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THE I MOVE MANIFESTO:

SCIATICA NERVE PAINDr. Tim Newton, DPT, OCS, CFMM

P: (410) 259-9096 F: (443) 430-2625

https://marylandmanualtherapy.com

Dr. Tim Newton DPT, OCS, CFMMTim is the owner and founder of Inspire Movement Physical

Therapy. His entire career has been devoted to manual therapy

treatment of complex musculoskeletal disorders. He earned

his Doctorate in Physical Therapy in 2009 from the University of

Delaware and is a board-certified Orthopedic Clinical Specialist

(OCS) through the American Physical Therapy Association. Prior to

that, he received his B.S. in Biology at Emory University and was a

graduate from McDonogh School in Owings Mills, MD.

Tim’s interests and specialties are in disorders of the spine,

headaches, complex pains, and athletic injuries. He has a strong

belief in the hands-on, manual therapy approach toward reducing

pain and regaining function. His training is in craniosacral technique, muscle energy technique, indirect

technique, myofascial release, among other areas. His coursework has been primarily through the

College of Osteopathic Medicine at Michigan State University and the Barral Institute.

Inspire Movement Physical TherapyManual therapy is what we do. We specialize in hands-on techniques to restore healthy movement in

your joints and tissues, enabling the body to naturally heal itself the way it is designed to do. We strongly

believe in preventative care and follow an osteopathic model, which is holistic, detail oriented, and

rooted in a thorough understanding of anatomy and biomechanics. The passion for solving the puzzle is

what drives us.

Inspire Movement is for people who want to move their best, feel their best, and be their best. We’re dedicated to providing the highest quality care possible to help you live your life to the fullest.

Treatments are one-on-one and last a full hour. These are typically no more than once a week, and are

with the same therapist each time. The majority of each session consists of hands-on techniques specific

to you, your condition(s), and your goals—that’s the Inspire Movement way.

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

What you need to know about Sciatica and Pinched NervesSciatica is an irritation of the sciatic nerve in the buttock, which is the largest nerve in our bodies. There

are dozens of websites out there that explain the anatomy of this in great detail that you should visit if

you’re totally new to this condition. Mayo Clinic offers a good one here. Untreated nerve compression

can potentially lead to permanent nerve injury, so an understanding of how to turn the tide in this

condition is very important for overall health.

Nerves in the body are like highways. Instead of

carrying traffic though, they carry electrical signals- such

as the command to fire a muscle, or transmission of

sensory information from our skin to our brains when we

touch something. The sciatic nerve is the biggest nerve

in the body- think of this guy as a 6-lane interstate going

both directions. As this “interstate” courses north (toward

our spines), or south (down our legs), eventually it splits

off into smaller, 2 and 3 lane highways, which themselves

eventually branch off into single lane roads, and

eventually your destination- your home, or your work.

Still with me? Now, imagine you’re driving to work. If there is a backup on the main highway, traffic

coming from all the other, smaller roads in the area will be affected. Similarly, if the traffic on one of

the smaller roads is blocked off, it will affect the traffic on the 6-lane interstate in some way. In the end,

traffic will be affected no matter where the backup was, and your commute (the transmission of the

electrical nerve signals) could be delayed the same amount by different backups in different places.

The reason this traffic example is useful is because the challenge of diagnosing the root cause(s)

of sciatica is very similar. Nerve signals can be altered in the body, causing pain, muscle weakness,

or numbness, but we can’t be certain where the signal is getting blocked without doing a full examination of the body to see where the nerve branches are actually being compressed.

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

The sciatic nerve is a big nerve in the buttock, formed by multiple smaller nerves coming out from the

lumbar spine (low back) above it. Lower down in the body, its branches off into different, smaller nerves

in the leg. The brain might detect pain or numbness in the thigh, or you may be weak in your leg, but

this isn’t always a sciatic nerve compression. The real nerve compression could be (and often is) in

another place. The symptoms will be the same. We all know what it feels like when we whack our funny

bone in the elbow- that zing we get into our pinky? This is the same concept. You feel it in the pinky, but

you actually irritated the nerve somewhere else in the body- the elbow. The location of the symptoms tells us very little about the real root cause.

To make matters more confusing, nerve pain (which

sciatica is) typically manifests itself differently over

time. One day it may be a pain in the buttock. Then

a tightness and pain in the hamstring. Then it’s pain

in the calf. Then the calf again, but the outer part.

Then not the calf but the back of the knee…and we

try to stretch whichever area is feeling tight on that

particular day. It’s exhausting if you are the one

dealing with it. So, this is what we tell our patients:

If pain moves around on you, stop chasing it. It’s

a fool’s errand. Take a deep breath, stop playing whack-a-mole, and give yourself a break.

What Do We Do Then? Very rarely in sciatica do we find a healthy lumbar spine and sacroiliac joint, and this is where a good

assessment needs to start [see our section on the Low Back for more on this]. The key to successfully

treating sciatica is not being distracted by the location of the pain, and instead focusing on where the

body is not moving right. When mobility is restored to these tight joints and muscles from spine to toe,

symptom relief is usually not far behind. A big mistake in rehab is trying to chase the symptoms with

one stretch one day, and another the next day, and so on. These may give some temporary relief, but

they are not addressing the root of the problem that would be much more obvious with a detailed and

thorough assessment in the first place.

