The biggest mistakes people make with sciatica recovery

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Hey guys, it's Sebastian, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time in the show. Welcome. We're about 250 episodes, or 225 episodes deep. I encourage you to go back and look into the archives and find some stuff that interests you. This show is really intended originally for lay public, but as I kind of get bored over the years, I decided to have more than just lay public conversations. So there are a mix of clinical-based conversations that we do with interview format on this podcast, as well as just going general good information that people really should know as they're trying to overcome some of the issues that they're having.

Overall, the goal is to improve our ability as clinicians, to improve our patients' outcome, and obviously patients want to feel better. They don't want to go to a place two to three times a week for the next three months or more to feel better. They just want to feel better now and restore function and get back to their life, and that's the whole kind of the point. So today's is going to be a more lay public-friendly type of podcast where we're going to cover the topic of sciatica. Sciatica is something that is, I want to say, mislabeled quite often, but also, too, it's something that's very common.

It's something that hurts a lot, and it's something that you really don't want to suffer from for too long for various reasons, not only because it's painful, but also some detriment of function can be a thing, too. So the way this is going to be formatted today is actually there are a couple opt-ins that we have on our site for things like audios and webinars and so on. And so this one is going to be cut up into chunks as I call it the biggest mistake that people make with sciatica, also the second and third biggest mistake. And these are going to be offered on our website. And so if it seems like they're cut up in chunks, that's why, because we offer them in different places.

I believe in repurposing content here and there whenever possible, and I know that not everybody's going to find this podcast. And so hopefully they find that often and they learn a little bit more about sciatica and maybe the mistakes they might be making so they can make the correct decision and get better faster. So we're going to start off with that. Hey, I'm Sebastian Gonzales. I'm a chiropractor who helps people with lower back pain, hip pain, sciatica. I love the lower back and lower quarter, if you will. And so I thought I would share some of the stuff that I've learned over the years that people are doing that is actually creating more of their pain, more of their sciatica.

And the biggest mistake I see people see is actually doing something that seems very benign, but actually I think if you're doing it and you're feeling that it's painful to do it, you're going to resonate very well with this. The biggest problem is you're stretching. Okay. And obviously this is something that not everybody does and some people will shy away from it knowing that it doesn't feel good and it doesn't have a good lasting effect. Now, I guess I should qualify a little bit about what sciatica is and what it's not. Now, a lot of people will say, oh, my sciatica, right? And so they are kind of pointing at an area of their buttocks just maybe above the crest or around the SI joint.

If you don't know where that is, if you were to put your hand kind of on your lower back and you find a couple bumps there on one side, that's the kind of SI joint area. And then you get in the meaty part of the glutes and so on. And so the area back into there is not technically your sciatica area. Sciatica actually means leg pain. I know that it's a diagnosis, but actually it is more of a symptom of a few diagnosis that can happen. It can happen from a low back disc herniation. It can happen from a low back disc protrusion, a sequestration. I know there's different types of disc issues. It can also help happen with things like central or foraminal stenosis.

And it can also happen from things like piriformis syndrome. I'm sure there's a couple of things that can create it as well. Typically, it happens on one side, although people do complain about pain of sciatica in both of their legs. By the way, it's probably important to note that if you are dealing with sciatica in both of your legs, it's probably important to think that it's probably coming from a central cause versus actually to each thing, one thing on each side. Now, sciatica is actually an irritation to a nerve, if you're not familiar with that too much. And it's pretty simple in regards to the concepts.

There's pressure on the nerve. And it's anywhere of the nerve along its path as it goes down into the leg, which can be at the spine itself. It can be at the spinal cord. It can be at the nerve as it comes. Actually, I should back up a second. It's a collection of spinal nerves which create the sciatic nerve. And once the sciatic nerve is created, it goes and passes through things that you might be familiar with, like your piriformis and your hip external rotators and your hamstrings and goes down to your calf and your foot and so on. And so it can be having pressure on it anywhere along the path of the sciatic nerve or the nerve roots that contribute to that area.

Now that we know that sciatica is leg pain that goes into at least the back part of the thigh, sometimes in the calf and sometimes in the foot, we can kind of all get a better idea of maybe the context and visualize what we're talking about here. Stuff into the gluteal region or a little back pain or SI joint pain, it's not technically sciatica. And I know a lot of people do say that and I'll probably sound like a broken record, but it's not. And so a lot of things you might read about sciatica might be misinformation because the context is different. Now, when I say the biggest mistake that people are making with sciatica is they're stretching it, I really do mean that, okay?

