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  1. 1. Low Back Pain and Sciatica
  2. 2. Low Back Pain and Sciatica The spine consists of four main areas Cervical Thoracic Lumbar Sacrum/coccyx Spinal Anatomy Overview
  3. 3. Symptoms • Depending on the cause, symptoms can vary – Dull, sharp or burning – Felt at a single point or over a broad area – Occurs suddenly or comes on gradually – Occurs with spasms or stiffness – Associated leg symptoms such as pain, numbness or tingling
  4. 4. Red Flag Symptoms • History of cancer • Progressive motor or sensory deficit • Prolonged steroid use, IV drug use • Major trauma • Numbness in groin/saddle • Bilateral leg weakness • Fever and chills • Unrelenting severe pain with rest • Loss of bowel or bladder function
  5. 5. Diagnostic Testing • Physicians will not generally order diagnostic tests in the first six weeks of low back pain • Most of the time, the causes for back pain cannot be found by x- ray, CT scan or MRI
  6. 6. Intervertebral Disks • Acts like a cushion between the bony vertebrae that make up the spine • 90% water • Wears with age
  7. 7. Potential Disk Problems • Degenerated disks • Thinning disks • Bulging disks • Herniated disks • Osteophyte (bone spur) formation
  8. 8. The spine consists of four main areas • The disks between our vertebrae act like shock absorbers • When disks are injured from either wear and tear or a sudden force, they are unable to repair themselves very well because they lack the rich blood supply needed for healing
  9. 9. Sciatica Sciatic nerve (largest nerve in body) • “Catch-all” diagnosis • Back pain radiates down leg to foot • Avoid long periods of sitting • Stand up every 20 minutes to recover • arch in spine • Keep mobile – go for walks • Stretch regularly • If pain persists see doctor
  10. 10. causes Sciatic nerve pain can have a number of causes:  bulging or herniated disc  narrowing of the spinal column  inflammation of the soft tissues in the surrounding areas  short or spasming piriformis muscle in the buttock (piriformis syndrome)
  11. 11. Sciatica
  12. 12. Natural sciatic pain relief Many natural and physical therapies, and simple lifestyle changes, can provide sciatica relief and prevent it from returning.  A healthy diet improves your body's ability to heal. Use citrus fruits and juices, such as lime juice - vitamin C boosts your immune system, prevents serious illnesses, and reduces the swelling around the sciatic nerve.  Proper posture, healthy weight, ergonomic working environments and an active lifestyle all play important roles in treating and preventing sciatic pain.  Relaxation techniques help you manage and reduce the psychological impact of chronic pain.
  13. 13. Relaxing the muscles around the sciatic nerve  Rest at regular intervals, in postures chosen to relieve sciatic pain to provide sciatica relief.  Intentionally relax all the muscles in your body in these positions:  Lay on your stomach with a pillow or rolled towel underneath your hips.  Lay on your stomach with one leg bent and out to one side - the first aid recovery pose. Put a pillow under the knee to remove any strain on your back.  My favorite - lay on your back with a pillow under your head. Rest your feet on a chair so that your knees are bent and your lower back is flat against the floor.
  14. 14. Massage to relieve sciatic pain  Ice: If you have acute sciatic pain after an injury, apply ice to the lower back for 10 minutes every few hours. Ice reduces inflammation and provides temporary pain relief in the first few days after your injury.  Heat: If you have longer-term sciatic pain, apply heat to the lower back to encourage circulation and tissue repair, relax the surrounding muscles and reduce pain. A hot bath or shower relaxes the muscles and calms the nerve.  Menthol-and capsaicin-based sports rubs or plasters may provide short term relief of chronic back pain.  Massage and spinal manipulation may provide some short term relief, but should only be performed on sciatica patients by qualified and experienced practitioners
  15. 15. Correct posture and ergonomics Use a balanced posture in all activities to prevent sciatic pain. • Walking / Standing: Use smooth, gentle and relaxed movements - tense muscles increase the pain. Stand tall, and make sure your lower back is not curved - keep your buttocks tucked in. • Carrying: Never carry a bag on one shoulder, or all the shopping bags in one hand. Distribute weight evenly on both shoulders, and in both hands. Use backpacks, not shoulder bags. • Lifting / Reaching / Bending / Twisting: Avoid heavy lifting if possible. If you must lift something, don't bend over or twist your back. Use your knees to lift and your feet to turn. Avoid twisting when reaching for something above your head or below your waist.
  16. 16.  Sitting: Use a chair which supports your lower back. Position your knees at the same level as your hips, with your feet flat on the ground. A lower back pillow, or rolled towel will support your lower back.Use the arms of the chair to help you sit or stand.  Note: constantly sitting tightens the piriformis muscle - get up and stretch regularly.  Driving: Avoid driving when the pain is severe. Use a pillow or lumbar roll to support the lower back and maintain a correct sitting posture.  Sleeping: A firm mattress with one supportive pillow under your head encourages good sleeping posture. An extra, soft pillow between the knees may provide sciatic relief. Be careful not to twist or place strain on your back when getting into or out of bed.
