So it seems I’ve gone for over a year without writing anything here. As the world of face to face massage appointments opened up again in fits and starts and then a steady stream, the draw of writing about massage became weaker against the reality of actually being able to give people massages, as well as all the admin, promoting, cleaning and body and brain tiredness that goes with it.
I have, however, been through an experience this year that has compelled me to pick up my quill and ink and send you all an e-pigeon to leave a mess on your tablet screens. The experience I wish to convey is that of chronic sciatica. This began around March this year after pulling my back a bunch of times during a house move and subsequent bout of DIY. The last straw was a decision to get back on a skateboard after a decade-long hiatus. I was rolling round with childlike abandon, trying out all the old tricks, when I felt something go whilst attempting a simple 180. It was then I went from having low-level backpain that I kept ‘tweaking’ to something more severe, with a pulsating burning or electricity-like pain running down the side of my right leg and a lot of numbness on the outer side of my foot. All the typical trappings of sciatica.
As the opening up of face to face appointments wasn’t set for another couple of weeks I had time to rest up physically. But as the back pain subsided, as it usually will do in a week or two, the sciatic pain didn’t go away and was set to become the more than niggling undercurrent for the best part of the year ahead.
Below is a cautionary tale for those, like me, who love to stay active, but find themselves hampered by the scourge of sciatica.
What is Sciatica?
The sciatic nerve is the largest nerve in your body and runs from your lower back down to your foot, controlling your motor function from the waist downwards. Sciatica, very simply, is pain of the sciatic nerve. It is a symptom of an injury that impinges, traps, compresses or irritates part of the sciatic nerve, causing a cruel and unusual array of pain, numbness and tingling along part or the entirety of the nerve. Some of the most common causes are:
- Inflammation, compression, herniation or slippage of a disc(s) in the lumbar spine
- Damage/inflammation of the piriformis muscle that runs through your glute
- Damage or misalignment of the sacroiliac joint
People who have sciatica often say they have sciatica rather than one of the above injuries or conditions because it is the sciatic pain that really takes over. In the throes of a sciatica attack, it doesn’t matter why you have it. All you know is that you do and that it sucks. Some of the common experiences of having sciatica are:
- It is ever present
- It remains ‘novel’ by changing in degree of severity
- It restricts your movement
- It saps your energy
- It’s harder to concentrate
- It affects your mental health – moody/irritable/depressed
It’s life-limiting. I reiterate. It sucks.
40% of people get it at some point in their lives. That’s a lot of limited life!
This can, of course, be said for most forms of chronic pain to a greater or lesser extent and has given me a valuable window into the inner life of all those long-term sufferers who come through my door. I feel compelled to get this down into words lest I forget.
How it Progressed
At a consultation with an osteopath shortly after the skateboard incident, I was told that, due to my range of movement, I probably didn’t have any serious issues with the discs in my lower back or otherwise and it would probably heal up soon as the muscles relaxed around my lower back. Although a little sceptical, I took this as a sign that I could manage the situation myself and more or less just get on with things as normal. I did attempt to make a GP appointment about a month after this. I got a call back and a referral was made to the back clinic for early October. About five months away at the time.
Fortunately work was still manageable, although I did sometimes have to rely on painkillers when I had a long day ahead and would generally lie down between and after appointments without my usual store of energy to get on with other social, personal or domestic aspects of my life.
It quickly become clear, however, that running was out for a while. I came back from short runs with a burning in my right calf as if I’d just run a marathon on it, which lasted for a number of days after. What I identified as the ‘bad’ type of pain. It still took me a while and progressive pain to realise I should stop completely.
I continued my usual morning yoga/stretching routine and added some extra stretches touted online to be good for sciatica. If you look at the usual suspects such as healthline.com or or the various physio-come-influencers on Youtube, the examples of good stretches for sciatica usually involve the word “pigeon” – various stretches involving putting your knee across your body and stretching through your hip and glute area. If you have a regular yoga practice you will be familiar with the exhilarating pain of a good stretch – meeting your appropriate edge, as they say. Although I felt pain around the glute and down the leg, it felt more like ‘good’ pain and I found I could stretch through it to gain greater range of movement. This felt good immediately after but the sciatica would return gradually along with the restrictions in range of movement throughout the day.
