Why Do I Still Have Sciatica? Will I Eventually Need Surgery?

-By Leading USA Sciatica Expert, Dr. Tom Padilla

Question:

I have sciatica and I feel like I’ve tried everything to help it. I’ve tried massage, acupuncture, chiropractic, stretching, exercising, you name it. e problem is, everything seems to help a little bit, but only for a short while. I’d like to avoid surgery, but I’m concerned that nothing seems to be working. Can this sort of thing be helped?

ank you for your insightsShannon

Answer: Hi Shannon, thank you for your question about sciatica, and whether or not there is a solution without surgery. is is a great question and sciatica can be quite confusing (for healthcare professionals as well!). For anyone struggling with recurrent sciatica there are a few things that are important to understand.

First of all, muscles are not smart. ey do not have minds of their own. Typically what happens in sciatica is that muscles in your back have gotten progressively tighter and more sti over years and months of recurring back or hip issues. Eventually this muscle tightness causes irritation in the joints of your back, and can even add additional pressure to the discs and nerves. Any of these areas can give you pain, for example: your pain may be caused by the tight muscles, the compressed joints, the discs, or the nerves. What’s important to know, is that none of this is the ROOT CAUSE of your pain, it’s the RESULT of a bad pattern.

Let me explain. e REASON a muscle gets tight in the rst place is to compensate for another muscle not doing it’s job, or to protect an injury. It’s the brain that tells it to do this, and at rst it’s a good thing because it allows us to heal and keep moving. e problem is that the brain is really good at learning new patterns. So this pattern of using the bigger muscles gets stuck in the brain. So the muscle now begins to be used for everything. Over time, the brain forgets to use the other muscles to support the back and these muscles atrophy (get smaller and weaker). is leads to more compensation being required. e compensating muscles gradually get more and more sti and exhausted, leading to an ache and tired feeling in the back. Eventually they get used so much they irritate the joints, discs, and nerves, see how these are a result of the brain’s pattern?

Second thing to understand: is is precisely why all of those treatments you’ve tried give you temporary results. ey focus on the tight muscles, sti joints, or nerves. While massaging the tight muscles, and opening the joints give temporary relief from the pain, the pattern in the brain remains unchanged, so gradually your symptoms return.

If you want to make lasting changes, what you need to do is change the pattern in the brain to get it to use the right muscles. Many people will confuse this with focusing on “core” exercises or needing to strengthen the small muscles. is leads me to the third thing. If you just jump straight into movements like squats, planks, and bird dogs, your body will continue using the wrong muscles. You have to nd someone who can help you gure out which muscles to target, as well as avoiding targeting the ones that are already compensating. e biggest thing to understand here is that if you nd someone who helps you correctly, your pain should change at least every couple of weeks, and you shouldn’t have to do the same exercises every day just to feel normal.

Now, I’m not saying that all sciatica can be xed without surgery, there are cases in which surgery can be a great option when the damage that’s already been done is too great. It depends on what your speci c situation is with your back. If you are considering back surgery, know that “prehabilitation” is also possible. Meaning that if you work to get stronger before your surgery, your outcome will also be better. ere’s also the question about injections. Sometimes injections might be the fastest way to pain relief. If the pain is excruciating and preventing you from getting relief in standing, sitting, or your daily life, this might be the right decision for you. If it works, it could buy you some needed relief to start doing the things that will x it for longer.

Now that we have that covered Shannon, if you have periods of time where you are able to be active and your back does not hurt, chances are that there is still something to be done without needing to consider surgery. e fact that there’s a situation in which your back does not hurt with activity, means that with some good detective work it can be gured out how to make that situation more permanent.

Here are some tips to start making some changes in your daily pain quickly while you gure out your next steps:

1. Make sure you’re not crossing your legs, this includes while you sleep, put a pillow between or under your knees.

2. Keep MOVING: Bedrest is not good and will only worsen the muscular patterns.

3. Drink plenty of water, at least half of your body weight in ounces daily.

If you try these suggestions and are still having trouble, before you get surgery come see us at “ e Doctors of Physical erapy.” We can help you analyze your movement patterns and which muscles your brain is favoring and help you understand what’s going on with you speci cally. Even if you have had physical therapy before, our “PHIX sciatica” program has helped many people in Arizona continue staying active without having to go down the route of surgery.

Shannon - whatever you do, nd ways to keep moving and living your life!

Dr. Tom Padilla is a Doctor of Physical erapy and owner of the Doctors of Physical erapy in Scottsdale. If you have a question you’d like him to answer, or would like a copy of his privately published Sciatica Report (Value $27) mailed to your home FREE, call DPT at 480-482-0651, or email him at info@thedoctorsofpt.com, send your name, phone number, address and just say “send me a Sciatica report” so we can mail it to you.

If you’re ready to solve your sciatica, you’ve tried many things, and you want to get back to being more active sooner, you may qualify for a complimentary individual root cause diagnostic (Value $179). To apply, email info@thedoctorsofpt.com and say “discovery visit” along with your phone number. Or apply at: www.thedoctorsofpt.com/discovery-session.

Dr. Tom Padilla, Physical erapist, and Sciatica and Back Pain Expert is the CEO and Founder at e Doctors of Physical erapy in Scottsdale Arizona.