Low back pain is one of the more common complaints we deal with at Strive Physiotherapy & Performance. Often times, our clients will express concern about having sciatica, as they may have had it, thought they had it, or knew someone who had it in the past. Sciatica is sort of a complicated topic and often times, any back pain, or any leg pain is confused with sciatica.
This blog post aims to clear up a few things about sciatica. We will discuss:
What is Sciatica?
In short, sciatica is a neurological (nerve) problem that occurs when the sciatic nerve is entrapped or irritated. What exactly does a nerve do? In short, nerves send the signals that are responsible for telling our muscles to move, and for telling our brain how/what we feel.
Having sciatic nerve (“neurological”) symptoms means that you will be experiencing fairly intense pain in the buttock area, and down your leg. You may also experience 1 or more of the following:
The sciatic nerve is big, and it covers a lot of ground within our bodies. In fact, we have 2 sciatic nerves, one for the left low back and leg, one for the right low back and leg.
Our lumbar and sacral spines have 5 nerve roots each (labeled L1, L2, L3, L4, and L5; S1, S2, S3, S4, and S5). Each sciatic nerve comes from 5 different nerve roots within the lumbar and sacral spines. Our sciatic nerves branch from L4, L5, S1, S2, and S3 on each side.
The picture on the left is a front view and shows the left sciatic nerve coming off of the lower 5 nerve roots (L4-S3). It also shows a ‘piriformis’ muscle (remember that for later!). The picture on the right shows how the 5 nerve roots (L4-S3) come together to make the sciatic nerve (big green one!)
Although those 5 nerve roots come together to make 1 sciatic nerve, our bodies tend to keep track of each nerve root. We know that because we have ‘myotomes’ and ‘dermatomes’. A group of muscles that are supplied by a single nerve root is deemed a myotome. A dermatome is an area of skin that is mainly supplied by a single nerve root. Here are some examples:
Most common sciatica symptoms:
Much like almost every injury, each sciatica case can present somewhat differently. That being said, the most common symptoms include:
What can cause sciatica?
Many different things can cause sciatica. Some of the more common causes include:
What else could it be?
Sciatica can sometimes be misdiagnosed, which is why it’s important to get a proper assessment. Other possibilities include:
The last one, piriformis syndrome, has many of the same symptoms as sciatica, so I’ll try to differentiate things a little bit.
Both sciatica and piriformis syndrome will present with a variety of symptoms including back/buttock/leg pain, numbness/tingling, and/or walking difficulties.
Here are some differentiating features:
What can I do about it?
First and foremost, it is important to have your pain and injury assessed by a healthcare provider you trust. Sciatica can come from a variety of sources, and it is important to try and determine the most likely source. This is because, depending on the source, the management can be completely opposite. For example, if you have sciatica due to a disc herniation pressing on the L5 nerve root, then you will likely prefer extension-type exercises. However, if you have sciatica from spinal stenosis, then you will likely prefer flexion-type exercises. Additionally, if you do the opposite exercises than what would be most preferable, you may actually make yourself worse!
If you think you may have sciatica, one exercise you can do to try and improve how well your nerve is moving is called a sciatic nerve floss. Here’s a good video of a sciatic nerve floss:
Remember to look up as you bend your foot, and look down as you straighten your foot. Timing is important, and doing it opposite (i.e. bending foot up while looking down), can make you more irritable. You should only complete this exercise if it feels relieving or if it feels like a “nothing” feeling. If it hurts, stop, and consult your physiotherapist.
How do I know if I’m getting better?
I will try to keep this section short and sweet. If you’re getting better, your pain will be lessening in intensity and frequency, and you should be finding it easier to move around (walk, get out of bed, etc).
One important thing to note is that, as you heal, your pain will likely centralize towards your back (i.e. move UP your leg). This is a good thing. The downside, however, is that it might make you feel more intense pain in your bum or back. That being said, as long as you have less (or no) pain further down your leg, that’s actually ok!
In conclusion, sciatica is a painful neurological (nerve) injury that usually affects only one side of your back and leg. There are many potential causes of sciatica, and many other things it could actually be, meaning it’s important to get a detailed assessment.
Do you think you have sciatica? Are you interested in decreasing your pain? At Strive Physiotherapy & Performance, we are committed to providing an in-depth, one-on-one assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
As physiotherapists, friends and family often ask us:
“Hey, I have a [insert negative adjective (i.e. painful, weak, tight)] [insert body part (i.e. back, knee, shoulder)], how do I fix it?”
In fact, you may have asked a physiotherapist you know the same question, hoping to get some quick, free advice. The unfortunate part is you probably got a vague, or less than satisfactory answer.
I promise you that it’s not because we don’t like you, we don’t want to give free advice, or we don’t know the answer, it’s almost always because the answer isn’t that simple. The answer is, in almost all cases: “It depends”.
Now of course, in many situations, there are some general strengthening or stretching exercises that are safe for the majority of the population, and may help you a little bit. But what if these exercises aren’t appropriate, what if they’re not helpful, or worse, what if they’re harmful?
