You did everything they asked. Six weeks, maybe twelve, twice a week. The exercises at home, the sheet on the refrigerator. The pain down your leg eased off and you were discharged. Then one morning it was back, in the same leg, and you are wondering what the point was.
I hear this story in my Honolulu studio more than any other. Here is what I tell people.
I am not going to tell you physical therapy failed. It calmed the nerve down, and that matters. But think about what it was aimed at: the place that hurt. The lower back, the buttock, the back of the leg.
Sciatica is not a diagnosis. It is a description. The sciatic nerve is being irritated somewhere along its path, and you feel it as pain, tingling or numbness running down the leg. The real question is what keeps irritating it. If nobody answered that, the nerve settles for a while and then gets irritated again by the same thing.
In 25 years of working with backs on Oahu, the cause has almost never been where the pain is. Three things show up again and again:
Your body is one connected system, held together by fascia, the web of tissue that wraps every muscle and joint. When one area locks up, another area pays for it. With sciatica, the leg is where you pay. It is rarely where the debt started.
Most rehab sheets are stretches and a few light strengthening drills for the sore area. They help while you do them. Two things are usually missing.
The first is the rest of the body. If the hip on the other side is the one that is locked, no amount of work on the sore side fixes it.
The second is load. A new range of motion that never gets strength put into it does not last. Your body does not trust it, so it tightens back up. This is why I open a range and then load it in the same session. In my experience, stretching alone snaps back.
Stop chasing the leg and find out where the load is going wrong. That is what my movement screen is for. I put your body through a series of tests you are supposed to fail. Every one you fail shows me something: a hip that will not rotate, a glute that is not firing, a foot that collapses. Failing is good news. It means we found it.
From there the order is always the same: release the fascial system, wake up the core, restore mobility, and then put strength into the new range so your body keeps it. You do not stop training while this happens. You recover and build strength at the same time.
One of my longest-standing clients is a golfer who came to me 17 years ago after two failed spinal injections. Two years ago sciatica hit him, and physical therapy told him they could not help. We went back to the same foundation work. He is playing golf again and still trains here every week.
100% of the people who tried this protocol got better. Many made a full recovery. The ones who did not still feel far better than they did, and they know exactly what to do the day the nerve acts up again.
Some things are not for a trainer. See a physician today if you have numbness that is spreading, a leg that is getting weaker, any change in bladder or bowel control, numbness around the groin or inner thighs, or pain that began with a fall or an accident. Once you are cleared to exercise, come see me. I work alongside your doctor, never instead of one.
Tell me what is going on: when it started, what you have tried, what it stops you from doing. I will tell you honestly whether I can help. If I cannot, I will tell you who can.
More on how I work with backs is on the lower back pain page, and I answered a related question in Will lower back pain go away on its own?
- Dan
A free 10-minute call. You tell me about your back and your leg, and I tell you honestly whether I can help.
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