And usually, if we have sciatica, we also have hamstring tightness. Sometimes we have calf tightness and sometimes back stiffness or pain too. And this can be really confusing to people and I totally get it because it makes sense. If my hamstring's tight, I should stretch it, right? If my calf is tight, I should stretch it. If my back feels tight, I should stretch it, you know? And it ends up being this kind of forward lean thing like we've been doing in high school or since middle school where you're kind of challenged to touch your toes when you're in a seated, long-seated position. And this is actually something which is a big no-no if you really do have true sciatica because this actually mirrors something called a neural tension test.

Neural tension test is pretty simple in regards to context of what it is. A neural tension test puts a nerve at tension. And so nerves that have some pressure on them or are irritated or have some irritation to it, generally we can say that they're pissed, don't like stretch. They're intolerant to be stretched, okay? And so some of the tests that we do, such as straight leg raise test, which you guys can Google this if you want to. I don't suggest that you try to learn everything you can about sciatica because getting into the weeds here, this is more for like the docs to know. The docs should know this, right?

And they should be testing your straight leg raise test. They should also be testing slumps test. And both of these tests are neural tension tests, which will give us a good idea of if your stretching is pissing the whole thing off or not. Because if those tests are positive, your stretching is actually advancing your problem. And probably the easiest thing to do, the easiest thing that I would tell somebody if we were working with them in person with this, is say, look, even if I didn't have you do anything else, the first thing we can have you do which will make the biggest bang for your buck is stop stretching and then start stretching later.

It's important to kind of mention that you can stretch at some point because I don't want to be the person to tell people that you shouldn't be stretching your hamstrings or calf like it just shouldn't be. But there are circumstances where doing something or removing something out of someone's repertoire is actually helpful in lieu of putting it back in again when the body is tolerant of that again. Maybe a good example of this is maybe a lot of, some of you have probably gone through elimination diets per se. Elimination diets are pretty simple. You eliminate a bunch of foods. You put the foods back in in a kind of an ordered process like I want to eat potatoes today.

Let's just try potatoes. I haven't had potatoes in like three months. I'm going to try potatoes. You try a potato. You feel fine. You keep it. Your body is now tolerant to potatoes. Then you decide to do tomatoes. And next day you have like this rash that forms and stuff or you just feel generally bad. This means your body is intolerant towards tomatoes. And it doesn't mean that you should never eat tomatoes again. It just means for the next few period, uh, for a period of time, you need to make it so your body can tolerate tomatoes. Now, does this come as gradually exposing it to tomatoes? That's a whole different story.

Um, but what I like to have people do when we're talking about stretching again is just trust me, just try not stretching it for a week. You know, don't do anything else and see what happens. And if you notice that your foot becomes less numb, your calf becomes less painful, and all of a sudden your back starts to feel sensitive, but it starts to come out of your leg. That's good. And the hardest thing for a lot of people to understand when they're dealing with sciatica is a progression of improvement. The progression of improvement really comes down to knowing how your condition is more advanced versus kind of, um, bare bones, I guess.

Right. And so the more advanced conditions are when people have stuff away from the spine, all the way down to their foot. Uh, the more, the more advanced ones are ones where people have, um, loss of function in the foot. And there's definitely things that you don't want to, um, wait around too much with sciatica because if you lose function of the foot or you have some other issues with bowel and bladder, or you get numbness in certain areas, um, those are what we call the red flags of back pain. And you should certainly look those up if you're dealing with dealing with any of those. You might want to talk to someone today, but when we're getting people to feel better, we want it to come up out of the leg like a thermometer.

But that also means that there's a possibility that it might start to increase as it comes around the sci joint or the low back. This sometimes scares people because having a numb foot is really not that bad, I guess, you know, but having some stiffness and, and pain around the sci joint kind of is, but it's actually better than having a numb foot. Like when we're working with people to try to get rid of the sciatica, we're trying to get it first above the knee and then it's much more manageable. So a simple thing like stretching and not subjecting the nerve to a tension, at least for a period of time, it's actually one of the easiest things you can do.

Now, can we get more creative with stretching? Like maybe is there a way to stretch the hamstring that doesn't put the nerve at tension? Sure. We can do that, but you're playing with fire. Okay. It's just easier just to not, you know, as I kind of say with people who are, um, a little bit more resistant to maybe programming changes. Like say, so you have someone running like 30 miles a week and they're like, look, you fractured your foot. Let's just not run for like a week. You're good. You know, you don't have anything coming up really. Let's just, let's just keep, let's just chill it for a second, chill it down.

