Understanding Sciatica Sciatica, or pain in your lower back that travels down your leg is an often-misunderstood disorder. Sciatica is a set of symptoms that occur somewhere along the path of the sciatic nerve. Sciatica describes the type of pain you might be having, but it doesn’t explain why you have it. Understanding Sciatica The dancer and teacher are vulnerable to sciatica because of the amount of focus on turning out the legs. This can often lead to piriformis syndrome, which is the first common cause of sciatica we’ll look at. Dancers also move in a large range of motion at the spine, which can put undue pressure on the spinal discs when alignment or body mechanics is poor. This can lead to herniated discs. Poor body mechanics, arthritis, and scoliosis can be factors in spinal stenosis, leading to sciatic pain. Detailed below are the common symptoms and treatments for these 3 types of sciatic pain, followed by some prevention tips. 3 common causes of sciatica 1. Piriformis syndrome: Piriformis syndrome is a condition where the piriformis muscle (which is the largest of the 6 deep lateral rotators) irritates the sciatic nerve. The sciatic nerve typically passes underneath the piriformis muscle, but in about 15% of the population the nerve goes through the piriformis muscle increasing it’s potential for compression. When dancers overwork their turnout the excessive contraction of the piriformis muscles may press on the sciatic nerve. This is a functional syndrome, meaning it isn’t easy to diagnosis through a MRI or CT scan. Symptoms ~Pain in the low back and buttocks ~Pain that can radiate down the back of the leg ~Sitting is difficult and uncomfortable Treatment: ~Physical therapy, focusing on stretching and strengthening the rotator muscles at the hip ~Ultrasound to the inflamed side may be given to release and soften the piriformis muscle. ~Anti-Inflammatory medication, (such as ibuprofen), is used to decrease inflammation of the nerve. For more acute cases, a cortisone injection may be suggested. ~Deep massage may be ordered to release the tension in the turnout muscles as well as surrounding pelvis and hip muscles. ~Surgical release is the last resort – only after a lengthy period of unsuccessful conservative treatment. 2. Herniated disc: Spinal discs are soft cushions of cartilage with a gel-like center between the boney vertebrae of the spine. It’s where the movement and flexibility of the spine is created. Discs often lose elasticity with age and become more vulnerable to injury. A herniated disc bulges out between the vertebrae where it compresses the spinal nerves causing pain in the lower back, often traveling down the leg. A herniated disc is confirmed through a CT imaging scan or a MRI. It is also commonly called a slipped disc, or bulging disc. Symptoms ~Leg pain usually over the outside of the thigh and lower leg and foot. Sometimes shooting down the leg, felt like an electric shock ~Persistent pain no matter whether you are standing or sitting. ~Tingling or numbness down the leg ~Muscle weakness ~Bowel or bladder problems (see physician ASAP with these symptoms) Treatment ~Anti-Inflammatory medication, (such as ibuprofen), to decrease inflammation. Physician may chose to do a steroid injection ~Physical therapy to redevelop muscle balance and proper spinal alignment ~Surgery is a last resort, if less invasive measures do not help. 3. Spinal stenosis: Stenosis means a narrowing of an opening, sciatic pain can occur from lumbar (lower back) spinal stenosis, while numbness and problems in the arms can occur from cervical (neck) spinal stenosis. The area where the nerves come out from the spinal column can inflame and narrow, creating pressure and pain on the nerve. This type of nerve compression most affects the older dancer from chronic poor body mechanics such as a swayback or tucking under, being overweight, having arthritis and/or scoliosis. Symptoms ~Pain in the buttocks, thigh, and calf ~Weakness of one leg ~Pain often increases with movement and walking, and decreases when sitting or lying down. Treatment ~Diagnostic tests such as x-rays and CT scans or MRI will be used to confirm the diagnosis ~Anti-inflammatory medication along with physical therapy is prescribed for mild cases. ~Surgery may be necessary to remove the pressure from the nerve, if less invasive measures are unsuccessful. Tips for Prevention If you have sciatic symptoms, there is no need to hang up your dancing shoes. The good news is it’s not an incurable disorder, the bad news is you may have to adapt your teaching style temporarily. Pulling back on demonstrating may be necessary, especially since teachers have bad habits of showing a movement without being fully warmed up! Check out the following list for additional tips! ~Stand easily in a turned out first position, Are your gluteal muscles rock hard? May be a sign of overworking the turnout and hip joint muscles. Periodically, sit on a chair with one leg crossed over the opposite thigh in an open position and lean forward. You’ll feel the stretch deep in the gluteals of the bent leg. ~Are you standing in a swayback? Then stretch out the hip flexors in the runners lunge. Often the hamstrings, gluteals and turnout muscles become overly contracted as they counter the pull of the hip flexors. ~What is happening at your feet? Pronation means your weight is not centered and your feet are rolling in – which then creates more muscular tension in the turnout muscles. ~Give your turnout muscles a break! Stand with your feet turned in towards each other, bend your knees then lean into one hip before switching to the other hip. It may look strange, but is a quick reminder that the turnout muscles need to be both strong and flexible. ~Is your weight appropriate for your height and activity level? Extra weight can put strain on the lower back and discs. ~Hamstrings weak or tight? Pay attention to the muscle balance around the hip joint and address any obvious weakness and/or tightness. ~Rest for a few minutes on your back over a large physioball. This helps to decompress the spine. ~Stand up straight! (Without tension, of course!) Remember not to slump when sitting and standing as it keeps the spine aligned and the discs and spinal cord happy! Releasing tension Working with a pinkie ball is an easy and inexpensive way to release stubborn muscular tension. Begin by placing a small 2-2/15 inch rubber ball between the back of your pelvis and the wall. The farther your feet are from the wall the more weight you place on the ball and the deeper the pressure. Start by rolling on the ball from sacrum (base of the spine), around the sides of the pelvis and down to the sits bone. The piriformis and other turnout muscles are in the middle of the buttocks and that area may be tender. Work slowly and easily and comfortably to loosen the muscles. If you notice any nerve signs, such as pain radiating down the leg, move away from that spot, or stop all together. Five minutes before or after class goes a long way to decreasing excess muscular tension!
Posted on: Tue, 27 Aug 2013 12:52:54 +0000
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