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

Helpful Blogs:The Myths of Bad Discs and Getting an MRI

Why Your Sine Health is Most Important of All

5 Secrets for a Healthy Spine

CLINICIAN’S CORNERCentralization Phenomenon and Sticking with the Plan

With sciatic nerve irritations coming from the hip and low back, it is imperative that the manual therapist have some objective data points (such as hip flexibility, ankle strength, etc) that are retested each visit. This is best practice in any orthopedic case, but because of the centralization of symptoms that occurs when the nerve roots are involved, here it is critical. Centralization is the commonly observed phenomenon in which pain may actually move to new areas, often in greater intensity, during treatment of an irritated nerve. That is, even when you’re doing the right things, it feels worse before it feels better. As the underlying causes of the pinched nerve are being corrected, that compression on the nerve is changing. Therefore, the symptoms experienced by the patient are changing too.

A good example of this: Patient John Doe who comes in with very bad pain in his left calf and posterior knee. The therapist begins with treatment to mobilize the lumbar spine and the hips. The next visit, John reports that the pain in the calf is gone, but remains in the knee. He also has had a bad hamstring cramp on the left side since last visit. The therapist notes however that his flexibility and strength are improving, and sticks with the course of treatment. John feels frustrated, but goes along. On the third visit, John is angry. His back is killing him and his left buttock is hurting very badly. He is losing faith in the therapist because he was supposed to feel better by this point; not have new problems. The therapist examines him, and flexibility and strength are still improving. When the PT inquires further, John no longer has calf, knee, or hamstring discomfort. Just this new, intense pain in the buttock and back, which is all he can think about. The PT convinces John to stay patient and stick with the plan of care, and in another two visits, John’s pain is gone, everywhere from the back and down the left leg.

The above story is a classic clinical example of centralization. The pain will move toward its origin (up toward the spine, NOT down toward the foot) and may even reach new areas and heighten in intensity before it disappears. It can be difficult for the therapist and patient to maintain faith in the process when this happens, but if that clinician is consistent with her approach and measurements, and is seeing positive objective changes along the way, the subjective changes are not far behind. Both parties need to hang in there and stick with the plan.

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

What we can do for youAs we discussed above, this problem usually requires more than just loosening buttock muscles like

the piriformis. For sciatic nerve pain to be fixed, the nerve needs to be freed of as much restriction

as possible from spine to toe. In fact, piriformis muscle tension often resolves once the spine is moving properly. You need to identify the restrictions to joint movement and myofascial tissue motion

along the nerve’s course throughout the body, and then they need to be corrected in order to get it

decompressed. In our experience the vertebral restrictions in the lower spine are the major cause of

sciatic symptoms, and this is where people need to start. If you are not getting the relief you need from

stretches, and are not a surgical candidate, a manual therapist specializing in the spine is probably what

you need, and that’s who we are. We have the experience in treating sciatic and lumbar conditions, and know how to find and correct the key spots efficiently and effectively. So get your life back,

and stop chasing these shifty symptoms. Give us a call!

Manual Treatment Videos:Treating the Tight Piriformis

Treating the Lower Thoracic Spine

Treating the Lumbar Spine

Treating the Sacroiliac Joint

Low Back Pain: Our Mechanical Approach

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

Disclaimer:The above information is for educational purposes only and should not be considered health advice for you

specifically. We advise that before attempting anything included here, you should first consult your physician or physical therapist to ensure that it is safe for you and your condition(s). Please use common sense and before trying

anything new, consult your licensed healthcare professional. With exercise and any physical activity there is an inherent risk of injury or adverse health event, and by engaging in these movements, postures, or habits you accept this risk. We also make no guarantees of any specific results from

the advice, exercises, or postures included here.

Holistic. Hands-on. Honed In.

https://marylandmanualtherapy.com

What you can do on your ownBelow is a collection of some of my favorite exercises to try. I usually advise people to focus most of

their effort on mobilizing the thoracic and lumbar regions first. We show how treating the lumbar spine

can loosen tight and painful hamstrings without a single stretch-see the video below. Also, before going

on to these stretches for the leg and hip muscles, be sure to check out our hip Manifesto section as well.

Hip mobilizations will also have a loosening effect on muscles in this region. Finally, if your sciatica is

really bothering you, be careful of overstretching and pushing too hard into the pain. It may backfire on

you a few hours or even a day later. Less is more in this case, and always remember the importance of

good sitting posture!

ExercisesPiriformis Stretch to Decompress the Sciatic Nerve

Sciatic Nerve Mobilization Exercise

Hamstring Stretch Exercise

Arch and Plantar Fascia Home Stretch

ErgonomicsHow to Have Good Sitting Posture

Good Sitting Posture in the Car

How to Make Your Own Lumbar Support

6 Reasons You’re Still Struggling with Your Sitting Posture

How to Lift Things: The Big, The Small, and the Awkward

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