  17. 17. Yoga to relieve sciatic pain Many gentle yoga poses can relieve sciatic pain. Plus there are many other stretching and back strengthening poses to prevent sciatic pain from reoccurring
  18. 18. Back pain relieving yoga poses  cat-cow pose relieves pressure and increases mobility in the back (marjariasana).  standing forward bendloosens the hips, stretching the hamstrings and lower back (uttanasana).  head to knee pose stretches the lower back and hips (janu sirsasana).  big-toe pose stretches the hamstrings and relieves lower back pain (supta padangusthana).  a butterfly leg pose opens and loosens the hips (baddha konnasana).  fire-log pose opens the hips (agnistambhasana).  lower back twist loosens the back muscles (bharadvajasana).  sage's pose loosens the back muscles (marichyasana).
  19. 19. Back strengthening yoga poses Be careful when attempting the strengthening poses. If at any time your sciatic nerve twinges, stop, stretch gently and relax.  extended side-angle pose stretches the outside of the leg and chest, and strengthens the back (utthita parsvakonasana).  warrior pose variations strengthen the legs and lower back (virabhadrasana).  cobra pose strengthens the back, but be careful not to over-stretch (bhujangasana).  downward facing dog lengthens and strengthens the back and arms (adho mukha svanasana).
  20. 20. Cat-cow pose (marjariasana) Steps :  Come onto the floor on your hands and knees. Bring the hands shoulders width apart and the knees hips width apart.  Inhalation slowly and completely. Open the chest forward, arching the back downward. Feel the tailbone and the crown of the head lifting equally towards the sky.  Exhale slowly and completely as you begin to arch the back upward. Tuck the tailbone and the crown of the head moving them towards each other. Use your hands and knees for support in the pose.  Continue to coordinate the breath and the movement of the spine, repeating this sequence and many times as is desirable. When you are ready to stop simply bring the spine back to a neutral position, parallel to the floor.
  21. 21. Benefits:  Excellent for creating a supple spine, preventing injury  Purifies the blood  Reinvigorates the spine and internal organs  Relieves tension in the low back
  22. 22. Cautions  Knee problems  Cronic or recent back pain, injury or surgery  Cromic or recent wrist pain or injury  Cronic or recent neck pain or injury
  23. 23. Standing forward bend (uttanasana)  Stand in Tadasana, hands on hips. Exhale and bend forward from the hip joints, not from the waist.  If possible, with your knees straight, bring your palms or finger tips to the floor slightly in front of or beside your feet, or bring your palms to the backs of your ankles.  With each inhalation in the pose, lift and lengthen the front torso just slightly; with each exhalation release a little more fully into the forward bend.  Uttanasana can be used as a resting position between the standing poses. Stay in the pose for 30 seconds to 1 minute. It can also be practiced as a pose in itself.
  24. 24. Benefits  Calms the brain and helps relieve stress and mild depression  Stimulates the liver and kidneys  Stretches the hamstrings, calves, and hips  Strengthens the thighs and knees  Reduces fatigue and anxiety  Relieves headache and insomnia  Therapeutic for asthma, high blood pressure, infertility, osteoporosis, and sinusitis
  25. 25. Contraindications and Cautions  Back injury: Do this pose with bent knees, or perform Ardha Uttanasana (pronounced ARE-dah,ardha= half), with your hands on the wall, legs perpendicular to your torso, and arms parallel to the floor.
  26. 26. Head to knee pose (janu sirsasana) Step by Step :  Sit with the legs outstretched in front of you, on a block if you back isn’t straight.  Bend your right knee and place the right foot on the inside of the left thigh towards your perineum, let the right lower leg rest on the floor, shin in a right angle with the left leg.  Keep the left foot flexed, lengthen the spine on an inbreath and on an outbreath turn the spine a little to face the left leg and than fold forward from the hips.  Keep your spine long chest open and shoulders drawn down. Relax your face.  Stay in the pose for 1-3 minutes.
  27. 27. Benefits  Stretches your spine, back muscles, hamstrings, and groins.  Massages and stimulates your internal organs like the liver and kidneys.  Improves digestion and helps heal gastric ailments.  Calms the mind and central nervous system.  Relieves anxiety, fatigue, headache, and menstrual discomfort.  Therapeutic for high blood pressure, depression, and insomnia.
