Why You Don't Have Sciatica- And What You Can Do About it Anyway

What does sciatica actually mean? First, it is important to understand that sciatica is not a diagnosis- it is a broad, umbrella description of symptoms that one may experience when their sciatic nerve becomes irritated. These symptoms nearly always occur on one side of the body, or are worse on one side than the other. They can include: radiating pain down the back or outside of the leg, a feeling of numbness and/or tingling in the leg or foot, weakness in the effected leg, pain with standing or walking, and pain with prolonged sitting. Symptoms of sciatica may or may not be accompanied by low back pain. In severe cases, loss of bowel and bladder control may occur. 

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Lymphatic Massage- The Most Effective Recovery Tool You are Probably Not Using.

When the lymphatic system malfunctions or is injured, lymph fluid cannot be properly removed from our tissues. Think back to high school biology...remember the principles of osmosis? Lymph fluid is rich in protein, therefore if it is not properly reabsorbed by our lymphatic system it will continue to draw water and fluid towards it. Soon, lymph fluid will begin to accumulate excessively. When the nearby body part begins to appear enlarged and/or swollen, we call this lymphedema. 

Lymphedema is NOT swelling, or edema. Swelling is what happens when your roll your ankle and it gets fat for a day or two. Swelling is what happens when your forehead walks into the side of the refrigerator while in search of a midnight snack (yes, speaking from personal experience). Swelling is a natural response to an acute injury and goes away with rest and time verses getting bigger and bigger and bigger. 

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"My Hip Is Killing Me." The five most common causes of hip pain and what to do about it.

One of the most common areas I treat as a physical therapist is the hip. In fact, patients often complain of back or leg pain which is truly a result of hip dysfunction. It is easy to overlook how many structures cross the hip, how high our hip bones travel, and how intimately related the joint is to our pelvis and lumbar spine. 

Hip pain can range from sharp and intense to dull. achy, and omnipresent. The cause and thus symptoms of such an injury differ greatly from person to person, however, the common theme is that hip pain is one huge bummer. 

Although each individual's injury is truly unique, I tend to see some common themes in patient's who suffer from hip pain. If these tips help you, GREAT! If they do not fully resolve your symptoms, do yourself a favor and schedule an individualized assessment. Keep in mind that hip pain is NOT normal, and you don't have to live with it! 

THE FIVE MOST COMMON CAUSES OF HIP PAIN

1. An Un-level Pelvis

She's a badass endurance athlete, but those hips don't lie

She's a badass endurance athlete, but those hips don't lie

Patients often tell me "oh, I have one leg that is longer than the other." Are you sure? Although it is possible for someone to have one leg with a femur that is actually longer than the other, it is unlikely. More often, muscles are tighter on one side or an individual stands in a asymmetrical posture which makes one leg seem longer. Do you have one leg that you typically like to stand on, and it just feels uncomfortable to lean on the other? Look down and see what that does to your pelvis. One side is up and one leg looks shorter, right?

Over time, muscles on one side can become short and tight and the pelvis can begin to elevate, rotate or shift on one side. This puts the hip joint and the associated muscles in a different position compared to the opposite hip. I always make the point that there is a reason that one side begins to hurt verses the other...it's not just a coin flip! Determining that reason and addressing it is an essential component of recovery. 

 

2. A Tight Psoas, or Hip Flexor

Not to be dramatic or anything, but I believe that the psoas is the window to the soul. It is an epicenter for so many injuries that I have become somewhat obsessed with it. It has become one of my personal missions to teach others how to properly stretch the psoas. 

Why does a tight hip flexor, or psoas, matter? The psoas is able to flex the hip (as in bring your knee closer to your chest) but it is also able to rotate, side bend, and extend the spine because it attaches to the front portion of multiple vertebra. How crazy is that? So a stiff psoas can compress your hip joint, decrease hip range of motion, cause an un level pelvis, contribute to back pain, decrease nerve space....the list goes on and on. Who knew one little muscle could cause so much mayhem?

3. Weak or Inactive Gluteal Muscles

The hip is a ball-and-socket joint, meaning that the head of your femur (the ball) sits in a cup-shaped portion of the pelvis called the acetabulum (the socket). This configuration gives the hip a ton of mobility, but also a lot of complexity. If muscles aren't working properly 360 degrees around the joint the ball can sit off-kilter in the socket and problems arise. One example of this would be a tight psoas, pulling the ball forward. Another would be weak or inactive gluteal muscles, pushing or allowing the ball to move forward inappropriately. 

Although strengthening glutes and learning how to fire them properly is a very generalized approach to treating hip pain, it often works! Check out this video from Garrett Mclaughlin for ideas on a basic hip strengthening program. 

