Fyzical Therapy & Balance Centers
12800 Middlebrook Road
Germantown, MD 20874
Understanding Lower Back and Sciatica Pain
Lower back pain and sciatica affects nearly everyone at some stage of their active adult life. It is commonly referred to as a slipped disc, herniated disc, arthritis, stenosis, degenerative joint disease and lumbago. Typically, back pain can fall into four categories:
1. Disc Problems – a disc bulge and a disc herniation. In the disc you have the annulus fibrosis surrounding the nucleus pulposus. In a bulge, the nucleus begins to redirect into the fissure segments that are created by stress on the disc with our active lifestyles. For instance, if you are sitting in a flexed position in your car or at work over the course of hours, the disc material begins to shift backwards and put pressure in the posterior aspect of the spine.
With a disc herniation the disc material has broken through the exterior wall of the annulus fibrosis and is sitting on the neural canal. If it is sitting on the nerve, there will be constant pain as the disc is herniated and does not have the ability to bulge back in. Disc herniations typically will respond to a flexion-based exercise program being careful not to overstretch this structure to create more symptoms. Many times, medications oral or epidural steroid injection(s) are needed in this.
2. Degenerative Disc Disease/Stenosis/Arthritis – These diagnoses typically respond to a flexion-based exercise program. People with these conditions are seen at the grocery store leaning over their grocery cart because it opens their spine into flexion which makes them feel better.
3. Sacroiliac Joint – The SI joint sits between your two pelvis bones. It does not move much; however, it needs to move in order for birth to occur and can move if you fall on your buttocks. This would create trauma moving the SI joint or causing inflammation. SI problems will respond to pelvic mobilizations and to spinal stabilization exercises.
4. Hip Problems – These can mimic low back and sciatica symptoms in the leg. Pain may occur when putting weight on the hip, especially the first few steps after sitting for a period of time. Hip symptoms also tend to radiate into the groin area versus down the leg. Hip problems usually have reduced range of motion in the hip and hip movements are painful when tested.
How Can a Physical Therapist Help?
The job of a physical therapist is similar to the job of your trusted auto mechanic. The trained mechanical therapist is to sort out the problem based on your symptom history and with mechanical testing to determine where your symptoms are coming from, develop a treatment plan that is right for you and prescribe exercises, stretching or positioning you need to go home with.