Wow, what a difference 3 weeks makes.  Since my back injury on January 2nd I spent a week off my feet, a week working in discomfort, and last week started to jog again.  This week there are almost no signs of my injury.  I can provoke pain with certain core stabilization exercises that stress muscles that I injured.

Muscular Injuries Can Be Really Painful

I am supremely grateful for the frequent, judicious chiropractic treatments that I received since the day of my injury.  Not without pain, I impatiently found the balance between resting, stretching, and exercise (walking).  I applied ice frequently, often after simply maneuvering onto the couch, and was careful not to move in any manner that would have made my condition worse.

Following a few basic tenets I was able to recover from an injury that brought a great deal of pain and cost me productivity.

• Chiropractic Care – good spinal motion is essential to health and promotes healing
• Ice to quell inflammation
• Good Nutrition – hydrate well, avoid foods that inflame, eat & supplement to reduce inflammation and oxidation (antioxidants)
• Know your limits – rest when movement hurts and extend your range of motion as you can tolerate

I’ve run 21 miles since last week and I’m registered to participate in the Southpark RaceFest 1/2 marathon again in April.  I plan to continue stability training so that I heal completely, strengthen my core, and protect myself for the future.  Of course I will continue with my regular chiropractic adjustments.

While many started the New Year with shopping or rest and relaxation, my plan included a home improvement project on the second day of 2012.  An accidental misstep led to an injury from which I am still recovering.  My accident left me with severe muscle strain and spasms, lumbar joint fixation (loss of joint motion between vertebral segments), an antalgic lean, bruises, and intense pain.  Last Wednesday, I was encouraged because I could walk in the grocery store while pushing a shopping cart for support.

Experiencing an injury allowed me to test all the advice that I normally recommend for my patients.  I was out of commission for a week, so I can tell you that I was eager to return to better functioning, productivity, and the ability to lift my children.  Activities as basic as bathing, dressing, getting in and out of the car, moving on and off the couch, or getting into bed were all provocative.

My Healing Recipe:

• Ice (20 minutes, then at least 20 min off) throughout the day, often needed just after moving onto the couch or into the car
• Avoid Movement and Rest
• Chiropractic treatment to increase ROM and facilitate joint motion
• Ultrasound therapy to reduce muscle spasm
• Position of comfort (leaning to my right offered protection while moving and could ease pain while resting)
• Anti-inflammatory products including NSAIDs, flax seed oil, bromelain supplement & pineapple, zinc, antioxidants
• Walking (first with the support of a cart, then on the sidewalk)
• Stretching as I could tolerate (before getting out of bed in the morning and throughout the day)
• Drinking plenty of water to flush toxins from my system

Chiropractic treatments were at times as painful as any movement I attempted, but Flexion-Distraction Therapy allowed my joints to be moved and helped me to stand straighter, however incrementally.  I received daily chiropractic treatments last week and have already had two visits this week.  I will always choose the discomfort of treatment over the soreness of inactivity when faster healing is possible.

I admit that I was very fortunate to have the support of family, friends, and extended family that made it possible for me to be so inactive for a week and to be transported to my chiropractic visits.  My range of motion is not 100%, I’m still sore to sit or stand for prolonged periods, certain movements can stop me in my tracks, and it hurts me to get into my car.  Take away what you will, but after sustaining an injury that wouldn’t allow me to stand vertically for 5 days, I was able to return to work a week later.  On Monday, January 9, 2012, I was able to return to treating my patients and I continue to progress daily.

Improve on my regimen for recovery by adding: Fish Oil, Resveratrol, Quercetin, and ginger to your diet for increased defense against inflammation.

Please be careful in all the activities that you do.  If you should sustain an injury, please let us help you at Matthews Chiropractic Center.

I was reminded again recently how ingrained is our instinct to put heat on pain.  The trouble is that there is a time for heat when treating injured muscles and joints, but not when an injury is new.  When muscles are newly injured, in a motor vehicle collision, sports injury, slip and fall, or otherwise, applying ice is the best first aid.  For new injuries treat with ice or cold packs, applied to the area of pain for 20 minutes, wrapped in paper towel or over a t-shirt, every 2-3 hours to alleviate pain and reduce inflammation for the first 48 hours or more.  Do not apply ice for more than 20 minutes at a time.  Allow at least 20 minutes to pass between treatments.

Applying any type of heat, be it a heating pad, hot water bottle, commercially available heat wrap, soaking in a hot tub/bath, or otherwise, to injured muscles can boost the inflammatory response and pain.  Increased inflammation can affect a broader area, intensify pain and delay healing.  Avoid heat for new injuries.

As a Rule…

if pain is new, sharp, shooting, or burning, then you should apply ice.  If muscle pain is more than a few days old, sore, or dull and achy, the use of heat may be more appropriate.  If after an injury you have pain radiating or traveling into the arms or legs, this is a sign of a more serious injury to the nerves.  You should contact our office for consultation or present to another medical provider.

Muscles do the work of moving the bones and joints in the body, so when muscles are injured or not working properly, chances are that spinal joints may also be affected.  This is why at Matthews Chiropractic Center my approach focuses not just on improving and maintaining movement of the joints of the body, but also on treating and instructing home care of the associated muscles.