In short, physiotherapists are trained to assess, diagnose, and treat a variety of musculoskeletal, neurological, and cardiovascular conditions. “Treat” is listed third because the first two (assessing and diagnosing), are crucial first steps in arriving at the appropriate treatment (aside: in some cases, an exact “diagnosis” is not completely important providing red flags are ruled out, and a thorough assessment is conducted, but those are thoughts for another blog post).
While a thorough assessment is important for all areas of the body, it is especially true for the low back/spine. For example, while a ‘disc protrusion/herniation’ and ‘spinal stenosis’ can both cause back pain and radiating symptoms down the leg(s), they are often treated in nearly opposite ways. Further, using the “stenosis treatment” (i.e. flexion pattern), to treat a disc herniation can actually worsen pain and symptoms in many cases, leaving you frustrated and irritable.
The purpose of this blog post is two-fold.
First, it is to help you understand that, unfortunately, not all injuries, or people for that matter, can be treated equally, with the same techniques.
Second, it is to encourage you to seek out a good physiotherapist who will do a thorough assessment to determine the most appropriate and safe treatment for you.
In closing, although the quick answer to “how can I fix my sore back?” may not be the most immediately gratifying, it should comfort you to hear a physiotherapist reply with two simple words: “It depends”.
At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy and Performance
Ankle sprains are a very common injury, one of which many of us have experienced. They make up approximately 20% of ALL sports injuries (1). That being said, the overall incidence of lateral ankle sprains may be underestimated as ~50% of those who sustain an ankle sprain do not seek medical attention (2). So that poses a question… did the 50% of people who didn’t seek medical advice do the right thing?
Studies have shown that ankle sprains can be more serious than commonly believed as people can develop more long-standing (chronic) problems (1). These problems include chronic ankle instability, chronic pain, and recurrent swelling (1). Additionally, strong evidence suggests that after an ankle sprain, you are TWICE as likely to have another ankle sprain (1)! Repetitively injuring the same spot over and over can lead to significant long term problems.
Lateral Ankle Ligament Anatomy
Before we discuss the types of ankle sprains, we will review anatomy and a couple of terms. You’ll remember from previous blog posts that we SPRAIN ligaments, and we STRAIN muscles. So with ankle sprains, we’re talking about ligament injuries. Remember, ligaments are passive (we can’t control them) structures that connect two bones together. Here’s a picture to help explain what I’m talking about:
Image source: http://danceinjurydvd.com/wp-content/uploads/2013/03/Footlig1.jpg
As you can see, there are 3 main ligaments on the outside of the ankle: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). There are many other ligaments in the foot and ankle, as well as a plethora of muscles. For simplicity sake (and because lateral (outside) ankle sprains are the most common), we will just worry about these ligaments in this blog post.
When someone talks about spraining their ankle, they usually mean a lateral (outside) ankle sprain. The ATFL is the weakest of the ligaments, and therefore the most commonly injured (70% of the time!) (2).
Types of Ankle Sprains and Chronic Ankle Instability
A lateral ankle sprain usually occurs when the foot is forced into forefoot adduction, hindfoot inversion, and tibial external rotation with the ankle in plantar flexion. Or, for those of you wanting me to speak English, this:
Image source: https://anklepro.files.wordpress.com/2015/12/mechanism-of-injury.jpeg?w=237&h=333
There are three grades of ankle sprains. Here’s a simple table to start to understand the grades of sprains:
* Remember to see a physiotherapist to get a complete evaluation and accurate diagnosis!
Simply put, Chronic Ankle Instability is when “feelings of giving way” or “feelings of instability” last for greater than 3 months after an ankle sprain. In addition, some intermittent pain and swelling may occur.
The Ottawa Ankle Rules
After an ankle injury, many people may be concerned of a fracture, and wonder if they should get an x-ray. Well, there’s a test for that! It’s called the Ottawa Ankle Rules, and it determines whether or not you should get an x-ray. Here are the Ottawa Ankle Rules:
Image source: http://www.bmj.com/content/bmj/326/7386/417/F1.large.jpg?width=800&height=600
Look at the image above carefully, because it fully explains the rules. In short, if you have pain when you press on points A, B, C, or D, and you’re unable to walk 4 steps, then you should get an x-ray!
Note: these rules are very accurate, but their accuracy does decrease slightly when used on those under the age of 18.
It’s just an ankle sprain - do I really need physiotherapy?
In 2017, an overview of systematic reviews with meta-analysis (science speak for the HIGHEST and BEST level of evidence) (3) concluded that the treatment of ankle sprains should include:
So, in short, YES! You should definitely get physiotherapy! A physiotherapist will tailor treatment individually to you, which will allow you to understand your type of injury, help you recover from your injury faster, and help you prevent re-injury!
Did you sprain your ankle, and need to have it properly assessed? Are you interested in preventing chronic ankle instability? At Strive Physiotherapy & Performance, we are committed to providing an in-depth, one-on-one assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy and Performance
1. Petersen, W., Rembitzki, I. V., Koppenburg, A. G., Ellermann, A., Liebau, C., Brüggemann, G. P., & Best, R. (2013). Treatment of acute ankle ligament injuries: a systematic review. Archives of orthopaedic and trauma surgery, 133(8), 1129-1141.