And they're like, well, you got to give me some mileage. No, I mean, you could, you could try, but you're going to really, uh, harm the ease that you could do, uh, the easy wins that you could do just by chill out for a week, you know, go for, go for a walk, read a book, you know, do something different. So stretching is definitely one of the biggest mistakes you can possibly make. Now, the second biggest mistake people make when they're dealing with sciatica is thinking that the thing is piriformis syndrome. I know probably a lot of you have done a lot of research and you've think you've thought, well, my sciatica is not responding to stretching and it's not responding to soft tissue work or whatever maybe you've tried and you're wondering, well, maybe the diagnosis is wrong.

Maybe it's piriformis syndrome. Yes, surely it's piriformis syndrome because it hurts in my piriformis and it hurts when I push there because it goes down my leg and my back really doesn't hurt that much. It hurts in my hip. It hurts my piriformis, which is in the backside of my hip. And when I push there, it goes down to my leg. I'm sure of it. It's a big mistake. Big mistake. Here's the reason why. And I'm not saying piriformis syndrome is not some people's diagnosis, but it's extremely rare. And in some of the other audios that I've done on piriformis, I've mentioned that a lot of times piriformis syndrome is actually back related.

Um, I'd say well over probably 75% of hip pain that is behind the front of the, or behind the body, like in the gluteal region is probably from the spine in some way, shape or fashion, or at least it's not located directly in the hip. Obviously it could be things deep within the hip and it could be the piriformis. But, um, I remember this workshop that we went to where, uh, he's like the nerve guy. Uh, he had to details us, told us a story where he finally saw after I probably had been practiced for, you know, 20 years or so, a long time. He had to tell us that he actually saw a piriformis procedure, a surgery where it was actually fixated to the sciatic nerve.

He had to tell us because it's so rare, you know, hardly any of us actually see a true piriformis syndrome when we're actually treating people with sciatica. And I know I hear what you're saying. I hear what you're probably thinking. You're thinking, but piriformis syndrome, Dr. Google says that I had the exact, exact symptoms of piriformis syndrome. I went to that one person. They said that I probably had it. I had a tight piriformis, which means I have piriformis syndrome. It's, it's typically wrong. And just because you have a tight piriformis does not mean there's a smoking gun indicating that the piriformis is the problem.

Okay. Also too, having an image of the hip won't necessarily reveal a smoking gun of the piriformis either. Tissue work over the piriformis that's painful and shoots down into the leg does not indicate piriformis syndrome either. Okay. And so I would be hard pressed to think of, I can't think of one single pure true piriformis syndrome case that I've seen in 12 years of practice. And I, so they're not common. And so the biggest mistake, the second biggest mistake that people make is thinking that their leg pain is from piriformis syndrome. And here's the reason why, because if you treat it like piriformis syndrome, you're not going to feel much better because what you're missing out on is the ability to actually treat it from the actual cause or the actual source.

Even though some of those areas might actually not, might not actually hurt it that much. And so sciatica kind of, the kind of thing is that the leg pain is way more intense than any back pain stiffness and they might have up there. And so it's kind of a misconception that it's like, well, the pain kind of exits out of the buttocks area. That's the main spot. It starts. And then it goes down the leg. It's not really, the back's tight, but it's not really, it's, it's typically not piriformis syndrome. And so that's a big, big mistake because if you focus all your care right there, you're missing out on such easy wins, such easy wins from, from the spine area and conditioning the hip, conditioning the hip and getting the glutes to work well, really help out in these, in these situations too.

And so I want to make sure that I'd really drive this thing home because I know there's a lot of, and we have a lot of videos on piriformis syndrome too. To be honest with you, the reason why they're out there is because there's people looking for them. But if you really listen to our, our, the words that we say in those videos, you'll hear that we're saying that it's actually rare, such as I'm saying now. And then I think that a lot of you that are seeing those videos are probably dealing with something else. And if you treat it like something else, you'll feel better than you ever thought possible.

All right. We're on to the third mistake that people make when dealing with sciatica. And this one is, I don't want to say it's a little vague, but everyone has a little different timelines on this, but I'll give some general parameters. The third biggest mistake that people make when dealing with sciatica is thinking it'll go away on its own. I put on my little notes here, quotation marks in, uh, uh, waiting longer than a week. Okay. Now, the reason why I think waiting longer than a week is because there are things that people have that are kind of circumstance based. I think of them kind of like when you hit your funny bone, it's like, there's a resonating, like there's some timeframe where it just kind of feels weird, right?