Glides & Tensioners

The two remaining methods are meant to treat sciatic nerves that demonstrate excessive tension and heightened sensitivity.  Because the sciatic nerve is already inflamed, the purpose of these maneuvers is to improve the motion of the nerve through surrounding tissues and desensitize it to stretching^[1].   Begin with the gentler “nerve glide” and progress to the more intense “tensioner,” as tolerated.  Start off slow and gently, remembering that the nerve is irritated.  If you proceed too aggressively, you may increase the irritation.  Should this happen (pain level increases), stop what you are doing and apply ice, wrapped in paper towel or over a t-shirt, to the lower back for 20 minutes.

**These activities are meant to treat chronic sciatic pain.  If you are experiencing a flare-up or symptoms that are worse than your normal level of pain/discomfort, you should avoid glides and tensioners.  Stick to the stretches from Home Care for Sciatica I, apply ice to the lower back repeatedly, and consult our office or your health care professional.

Self-Care Basics

• Move slowly and carefully, this gives you time to respond if the movements aggravate
• If any maneuver causes pain, stop the activity and discuss with your health care provider

Sciatic Nerve Glide

To perform the nerve glide movements, sit on a stool, the edge of a chair, or low table.  Simultaneously slowly lift the involved leg off the floor and lean the torso backward.  Next, cautiously lean forward while bending the involved leg back (ultimately bringing the leg with pain behind the uninvolved leg).  Maintain your low back curvature when bending forward.  You should not feel pain or nerve tension, in the leg or spine, during this glide activity.  Repeat this series of movements 10 times, several times.

Sciatic Nerve Tensioner

Start by lying on your back as shown.  Bend the knee on the affected side and raise the thigh to a vertical position (knee should be bent 90 degrees).  Tensioning begins by slowly extending the involved leg (straightening the lower leg).  Once you begin to feel slight tension on the nerve, immediately let the leg lower to the starting position.  The goal with this nerve tensioning technique is to approach tension/pain, then back away and repeat, without causing added discomfort.  Repeat the tensioning 10 up to times and repeat several times per day.  Performing this stretch is meant to reduce the nerve’s sensitivity to being stretched.

If these activities are not helping to control your sciatic pain, consider a consultation with Dr. Leibman at Matthews Chiropractic Center.  Many patients gain relief from sciatic pain with the help of chiropractic manipulation and other conservative therapies.

1. Marc Heller, DC.  “Correcting Sciatic Nerve Tension, McKenzie, Decompression and Nerve Glide/Tensioning.”  Dynamic Chiropractic.  EIC. Ramon McLeod & Peter Crownfield, EE.  2008.  MPA Media.  6 May 2008.  <http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53203>.  [↩]

Back Pain & Sciatica

Irritation of the sciatic nerve can cause pain, tingling, or numbness along the course of the nerve and its branches, from the backside to the toes.  Many people who have history of lumbar disc injury, even following surgery, experience pain which travels into the buttock and/or legs.  This type of radiating pain is usually the result of chemical or mechanical irritation to the nerve roots that exit the spine and contribute to the sciatic nerve.  For many sufferers, it is possible to manage their pain with the help of stretches and exercises.

Stretching Basics

• Relax your neck and shoulders, you’re not doing sit-ups
• Maintain slow, even breathing while holding 30 second stretches
• Don’t bounce, hold steady and try to gently increase the stretch with time
• If any stretch or maneuver causes pain, stop the activity and discuss with your Doctor

Knee-to-Chest Stretch

Aside from ice and rest, this stretch is generally the first line of defense against lower back pain with radiculopathy (radiating nerve pain).  I recommend that patients with sciatic pain do the knee-to-chest stretch on a daily basis.  The stretch can be especially effective when performed after waking, but before getting out of bed and putting weight on the back for the first time in the morning.  To stretch, lie on your back and bring the knees towards your torso.  Pull with your arms around your knees or legs to increase the intensity.  Hold the position for 30 seconds while slowly breathing and gently trying to bring the legs closer to the body.  Repeat 2 to 3 times.  If stretching both legs at the same time is too intense, then start by bringing one leg towards the body, stretching then switching to the opposite side (lower illustration).  Alternatives to stretching on the back include deep squatting and pulling the knees to your body or bending to touch your toes while sitting in a chair.  These moves can be repeated multiple times a day.

Piriformis Muscle Stretch

The first stretch that I recommend is for the piriformis muscle.  The sciatic nerve usually runs under and sometimes through the piriformis muscle as the nerve travels between the sacrum and hip, then towards the leg.  Stretching of the piriformis muscle can be achieved in a seated position.  While sitting in a chair, cross the affected ankle over the opposite knee.  With one hand, stabilize your ankle on your knee and with the other hand or forearm apply gentle pressure downward on the involved knee.  If you have strong pain to push down on the knee, than simply stabilize the crossed leg and avoid the added pressure.  *If this movement significantly increase your pain, than stop immediately.  You should start to feel the stretch in your buttock.  From the crossed leg position, with the knee being held down, you can further increase the intensity of the stretch by slowly leaning forward, bringing your chest closer to your knees.  Always maintain the lumbar lordosis or curvature of the back – think “arching the back” while bending forward.  Be sure to maintain slow breathing while performing this and any other stretches.  Try to hold the stretch for 30 seconds, repeat 2 to 3 times and don’t hold your breath.

The next installment of this series, Home Care for Sciatica II, will include nerve glide and sciatic tensioning maneuvers to add gear to the self-treatment toolbox.