. Inquire about your limitations during pregnancy, especially during unique circumstances.

    Third, exercise moderately. Most experts recommend not letting your heart rate get above 140 beats per minute. If you do not own a heart rate monitor, use the “talk test”. If you are too winded to talk in a normal fashion, it is time to slow down. Other signs that you need to take a break are dizziness, feeling faint, and nausea. Headache, shortness of breath, a racing heart, uterine contractions, and bleeding or leaking fluid are also signs to stop and see your physician.

    Fourth, do not over stretch. Hormones, like relaxin, soften the ligaments in your body to allow your joints to spread for the birth of your baby. Consequently, women do experience more strains in their bodies during this time. You will want to be sure not to overstretch. Working in a smaller range of motion, avoiding bouncing exercises, and strengthening the muscles around your hips and spine will help you avoid the pain of strains.

    Fifth, stay off your back. In the second trimester it is time to stop doing exercises while lying flat on your back. Your uterus has grown out of your pelvis and can press down on the major vein in your torso. This reduces the amount of oxygenated blood flow to your baby, and causes most women to be dizzy or light-headed.

    All in all, pregnancy could be a very rewarding time to tune inward and connect with the principles of Pilates: centering, concentration, control, precision, breath and flow. Consistently working with these philosophies may enhance your workout experience and offer skills to bring to the birth and care of your baby.

    If you are an expecting mother and would like to begin a Pilates program during your pregnancy, please contact Danielle.

    Goggles for Open Water Swimming

    Goggles are goggles right? Not necessarily. Just like choosing which layers to put on when going outside, choosing your goggles for open water swimming is a must.

    Some things to consider:

    1. Light reflects off water. The brighter the sun the harder it is too see. Opt for reflective and darker gogglers at this time. The TYR metalized tracer or nest pro-nano are perfect in these conditions.
    2. Even during “overcast” there is still some light reflection from the water. Opt for tinted lighted goggles in this case. The TYR tinted Tracer or Nest Pro Nano in pink and blue or clear are great for these conditions.
    3. If it is dark and gloomy and the visibility is limited in the water (think lakes that look red, murky, etc) then opt for lighter colored goggles. The clear, pink, and blues.
    4. If the water is super clear then still err on the side of caution and opt for the light reflective goggles. As for goggles fogging up, well, it happens, and as an athlete we must deal with what is thrown at as. There are different temperatures in the lakes, the air and such causing the “foggy-ness”.

    Tips:

    1. Anti-fog liquid works for some lucky folks, try it and see if you like it.
    2. Buy new goggles for race day that are the exact same pair you currently train with, try them once before hand to make sure they fit and there are no “leaks”. New goggles tend to fog less.
    3. Avoid putting your fingers or other products on your goggle lenses pre-race. Imagine sunscreen lathered fingers in lens creating a mess and limits visibility. The fit is super important, especially for the longer the races. Find goggles that fit comfortable, yet snug. It is nearly impossible to find goggles that don’t leave the “I just swam” lines on your face hours post training, so forget about trying to fix this look.

    Fit:

  • Make sure it is snug but not overly tight.
  • Make sure the goggle straps are straight behind your head, not sitting down super low and super high.
  • To tighten goggles, tighten the strap, but also pull the strap a tad more snug by the eyes. No need to push on the front of the goggle to jam the eye holes on your face.
  • Happy Swimming!

    Pilates Exercise of the Month: Roll-Over

    Purpose: To stretch the lower back and hamstrings; develop spinal articulation and improve control of the abdominal muscles.

    Note: if you have a bad neck or lower back, leave this exercise out.

    1. Lie on the mat with arms by your sides; palms down. Lift both legs to a 60 degree angle from the mat.
    2. Inhale, lift the legs to a 90-degree angle. Initiate from the abdominals; bring your legs over your head peeling your spine off the mat. Keep reaching the arms long, shoulders pinned down. Don’t press onto your neck.
    3. Exhale and open your legs just past shoulder width and flex your feet. Keep the back of your neck long, avoid any tensing or crunching in the front of the neck. The arms continue to press into the mat. Your body weight should rest squarely in between your shoulder blades.
    4. Begin rolling back toward the mat, feel your spine stretching longer and longer as you articulate down until the tailbone touches the mat.
    5. When the tailbone reaches the mat, take the legs to just below 90 degrees and squeeze your legs together again. Repeat the sequence.
    6. Complete 3 repetitions with legs together when lifting and 3 times with legs apart.

    Head to Toe Checklist: