Category Archives for "Sciatica"

Low Back Pain Sciatica with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, he's the chief clinical director of Insync Physio in North Burnaby. And we're going to talk about a really common thing. A lot of people call it sciatica. It's actually low back nerve pain. What's going on here typically, Iyad?

Iyad: So sciatica is kind of a broad term to describe pain along the sciatic nerve distribution. And I mean, if you think about it, the sciatic nerve kind of runs through the entire back of your leg. So it starts in the gluteal area and it goes down through your hamstrings, into the calf, into the foot. So broadly speaking, anytime you have pain on that distribution, it's called sciatica, but the sciatic nerve doesn't just come out of the back.

You have a bunch of little roots that joined together to form the sciatic nerve. So any disruption or injury or sensitization in any of those nerve roots could contribute to sciatica. And then after that, it travels through a bunch of tissues, so it goes through your gluteal muscles into the hamstrings down behind the knee, into the calf. And then it also feeds the front of the leg, like kind of your shin in the back of your calf. 

So once you think about it that way, you can have sciatica from multiple, multiple things. Typically the most people associated with some kind of diagnosis of a low back injury or a disc herniation with pressure on a nerve root. We don't see that being always necessary. That's not the only way you can get sciatica. There's a lot of reasons why a nerve can hurt. 

I'll tell you the funniest one I've seen in clinic, which is a person sitting on a toilet seat too long playing candy crush and their feet go numb. And then they're diagnosed with sciatica on the phone. But it's really simple for that person. We just don't need to apply direct pressure on that. And then there's the more kind of traumatic injuries. For example, somebody fell, hit their back on a post and then they start to develop these what we call radicular sites, where the nerve root is getting impacted. And they tend to lose a bit of the function in that nerve.

Mark: So what would the typical symptoms be that somebody would, it's just a low back pain? Is that, or is it a low radiating into your butt and your legs? 

Iyad: So it tends to be that exactly. We're looking at the low back cluster of sciatica or let's call it the nerve root issues. Yeah. You'd have a bit of low back pain or sometimes a lot of low back pain. It really depends on the person. Some people complain more of leg symptoms than back symptoms. And the pain radiates down the leg. And that's a really good sign that you should probably get it checked out. If you're getting some kind of sensation, it could be tightness, numbness, tingling, burning. Those all kind of tend to be nerve symptoms. 

Some people just have pain and they're like, it just hurts. I just don't know what to describe it as, it's just painful and it's uncomfortable and I can't sit. So that's what we'll end up seeing. But back pain tends to be usually associated if we're looking at the nerve root issues that contribute to sciatica. 

Mark: And generally, does it show up more when people are sitting or does it show up in movement and in walking and standing? 

Iyad: Excellent question. You have both. That's the confusing part. We used to think that it was only in sitting because when we used to think of things very mechanically and only that way. Yeah, we were like, oh, so if it hurts with sitting and it feels better with standing that it's gotta be this. And then what we're finding is, the more we study people and the more we look at it, it's not quite as simple as that. So it tends to be varied. You can have actually two people with the same injury presenting in exactly the opposite pattern.

So one feels better when they're standing and one feels better than you're sitting. And then vice versa. And then you have people who say, I love it when I walk by pain goes away. And some people say I can't walk because anytime I straightened my leg, I got a bit of a zinger going down my leg. So it really depends on that. Tends to be just like, if you just get assessed properly, we would be able to figure out what kind of way we can kind of manage that person, because again, you could have the exact injury in completely different presentations. 

And the other thing that's kind of confusing about this is, and this is where people sometimes, if you go on a kind of a wild chase to see what's going on with my back and you get imaging and people will come in, for example, without any symptoms of, let's say sciatica or pain down the leg, but then they're showing on an MRI that they have a disc bulge and they're confused. They're like it says here that I should be feeling leg pain, but I'm not, well that also can happen because a lot of people can have abnormal findings on scans and not present with any symptoms.

And that's the biggest breakthrough that we've had in learning about how to interpret imaging findings. You know, when we're seeing a disc bulge or degenerative disc disease on scans, they don't always correlate with symptoms. And that's where if you're just going hunting for something and you try to find something, you might find it, but we still can't say confidently that that's what's causing it.

So it tends to be largely a diagnosis done in clinic, based on what we find. We move you through a bunch of stuff. We do a bunch of tests, and then we will treat you that way. Regardless of what your scan says. 

Mark: So the diagnosis becomes critical then in terms of determining what your course of treatment is going to be?

Iyad: Yeah, because like we said, imagine if let's say two people have a symptomatic disc bulge, especially on the nerve, but one of them feels really good when they bend forward. The other one feels really good when they bend backwards. If we were to just treat based on just the imaging findings and not actually assess that person in clinic, we could be really making them suffer. One person really suffering the other person feeling good, for example. If we had just kind of like progressively pushing somebody into that sore spot. 

So what we ended up finding is usually the first assessment tends to be trying to figure out what's affected. So we would do a very thorough exam, like of the back. We would scan their nerves. We would do a bunch of testing for reflexes to see if the conduction spine. We're always vigilant for any potential red flags that we would need to send out to the ER, in cases like where and those tend to be very rare, but we're always vigilant for those obviously. And then we will try to figure out what positions and what movements that person's comfortable with. Get them moving slowly and kind of gradually. And they tend to do really well with the rehabilitation program, which is the good news, I guess.

Mark: If you have some back pain and you're not sure exactly what's going on, get to see the experts at Insync Physio. You can book in North Burnaby online at You can also book for the Vancouver office if you wish to go there. If that's closer for you. To call the north Burnaby office they're at (604) 298-4878. Get in to see the experts. They'll look after you and make sure that your back is doing better, properly and for the long run. Insync Physio. Thanks, Iyad 

Thanks Mark.

Chronic Low Back Pain & Hamstring Tightness-Sciatic Nerve Floss

This exercise is great for when you feel like you have tight hamstrings or when it feels tight getting into a straight leg position with a flexed trunk. Usually it’s not due to tightness in the hamstrings and is from irritation of the sciatic nerve. You may also have chronic low back tightness and tension or a previous history of acute low back pain. If you are unsure about your current pain or how to do this exercise, please consult your physiotherapist. You want to start sitting straight in an upright position. Then extend your knee straight with your toes pointing towards you and bring it back down. Repeat this for sixty seconds, doing five sets there times per day. The progression of this exercise is to start by moving into a slump posture with the back flexed and then extend your knee straight with your toes pointing towards you and then sit back upright and then bring the leg back down. Repeat this for sixty seconds, doing five sets there times per day.

6 Stretches for Sciatica Pain Relief

6 Stretches for Sciatica Pain Relief

Sciatic nerve pain can be so excruciating and debilitating that you don’t even want to get off the couch. Common causes of sciatica can include a ruptured disk, a narrowing of the spine canal called spinal stenosis, and injury.

The sciatic nerve runs down the spine and branches off, like a zipper, down the legs. The pain of pressure on the sciatic can feel like sharp shocks running down your leg (generally just one at a time) or nagging lower back pain. Sometimes people experience numbness or tingling in the leg, too.

Sciatica pain can occur for a variety of reasons. Identifying ‘what doesn’t move’ is the first step toward solving the problem. Often, the most problematic body parts are the lower back and hips.

The best way to alleviate most sciatica pain is to do any stretch that can externally rotate the hip to provide some relief.

Here are six exercises that do just that.

Pigeon pose

Pigeon Pose is a common yoga pose. It works to broadly open the hips. There are multiple versions of this stretch. The first is a starting version of the pigeon pose, known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first. Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions.

Reclining pose

  1. While on the back, bring your right leg up to a right angle and grasp it with both hands behind the thigh, locking your fingers.
  2. Take your left leg and place your ankle against the knee. Hold the position for a moment before changing legs. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve causing pain.
  3. Repeat by switching sides and doing the same exercise with the other leg.

Sitting pose

  1. Sit on the floor with your legs stretched out straight in front of you. Then bend your right leg, putting your right ankle on top of the left knee.
  2. Lean forward and allow your upper body to lean toward your thigh. Hold for 15 to 30 seconds and then switch sides. This stretches the glutes and lower back.

Forward pose

  1. Kneel on the floor on all fours.
  2. Pick up your right leg and move it forward so that your lower leg is on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right.
  3. Stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.
  4. Shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
  5. Take a deep breath. While exhaling, lean your upper body forward over your lower leg. Support your weight with your arms as much as possible.

Knee to opposite shoulder

This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve.

  1. Lie on your back with your legs extended outward and your feet flexed upward.
  2. Clasp your hands around your knee and gently pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds and then push your knee so your leg returns to its starting position.
  3. Repeat for a total of 3 reps, and then switch legs. Remember to only pull your knee as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.

Sitting spinal stretch

Sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure from the sciatic nerve.

  1. Sit on the ground with your legs extended straight out with your feet flexed upward.
  2. Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
  3. Place your left elbow on the outside of your right knee to help you gently turn your body toward the right. Hold for 30 seconds and repeat three times, then perform this stretch with your left leg bent and body turned to the left side.

Standing hamstring stretch

This stretch can help ease pain and tightness in the hamstring caused by sciatica.

  1. Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it.
  2. Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain.
  3. Release the hip of your raised leg downward as opposed to it lifting up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. Hold for at least 30 seconds, and then repeat on the other side.
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.


Sciatica is not actually a specific diagnosis, but actually a symptom of another underlying cause. Sciatica refers to the pain that is produced in response to pressure on the sciatic nerve, which runs from your lower back (or lumbar spine) down to your buttocks, hip and lower limb.

Characteristics of sciatic pain:
– Pain that radiates from the lower back and down the leg; more common: to the knee; less common: to the foot and toes
– Pain that can be described as tingling or burning (rather than an achey pain) or numbness or weakness with lessened ability to move lower limb or toes
– Pain that is worse with sitting
– Pain that is only present in one leg (generally affects only one side of the body, not both)
Causes of sciatic pain:
As mentioned above, sciatica is the pain that is experienced due to an underlying issue. The most common causes of sciatic pain include: herniated lumbar disc, degenerative disc disease, isthmic spondylolisthesis, lumbar spinal stenosis, piriformis syndrome and sacroiliac (SI) joint dysfunction. Essentially, any of these listed diagnoses create pressure against the sciatic nerve. When the nerve is pushed or pinched by another structure, it causes an irritation of the nerve. Because nerves have pathways within them that send messages from your body to your brain and vice versa, your brain will register this irritated sensation as sciatic nerve pain. 
Other causes of sciatic nerve pain might include things such as pregnancy. With pregnancy, a woman’s body can go through many changes and with the additional weight this can cause pressure to build up against the sciatic nerve. Fractures of the lumbar vertebrae due to traumatic injuries from car accidents or a fall or in response to a weakened bone from osteoporosis can also create issues along the sciatic nerve. In rare cases, a spinal tumor or infection might cause sciatic nerve pain.

Treatment of sciatic pain:
In some cases, sciatic pain can be temporarily relieved through the use of a hot or cold compress or with common pain medications, such as ibuprofen (Advil) or acetaminophen (Tylenol), those these options will not treat the underlying cause of sciatic pain. Since the cause of sciatic pain can be any number of things, it is best to make an appointment with your physiotherapist for a full assessment to determine the cause itself. You do not need a doctor’s referral to make an appointment with a physiotherapist for sciatic pain in British Columbia. In some cases, you may also need to see a doctor for additional tests, such as diagnostic imaging. In the most severe cases, you may be referred for a surgical consultation. This is generally reserved for those experiencing extreme weakness in the lower limb(s) affected or for those with impaired bladder function due to irritation of the spinal nerves. 

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Strengthen the Sciatic Nerve

When you have sciatica, you experience pain radiating from the sciatic nerve. Symptoms of sciatica include pain starting at the buttocks and extending down the back of the legs. To treat sciatica, a doctor may recommend exercises to strengthen the sciatic nerve. If you are pregnant, speak to your doctor about any modifications you need to make before doing the exercises. Here are some steps on how to strengthen the sciatic nerve.

Step 1

Exercise daily. Exercise is better than rest for sciatic nerve pain. If you do not exercise, the muscles weaken and the condition may worsen. After a flare-up, rest for only two days until you start working the area.

Step 2

Stretch the hamstring muscles. Hamstring stretching will help strengthen the sciatic nerve if done on a regular basis. Place your right foot in front of you with the toes pointed upward. Lean forward until you feel a stretch in the back of your legs. Hold for five seconds and switch legs. Do a total of 10 reps for each leg.

Step 3

Perform 20 reps of prone extensions. Prone extensions help strengthen the sciatic nerve and can provide relief for individuals who suffer from sciatica as a result of a herniated disk. Lie in the prone position with your body propped up on your elbows. Press the hips into the floor and stay in place for approximately 10 seconds.

Step 4

Work the back to strengthen the sciatic nerve. Back stretches are types of exercises helpful for sciatic pain from nerve compression. Lie flat on your back and push your belly button into your back. Contract the abs and hold the stretch for 10 seconds. Repeat eight times.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.