Although the NHS safety advice on its exercises for sciatica suggests “stop the exercise immediately and get medical help if you feel any pain or feel unwell”, I felt this to be a bit drastic when I was also reading that “more pain doesn’t necessarily mean more injury” when it comes to sciatica. Nerve pain is not like other pain as it is about false messages being sent to the brain from the nerve due to its compression or irritation. You couldn’t necessarily trust what it was telling you and should stay active as much as you can. So I read..
To try and help my condition I had massages over this period that felt great and helped me relax but ultimately didn’t improve the issue. I also tried acupuncture, which had no discernible effect.
I continued in the steady, yet miserable fashion for around four months until a number of things happened in mid August. First I felt a bit better, then I did some gardening, then I thought I’d try running again. I ran around the park. It felt wonderful. So I thought maybe I could run a little further the next day. That felt wonderful too in the moment but that burning calf pain reared its fiery head again throughout the day and the next day and onwards, and for the next week, the pain up my leg and into my lower back got progressively worse.
It culminated in me cancelling work and a trip to urgent care at Lewisham hospital on a miserable Monday morning. There I sat, full of codeine, face to masked face with what turned out to be the first sensible and practical professional person I’d spoken to since the beginning of this sordid affair.
“Stop stretching. You’re constantly reinjuring yourself” said the nurse practitioner, after making sure that my bowels were working fine and I had sensation and movement in my feet. “Here’s a sheet of gentle exercises and this is how you take painkillers properly. And remember to swing your arms when you walk.” She said I probably had an issue with a disc in my lumbar spine. Thanks osteopath #1…
Honestly, my orthodoxy towards the power of stretching the body had meant I’d never really considered just stopping. It seems I had a blind spot.
Over the next couple of days, things settled as I stopped stretching, did the exercises and just went gentle arm swinging walks. I also decided to give another osteopath a go to see if I could get a bit more support. This time I was lucky. I was listened to, understood and she reaffirmed that I most likely had a disc issue. I was given Pilates style strengthening exercises to protect the core area while my back healed.
Over the next month I did these exercises everyday and felt real improvements. Although something is still up in the lower back area and I can’t get anywhere near touching my toes (I refuse to stretch through any pain now), my sciatica symptoms have gone completely. I can sit in any position I want. I can cycle. I can work pain-free. Apart from running, I have my old life back.
My Takeaway Messages
I tell you all this as this personal experience has been one of the steepest learning curves in my professional life just as much as in my personal life. It has given me more insight into the pain many people who come through my door feel, how I think about what is needed for them in the session and what kind of advice I give or don’t give. So here are my take away points from the experience. They do, of course, come with a caveat. This is what I would do if I could go back to the beginning of the experience and should in no way be taken as medical advice. I am a massage therapist and not a medical professional qualified to give a treatment plan for this specific condition. However, I hope it helps anyone who has recently found themselves with sciatic pain think about how to move forward, especially for those, like me, who have never experienced a chronic injury before and are accustomed to a very active lifestyle.
There would no doubt be a very different way forward for those who have the condition, as can commonly happen, through living a sedentary lifestyle. But some of the same points may well be useful.
1. Sciatica is a symptom, not a problem in itself. Find out the underlying cause as soon as possible.
Although it is important to treat the symptom to make your life more enjoyable, it will not heal unless you treat the underlying injury. For this you’ll need to engage with doctors or a decent osteopath as soon as possible. Ideally both. Triangulating the information and advice given can be very useful. Start the process as soon as possible rather than wait to see how things go.
2. Seek advice and trust your gut as to whether it feels like good advice.
I was unsatisfied with the first response I got from an osteopath but didn’t follow it up. If I had listened to my gut at the time, I knew his opinion wasn’t satisfactory. I should have either followed this up with him or looked for someone else right afterward rather than seeing how things went for a bit. There was also an element of confirmation bias here in wanting to carry on with my normal activities. I address this more below.