Eventually it does go away. Like the body's really good at healing itself. It does tend to go away. Um, but if it lasts longer, we have a need to look. And so if you did a big workout and you feel like there's some leg pain going on, the hamstring tightness, it's not necessarily any of the big, bad, scary three things that we mentioned before, or the, the red flags of sciatica, then there's a possibility it just goes away on its own. You know, as the late onset muscle soreness goes away, as some of the stiffness from the workout, if you lifted heavy goes away, some of this might just go away. Now, will it come back on its own when you lift again?

Possibly. Um, and that might come down to a little bit more diligent coaching of what musculature you're using, what cues you're using during your lifts. Um, but let's just say for the sake of, will it go away on its own? Yeah. I mean, I think you can, we can probably all agree that a lot of people who have dealt with leg pain or sciatica over the years is a, you know, I did this. I just rested for a couple of days, got off my feet. I recharged. It felt good. I went back and I didn't have it again for another year. Yeah, that happens. It definitely happens. Or yeah, I saw this YouTube video and this guy said I should lay on my back a little bit or, you know, I should take a walk, walk for an hour a day.

And you know, they all, yeah, yeah. That all can work, you know, but have we restored function back? There's probably a reason why this happened in the first place. Uh, I know that a lot of people who are dealing with sciatica, they, you know, they kind of, I guess we can say they woke up with it. They didn't do anything that created it. It wasn't anything out of the normal. Yeah. That's all common. I hear you. Um, it's funny sometimes when people say that, I think, you know, you're like, it's kind of like they're pleading their case. Like, I don't, I don't deserve this. You don't deserve this pain.

And I agree, you know, one deserves to have this pain. Um, but there are things that are happening probably over months to years that are creating these circumstances. Now in this current day and age, which obviously this audio might be on here for years and you know, the circumstances might change, but as of this point in time, there's a lot of people doing zooms, you know, schools are doing zooms. Um, you know, people are working from home. They have poor ergonomics. They have, they're working from their couch or laying in their bed. And, uh, it's really challenging to have good spinal and sciatic nerve health in these circumstances.

All right. Um, I mean, people even working at ergonomically friendly desk at their job end up having some of these issues too. Um, but having, uh, one of the biggest things we can do is actually changing what's going on in our day to maybe take away that outlier. As I mentioned before, maybe you weren't sitting on your couch for the last, uh, year, but then over the last month you have, and all of a sudden now the sciatica came to be, or, you know, you were working on the couch and you were okay. And then you decided to work from your bed and all of a sudden this changed, right? Or you decided to pick up a new workout program and you thought, Hey, I'm going to lose that 10 pounds just before New Year's and I'm going to do it and I'm going to work out hard.

And all of a sudden this sciatica came on. There are circumstances where that happens, where they don't have to actually be really intense things like trauma that create sciatica. It's just accumulation of things, you know, um, it could be sitting too much. It could be that you're laying down too much. Maybe you had a spike of activity. Maybe you had multiple spikes of low grade activity, meaning, uh, instead of doing a three hour workout, one day you did one hour workouts, three days, and you weren't doing anything. Or maybe you did 20 minute workouts for seven days in a row when you weren't doing anything either.

Or maybe you were working out and you decided you're not going to work out anymore and you're just going to go on a road trip and that's all. And she hadn't worked out, but also you sat more. So there's usually an outlier that people can identify if they really come down and think about it. And one of the easiest things is maybe it's overcome that, like change that. So will sciatica go away on its own if you rest it? Yeah, it can. And it can go away on its own if you just tend to identify what's creating the issue and reverse that or remove it. But if you're dealing with it and it's been over a week, I think it's safe to say that you might need some professional help.

Okay. Somebody who's been dealing with it for a long time or someone who's been coaching people out of it for a long time. Um, in any of the circumstances with the biggest mistake of the first biggest mistake, which was stretching the second one, which was thinking that someone has piriformis syndrome when it's actually not the third mistake. Now, which is thinking it'll go away on its own. If it's been beyond a week in all of those circumstances, I'd say it's safe to say that you probably need a little bit more attention from a professional who's been helping people over it for years and years and having success with it because there are a lot of times where people will in the mistake.