2. McGovern, R. P., & Martin, R. L. (2016). Managing ankle ligament sprains and tears: current opinion. Open access journal of sports medicine, 7, 33.
3. Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med, 51(2), 113-125.
We get excited when people graduate! May it be graduating from physiotherapy or even graduating onto a new progression of an exercise! Today you move onto new challenges as Mike & Tyler demonstrate the final side plank progression. If you missed our last progression, you can check it out here.
Have you ever fallen in love with an exercise, then realize it's no longer challenging? So have we! So that's why we LOVE progressions! Tyler & Mike go over the final progression to the glute bridge, are you ready for a challenge and burn? If you missed our last progression, you can check it out here.
Squatting is one of the most, if not the most functional movement in human life. Getting on/off of the toilet, lifting things up, putting things down; a lot of what we do in life involves squatting in one way or another. Therefore, squatting is often an integral part of physiotherapy management, gym routines, and functional training. This means that as physiotherapists, we are often asked questions about squats. This blog post aims to address some of those questions.
Disclaimer: * We will start your new understanding of squats first by saying, if anything hurts, and continues to hurt after some easy cues (read on!), and you don’t know why - please see a healthcare practitioner you trust and complete appropriate rehabilitation.
I’ve Never Squatted Before! Where Should I Start?
Here’s where you start:
Do your best squat in front of a mirror. Keep your heels on the ground and lower yourself as far as possible.
Simple Squat Cues and Progressions
To perform a comfortable, safe squat, try these cues:
Once you are able to squat with perfect form (see this video of a perfect goblet squat:)
(a body weight squat looks the same just without the weight!), then start working them into your daily routine! Try to do 10 squats, 2-3 times per day and progress from there! Remember to keep good form!
As you get comfortable with body weight squats you may want to progress to weights. Typically, progressing through different types of squatting looks something like this:
What’s most important is that you have safe, good form. It doesn’t matter how much weight you can lift if you can’t do it safely. Choosing the proper squat also depends on your goals. Is your goal to safely get on and off the toilet 5-10x/day?, or is your goal to compete in a bodybuilding competition? Work towards a goal, and work towards it safely.
How Low Should I Go?
Again, this depends on your goal. If your goal is to get on and off of the toilet safely, you need to be able to squat low enough to reach the toilet. That would mean very different things for someone who is 5’0” and someone who is 6’5”. It might mean squatting to 80 degrees or squatting to 110 degrees.
If muscle building is your goal, it depends what muscles you are trying to build. This picture shows the maximum muscle activity of each muscle at different squat depths:
So if your goal is to build your glute (bum) muscles, you should squat past 90 degrees to maximally activate these muscles. Again, only if you can do so safely, with good form. We will touch on depth again in the ‘Squatting for Performance’ blog post (coming soon), but if strength and function are your goals, you want to squat as deep as you safely and comfortably can, because that way, you’ll be able to use this range and strength throughout everyday living! Train the range you want to use!
Lose Your Balance? Knees Fall Inwards? Can’t Squat Deep?
Many people will experience some sort of issue when trying to do a squat with perfect form, even if it’s a body-weight-only squat. There are many potential causes to these problems:
Want to get excellent at squatting? Want to improve your function or get out of pain? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book a one-on-one appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Mike Major and Tyler Allen
Physiotherapists at Strive Physiotherapy & Performance
We are thrilled to announce, as of June 19, 2017, Strive Physiotherapy and Performance will be offering additional availability for massage therapy. We now have massage therapy available Monday to Thursday evenings and Fridays.
We would like to introduce Dawn Nafziger, Registered Massage Therapist, who is eager and ready to begin taking clients!
Dawn graduated from the Canadian College of Massage and Hydrotherapy, where she participated in palliative care and sports massage. Since then she is continuously researching and taking courses to enhance her treatments and client experiences.
She has experience in treating multiple different conditions and injuries such as tension headaches, plantar fasciitis, concussions, and pregnancy massage, just to name a few.
She is looking forward to working with you, to help create the best treatment plan that includes both therapeutic and relaxation massage techniques to help you achieve your goals.
Call (519) 895-2020 or use our on-line booking tool to book your consultation with Dawn today!
Doing the same exercise and routines cannot only become boring, but repetitive as well. Try mixing things up by adding new moves and new challenges. Your body will appreciate the change, your muscles will work in a new way and you will find yourself more interested! Here is a great variation of the classic side plank. Enjoy and have fun! If you missed our last progression, you can check it out here.
How are your core muscles feeling? Are you ready for the next progression? Of course you are, because who doesn’t enjoy a challenge! Today we will show you how to take your side plank to the next level and if you missed our last progression you can check it out here.
When it comes to making a difference, sometimes all it takes is a minor change to make a big difference. Today we are going to be doing just that! Mike and Tyler take you through the third progression on the glute bridge and help you take your work out to the next level. Stay tuned for those progressions! If you missed our last progression, you can check it out here.