  28. 28. Cautions  Knee injuries - Avoid flexion of the injured knee if discomfort occurs. Try performing with the bent knee supported on a folded blanket.  Low back injury especially if history of lumbar disc herniation.  Diarrhea  Asthma
  29. 29. Big-toe pose (supta padangusthana) Step by Step :  Lie on your back, legs extended, feet flexed pressing out through the heels.  On an exhalation draw the right knee into your chest, fold a strap around the arch of the right foot and extend that right leg up to the ceiling, hold the strap with both hands, walk hands up along the strap till the arms are straight keeping shoulders pressing in the floor.  Keep strongly extending through the left leg pressing the top of the left thigh down and extend through the right heel creating a comfortable stretch in the back of the leg.  Stay here or turn the right leg out and bring the leg down to the floor on your right side, keeping the left hip grounded.  Stay in both variation for about 1-3 minutes.  Once back to centre, hold the leg up for another 30 sec
  30. 30. Benefit  Stretches the back of the legs, the hips and lower spine  Balances the nervous system and calms the mind  Improves digestion  Relieves lower back ache, menstrual pains and sciatica  Restores your energy  Strengthens the muscles around the knees
  31. 31. Contraindications and Cautions  Diarrhea  Headache  High blood pressure: Raise your head and neck on a folded blanket.
  32. 32. Butterfly leg pose (baddha konnasana) Step by Step :  Sit with your legs outstretched in front of you, you may want to sit on a blanket or pillow to raise your hips, so you can sit with a straight back.  Pull in your feet and place the soles of the feet together, as close as possible to your pelvis, let the knees fall out to your sides.  Release your groins, the head of the thigh bones, and allow the knees to relax down as well, don’t push them.  Hold your big toes with the first two fingers and your thumb, or hold the outsides of your feet.  Keep your pelvis level, sit with a straight back.  Firm your shoulderblades into your upper back, to help open your heart.
  33. 33.  Helps in opening your hips  Stretches groins, inner thighs and ankles  Uplifts your mood  Stimulates abdominal organs  Beneficial for menstrual pains  Stimulates the circulation in the pelvic area  You can stay in this pose anywhere between 1-5 minutes  To come out you lift your knees and straighten your legs again
  34. 34. Cautions  Groin or knee injuries  Lower back injury or a herniated vertebral disc
  35. 35. Fire-log pose (agnistambhasana) Steps:  Sit on your mat with your knees bent in front of you, feet flat on the floor and palms pressing into the earth behind you.  Lean back in to your hands, releasing your shoulders down your back. Cross your right ankle over your left knee, until you make a figure four shape with your legs. Keep your right foot flexed and draw your right knee away from you until you feel a stretch in your right hip.  Wiggle or heel-toe your left foot towards the right. Walk your hands slightly forward, so that you have enough room to sit up straight and stack your legs.  Line up the ankle or side of your right foot over your left knee, and your right knee over your left ankle, or side of the foot. Try to make your shins parallel to each other, with the right stacked directly over the left.  Breathe here, or walk your hands forwards and recline forwards. Hold for 1 minute or more, and then uncross your legs to come out of the pose. Repeat on the opposite side.
  36. 36. Benefits Double Pigeon Pose is an intense hip opener with several benefits:  Stretches and opens the hips  Stretches the groins  Relieves anxiety, tension and stress
  37. 37. Cautions  Knee injuries  Ankle injuries  Tight hips or groins
  38. 38. Sage's pose (marichyasana) Steps :  Start in Staff pose. Draw your right knee in towards you with your foot planted firmly. Make sure the right thigh is making contact with the right side of the torso. Keep the left leg strong and active with your left foot firmly flexed.  Sitting up tall, extend the right arm forwards with your palm facing out and your thumb pointing directly down to the ground. Lengthen your torso and reach forwards through your fingertips as you take a deep inhalation. On the exhalation, sweep the right arm around the front of the right shin.  Keep reaching forwards through the crown of your head as you sweep your left hand in behind your back. Grab hold of the left wrist in your right hand.  Lengthen your torso forwards and begin to fold in towards your left thigh. Ensure your chest stays open by pulling your shoulders away from your ears.Your right sitting bone may come off the ground.  Stay here for up to one minute, then return to Staff Pose. Repeat on the other side.
  39. 39. Benefits This seemingly simple, yet challenging pose offers many benefits:  Stretches the hips, hamstrings and shoulders  Activates the abdominal organs  Stimulates digestion and metabolism
  40. 40. Cautions  Asthma  Diarrhea
  41. 41. Help and Healing Sciatica with Nutrition  Diet needs to contain fibre rich foods, lots of fruits and vegetables that will prevent constipation.  2 – 3 cups of green tea per day  Turmeric, garlic, ginger  The B-Vitamine are highly important and can be found in green peas, spinach, navy beans, nuts, pinto beans, bananas, sweet potatoes, whole grain fortified cereals and breads and unpolished rice and legumes.  Foods rich in A-Vitamine such as dairy products - milk, cheese and yogurt, carrots, dark green leafy vegetables, orange-coloured fruits, e.g. mangoes and apricots,  C-Vitamine is found in fruits – especially citrus, regular and sweet potatoes, cabbage, spinach broccoli, tomatoes, and green and yellow vegetables.  K-Vitamine sources such as broccoli and spinach, alfalfa, vegetable oils and cereals.  Drink plenty of water.