Number one, people are creating their own pain unknowingly in mistake. Number two is people are chasing the wrong diagnosis. And even in the entire wrong section of the body, they're chasing the hip versus the back or so on. And then the third one is they're deconditioning their body and they're making it harder to overcome the larger problem that can come later, which is like, I've been doing anything for two years. I thought it would go away. You know? So I hope you guys see where I'm going with this is there's big mistakes that people make along the way. Obviously, there's more and there's a lot of good things that people do, too, which in like I said earlier, it tends to go away on some people.

They've clearly done the right thing. They have not made the mistakes. They didn't force the stretch. They didn't dig too much into treating a piriformis. And, you know, they took they took they took the initiative to deal with it in the first week or so in identifying what do I need to do? How do I make this not linger on too long? I've heard somebody had this and they had it for a long time. Let's not be that person. Now, I don't want to strike fear in the hearts of people out there dealing with sciatica because there again, there are a lot of good things that you guys do. And there is a high probability that a lot of you will get better with or without professional help and you won't have to do anything extremely severe or invasive.

OK, a lot of people do get better without using medication or or injections or surgeries. But there is a time and place. I don't want to say that there's not. There is circumstances where we've referred people to specialists. We've referred people for images. We've referred people for injections and and pain management approaches. But more so, if we're looking to reduce their pain, we're looking to do so so we can reintegrate back in and improve function. We're trying to get them over the hump where we can actually get them to do things that are going to have a better long term effect than just managing pain.

I think the term managing pain came along and it it it sounds to me, it sounds just how it should. You're just managing it. You know, you're not getting rid of it forever. You're managing it. And so let's not just manage pain. Let's improve it, get rid of it and then build a nice supportive body so it doesn't come back. OK, and I guess I should regress one time before we go as well is that MRIs, x-rays. Yeah, they're useful. But if I were to pick a fourth mistake, I guess it would be that people spend way too much time thinking about what is going on in there when most of the time we don't really need to even see those images to even start care with somebody.

And by the time their image, it would be approved by the time they stop or were done paying the bill for it. And by the time the images came back, they might just feel dramatically better anyways. You know, as I said, some people just feel better on their own anyways. But if you have the right approach, you'd probably feel better quicker. So I hope this podcast was helpful to everybody. And obviously subscribe to the podcast if you like it. We do offer that if you're dealing with this, feel free to contact us. We we answer any email that you send. It's info at P2SportsCare.com or we might put in the link description, we might put a form where you guys can take advantage of telling us a little bit about your story.

And our goal is really that you don't even need to come see us. We would just love you to see somebody or find the right care for you. We've been fortunate to we have some books on low back pain that I've released and we we send these books out. Everyone just pays for shipping is all and the book is free. But it's amazing to see how people respond when they get good, positive information and acknowledgement that they can get better and just finding the right direction to take, knowing that they can improve, knowing that it doesn't necessarily have to be painful to improve either. And it doesn't take forever.

Sometimes the hardest thing is just getting started. And so if you're looking for a little kick in the butt and you're ready to take action, if you're honestly ready to take action, just contact us. OK, obviously, if if docs are using this for their own information, for their patients. Great. Cool. Talk to your doc. Whoever helps you. It doesn't have to be us. It just has to be someone who cares, who's willing to take time with you and can deliver the results that you're looking for. OK, give all your docs and your therapist a good fighting chance to show that their treatments will work or not.

I'd suggest two, three weeks is fair to get about a 50 percent change or so, or at least look very promising. OK, it's really hard when at least from the clinician side to make the judgment calls about what you should and shouldn't do, how to dodge and weave through the treatment plan and kind of make artistry of it if there's a lot of cooks in the kitchen. OK, and so give each person a fighting chance. Let them state their case, do the homework or anything they suggest, as long as it makes you feel better. OK, and obviously, if you want to work with us, you can always work with us, too. We do have in-person or virtual.

We've been very successful with helping people with either format, especially with sciatica, lower body cases and so on. And so we love working with people with lower back, hip, two piriformis, SI joint and sciatica. It's something that we really enjoy because me, as well as Dawne Costantino and the interns, we've all dealt with it. You know, we've all had this type of thing before. It's the most common low back pain or a low back referral can be the one of the most common things out there. All right. It's I think it's up there with heart disease and diabetes. It's up there. Everybody's going to deal with it at some point.

And the sad thing is that everybody has their first experience with it. And it's hard to know what to do the first time you experience something. So let someone help you. I do mean that from the bottom of my heart. You'll get through it quicker than you ever thought possible. And and you'll feel like you can have your life back. So thank you for being part of the movement. I'll see you guys next time.