 

4. Tight or Inhibited Gluteal Muscles

All of our muscles have a normal "resting length", meaning the length the muscle prefers to exist at in order to contract strongly and perform optimally. Try jumping by just using your calf muscles. Keep your knees straight and hop up and down like you are jumping rope. Take note of how high you can bounce. Now try to do the same jumping exercise by starting on your tip toes, which is a shortened position for the calf. Stay on your tip toes and don't let your heel come down at all as you try to jump. Now how high can you go? Can you get off the ground at all without cheating?

Tight gluteal muscles will be similarly weak and dysfunctional. You may have proper strength, but if your butt is all knotted up then good luck getting it to properly stabilize your pelvis. (A trip to Franklin Massage, anyone?)

 

5. Poor Movement Patterns and Habits

Here is where I swallow my pride and post pictures of myself running terribly in order to prove a point. I'd love to pretend that because I am a physical therapist I magically move perfectly, never get injured, and have perfect biomechanics. Shockingly...not the case. I've had a longstanding left hamstring and hip injury for over 2 years. Why the left side and not the right? As I said before there has to be a reason. Overuse injuries don't land on one side like the flip of a coin. 

Take a look at me when both feet are off of the ground. My hips are level left to right, which is the ideal position for running. When hips are level in this plane it minimizes the force that goes through our joins and soft tissues. 

When both feet are in the air, my hips are level from left to right. This is ideal. 

When both feet are in the air, my hips are level from left to right. This is ideal. 

When I am in stance phase on my right leg, my hips still stay fairly level. Not perfect, but not too bad. This indicates that my right gluteal muscles are strong-ish and function properly. 

When I am in stance phase on the right, my hips stay mostly level. My right hip glutes and stabilizers are sufficiently strong and active. 

When I am in stance phase on the right, my hips stay mostly level. My right hip glutes and stabilizers are sufficiently strong and active. 

My left glutes and stabilizers are a hot mess. Yikes. 

My left glutes and stabilizers are a hot mess. Yikes. 

Ouch and yuck. My left glutes just didn't want to get out of bed today. Can you see how this would stretch the outside of my left hip with every step? The inside of my left knee? Compress the outside of my left knee and stretch my IT band? Make my right leg have to bend further to swing through and not stub a toe? With every single step?!? Bleh. Just gross. 

Like I said, overuse injuries are never a coin flip. 

Have you struggled with hip pain, or just tried to live with it? Don't. Ain't nobody got time for that. Find out what's going on and what you can do about it. 

 

Knowledge is Power my friends. 

leahsawyerpt.com

Diastasis Recti - The Five Things You Need to Know About Abdominal Injury

The symptoms of diastasis recti extend far beyond the visual change in your stomach's appearance. Diastasis recti can compromise the integrity of your core musculature leading to consequences such as incontinence, difficulty lifting, low back pain, and increased likelihood of developing a hernia. The good news? A little bit of knowledge goes a long way. 

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Rock Climbing and Finger Injuries- The Five Things You Need To Know

We know that the hand is anatomically complex and the various parts are small, so how confident are you that you can correctly diagnose yourself via a google search and a hunch? Know what you don't know- spend the time and money to be evaluated by a professional. Get an assessment of your unique injury, a diagnosis of what was specifically injured, and an educated estimate of how long it will take to heal. This will likely save you time, money, and heartache in the long run. 

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Why keeping my costs low keeps your pocketbook full- Five reasons that going to a cash-based physical therapist will benefit your health and your budget.

 I am not pressured to see a certain number of patients in order to "make rent". Nor am I hindered from taking a few days to travel, attend a continuing education course, or just holing up to write. I am only driven to treat patients and treat them well. As a result, I am able to pass those savings on to you by charging substantially less than market value. Go ahead and check the full price of your last physical therapy appointment, or get an accurate quote from a physical therapy office that follows a more traditional model of treatment. Let me know how I compare. 

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What do I tell my PT? The details your physical therapist need to know in order to treat you effectively!

I always give a little inward sigh when a new patient begins with a phrase like "well, when I was 12 I fell on my tailbone..." Unless you are currently under the legal drinking age, or that fall was off a multi-story building, it is very unlikely that such accounts will effect your symptoms and your treatment today

I get it though. As a patient, it can be very difficult to know which details are significant and which are inconsequential. Why not share every single one you can think of and hope that the important ones stick? 

Unfortunately, time is a limited resource for us all. If your elementary school health history takes 5 minutes to tell, you haven't even gotten to your high school track years, and you are coming in for an ankle sprain that happened yesterday on your 40th birthday after one too many cold ones... well we are taking up quite a bit of time here. I've had people show up to their evaluation with binders (yes, plural) of every test and medical visit they have had since the invention of the printer.

Yikes. 