3. Err on the side of caution
If you’re not sure whether you should be doing something (in my case running and stretching), then don’t until you have clear advice based on a solid diagnosis. Whilst waiting for advice I would take an approach much like trying to find the cause of an allergic reaction. Cut out all probable irritants completely and reintroduce them one at a time to assess their effects on the condition.
4. Don’t trust the internet
Humans are prone to confirmation bias. If you look for long enough online you will find the advice that you want to hear. I took the “more pain doesn’t necessarily mean more injury when it comes to sciatica” to heart because it’s what I wanted to believe to carry on with the activities that I loved. This also goes for the advice given that you should get back to physical activity as soon as possible. I took this in the broadest sense possible.
Especially with something as multifarious as the possible causes of sciatica, it is worth second guessing everything you read even if the source looks very credible. A consultation with a healthcare professional will be personal and help you work out what advice applies in your case.
5. Recognise your blind spots and reassess your relationship with pain
This is the most important thing I learnt from the whole experience.
Anyone who knows the thrill of the various stages of discomfort of a long run or finding your edge in a yoga class knows the distinction between good and bad pain. This is also true in my work. In massage therapy, working with the pain associated with muscles tension is a massive part of providing an effective massage. However, when it comes to an injury, this distinction may need to be thrown out the window. For those used to working at the edge of the pain threshold, this might also mean re-evaluating what your pain signals are telling you. I believe that as I was regularly inducing a certain level of pain through physical activity before my injury, I was unable to effectively determine what the pain of my injury was signalling to me.
This was encouraged by my belief that stretching was inherently good. Within the yoga industry in the west, the general consensus is that you should stretch to become as flexible as possible. I am now thinking there might be a dark secret behind this that isn’t talked about much in yoga (there are exceptions of course). The simple fact that stretching past your limits can be bad for you.
The subjects of pain tolerance and the benefits and harms of modern yoga practices are two very meaty topics. Maybe a topic for another year..
6. Strengthen over stretching
When injured, the area of injury needs protecting, not pulling apart and moving around. Being given a few simple strengthening exercises was a revelation to me. Both in terms of how obvious this was and also in the beauty of the mechanics of the body. Once out of the very acute first stage of an injury, which will require rest above everything else, there will usually be some exercises that work to strengthen the area around the injury without aggravating it. It felt like the body is set up to heal itself if you just find the correct movements to work with.
When I am able (hopefully soon now!) I will be swapping my morning yoga/stretching practice for a more strength based Pilates approach.
Can Massage Help With Sciatica?
In the spirit of this blog, I must address the usefulness of massage for sciatica. In my experience it allowed me to relax in a way I wasn’t often able to when in the throes of sciatica. It is also the case the when we are injured, we start to use the body in a different we. We will over-compensate in other areas to protect the injured area. Massage will help alleviate muscles tension where the muscles are over-compensating and help prevent further issue from this. So yes massage can help.
The more pointed question is whether massage can be remedial for sciatica. This depends on the underlying cause. Massage works with the muscles so the more the sciatica is associated with muscles tension, the more it is going to help. A massage was never going to fix my disc bulge or anything else going on in the spinal column, but if the issue was due to tension in the piriformis muscle or any other muscle in the glute or leg causing compression of the sciatic nerve the massage may well be magic.
As is always true with massage, it is better as a preventative measure. Muscle tension affects our movement and our posture. Unaddressed tension in the muscles can make the chance of injury a lot more likely.
I hope you have found my story useful and not just the grumblings of a man not as young a supple as he used to be… The experience of the last year has humbled me. I have been a little concerned about writing about this mishap and my mistakes in self-treatment in case it affects my authority in providing care in the eyes of my clients. However, I want to be open about my learning journey and also hope to convey that human health and the human body is vastly complex and no one has all the answers. If someone treating you doesn’t admit to their ongoing learning, self-awareness and recognition of their blind spots, I would be wary of putting myself into their care.
One thing that compelled me was that both the sensible nurse practitioner and the MSK specialist I have just been to see relayed their own experience of their back issues and what they did wrong at the time. This made me feel better about their advice. I therefore only see this experience as offering me new perspectives and insights into how to care for those who come through my door.