It's not that I don't want to hear the intricacies of your life! If I could sit and chat all day, and have endless time to treat, I would! Yet would you even let me? We are a society of busy people. When patients recall every minute detail of their health history, I become increasingly anxious. Again, I love to talk. I love to listen. I just want to make sure that you get every bit of treatment time available to you. I'm sure you want the same! The idea of wasting your time makes me a little damp under the armpits. (gross, sorry)

So what details are important to share? Let me preface this by saying if there is something you feel is important for your physical therapist to know, tell them! Do you love knitting, which is completely unrelated to your knee pain, but you just feel in your bones that your PT should be aware? Share that! Don't let me cramp your style! However, in general, the most important things to tell your physical therapist (or any healthcare provider for that matter) include: 

  • The duration of your symptoms. How long has this been bothering you? Did it come on gradually over a certain period of time, or did it come on suddenly? Was there a trauma or fall? Have you had it for months or years and it recently worsened? Knowing the duration of your symptoms will help your PT decide which exercises and treatment techniques you will best respond to. A very new injury will respond much differently than an injury that you have been battling on and off over a long period of time. 
  • The nature of your symptoms. What words would you use to describe your symptoms? Is it constant? Sharp? Dull? Achy? Tingling? Numb? Again, this gives your PT a clue into what structure is causing your issue, such as muscle, nerve, ligament, tendon, and/or joint.
  • "Stuff" that makes you better, and "stuff" that makes you worse.  When do you really notice your symptoms? Going downstairs? Waking up in the morning? At the end of the day? After a run? When lying on a certain side? It is equally important to note what reduces your symptoms. For example, does ice, heat, medication, rest, stretching, foam rolling, or drinking gallons of goat milk while meditating in a headstand position help? Great! Tell me. 
  • How do your symptoms progress? The easiest way to explain this one is to use a running analogy: If you have pain with running, does your pain come on after a certain distance? Does your pain get better as you warm up? Does it hurt when you start your run and just get worse as you go? Do you feel fine when you run but notice your symptoms after? These details help your PT assess the severity and stage of your injury. 
  • What have you already tried, and did it work? Are you currently going to a chiropractor? Have you already been to a physical therapist for this injury? Are you trying exercises prescribed to you by Dr. Google? If so, I need to know these things! It's ok to have a few cooks-in-the-kitchen so to speak, but I need to know who seasoned the soup already otherwise we are going to have an outright salty dinner. Stay with me now. 
  • History of the same, similar, or related symptoms. I realize how subjective this is. Do you feel like your fall as a 12yr old really did contribute to your current day symptoms? Then spill the beans! If not, go ahead and skip over it. If you have had episodes of similar symptoms, have a history of re-occurring injury on a specific side, or a history of the same type of injury on both sides...you can go ahead and bet that I will want to know. Patterns like this indicate what type of root cause may be contribution to your symptoms. They also help your PT determine the most appropriate intervention to break your cycle of injury. 
  • Have your hobbies or normal activities changed? Are you unable to run, buckle your seatbelt normally, or put on a bra? Are you unable to grip a coffee cup or shake a hand firmly? These details help set concrete goals and measure your progress. Did it hurt to swim more than 10 minutes originally, but you swam 30 this morning before your shoulder started pestering you? Great! We are not there yet, but we are making objective progress!
  • Are you training for anything or would you like to be? If you have your dream race coming up in 2weeks we may approach your situation much differently than if your race is 3 months away and you have just started training. I will always aim to get my patients well as soon as possible, but the best path to doing so differs on a case per case basis. 
  • Have you had any images (MRI, x-ray, etc) or are you on any notable medications? I can certainly take an educated guess as to what is going on in your joints, but if you already coughed up the money for an image why would I? Share the knowledge! Did you get an x-ray and it came out clean? Great! Now we know you don't have a fracture and can be more aggressive with your exercises. Do you take medications for your heart, lungs, blood pressure, or are you on prescription anti-inflammatories? Do you have asthma? Yeah, I probably need to know all that. If any medication changes the way you are able to exercise or the way you feel your pain/symptoms, I want to know.
  • How is your health in general? Do you burn the candle at both ends, or do you get a solid 8 hrs of sleep every night? Are you generally bullet proof, or do you feel like you are always injured and sick? Do you live on a diet or Starbucks, Halloween candy, and wine or are you the same weight as you were in high school, thank-you-very-much?
  • Is anything weird. Do you have any radiating pain? Numbness or tingling? Unexpected weakness or dis-coordination? That's totally normal...NOT. You guessed it, I need to know that too. Let's rule out some of the Big Scaries before we just assume that your symptoms are a run of the mill injury. 

So let's save the story of your 12yr old fall for a get together at Frothy Monkey. I can tell you a few embarrassing moments from my own childhood. During your treatment time though? I'm focused on you, what's going on with your body, and your recovery. Be a good historian, and help your physical therapist help YOU! Get the treatment you deserve!

Stay thirsty, my friends. 

leahsawyerpt.com

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