Sciatica – Management Versus Cure

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67 Comments

  • Deborah

    Reply Reply August 1, 2011

    Hi there

    I would like to thank you for your website, most insightful and in line with other literature I have read.

    Really appreciate it.

    Regards

    Deborah

    (from Australia)

    • Dr. George Best

      Reply Reply August 1, 2011

      You’re welcome Deborah! Thanks for your comment.

  • Elmarie Theron

    Reply Reply August 8, 2011

    Hi Doc,

    I am going to try your stretches-have been a sufferer for the past 5 years.I’m a runnner,personal trainer and spinning instructor.I ran my first Comrades (89km) last year-a well known race in South Africa.My pain worstned afterwards.I have been running for all my life.Noticed 5 years ago a pain in my glute-resulting in pain running down my leg.in the past year I have been to a physioterapist for 6 months,an orthopedic physio for 3 months,had a bilateral pyriformis-release operation done by orthopedic surgeon a year ago,seen a pain specialist for cortisone treatment and pain block-and I am still in pain.I am 44 years old,fit and thin-live healthily and workout correctly-have good core and overall muscle stability and strength.My next resolve is your stretches-I have also stopped running in the past 6 months-it got better,but I have started again two weeks ago-and all pain is back.Sitting is the worst.I will try your stretches.Thanx for your good website.
    Elmarie Theron
    (Welkom -South Africa)

    • Dr. George Best

      Reply Reply August 8, 2011

      Thanks for your comment, Elmarie. If the stretches don’t provide lasting relief, there may be some other problem causing the muscles to stay tight. The two most common issues are sacroiliac joint dysfunction and disc herniation.

      Sacroiliac dysfunction is something a chiropractor or osteopath can evaluate for and probably correct (depending on the nature of the problem).

      You were probably checked for a disc problem by now, but if not, an MRI of the lumbar spine would be a good idea. In some cases there is a disc bulge that is deemed to mild to be the cause of direct nerve compression, yet it can still be enough to trigger some nerve irritation that in turn causes the piriformis and/or other muscles to remain overly contracted.

      Hope this helps you.

      Good luck!

      Dr. Best

  • Janis Martinez

    Reply Reply September 14, 2011

    I like your message about management. I had a major flare up over the Labor Day weekend. I am walking, like I always do, for at least an hour p/day. Sometimes I have to divide the time up into 30 minutes. Sometimes I can walk at a normal pace and sometimes I have to take baby steps.

    I am going back through the first 3 videos and learning and doing as much stretching as I can that I see there. I liked what I see because most stretches, even for arthritis, are way too much for me right now.

    I will have to take it slowly before moving on to the “membership” part. I have to take baby steps.

    One thing I want to go over is how much “pain” is tolerable when walking or stretching. Some doctors say, “if it hurts don’t do it.” While if, I understand correctly, you are saying that the stretches you suggest are working if the pain from the bottom, like foot or heal is lessened while stretching, then you are doing okay, even if you still have pain in the thigh and buttocks. Did I get that right?

    • Dr. George Best

      Reply Reply September 15, 2011

      Yes, you got it right. As long as the symptoms furthest from the spine are improving, you are on the right track, even if you still have pain in the areas closer to the spine. So you’re looking for the pain to leave the foot and ankle, then the calf, then the thigh, then the buttock, then go away altogether. This progression may take several days to achieve lasting elimination of the pain, but with repetition of the exercise, it usually will come. Good luck!

      Dr. Best

  • Tom

    Reply Reply October 4, 2011

    My problem started on the golf course. My foot slipped as I was swinging through the ball and it caused me to come up at an awkward angle. For about a week and a half the pain was entirely in my lower back then one day it changed. It started hurting from my lower back all the way down to my ankle. Simple things like getting out of a car cause horrible pain. I sometimes have to stand outside of the car for a few minutes before I can even walk. Any thoughts?

    • Dr. George Best

      Reply Reply October 5, 2011

      With the mechanism of injury, it could be a disc protrusion or the symptoms could be due to jamming of the sacroiliac joint and/or lumbar spinal joints with associated reaction in the piriformis and/or gluteus minimus muscles. If the pain is more to the outside of the leg rather than down the back of the leg, that suggests the gluteus minimus muscle is involved. My suggestion is to try the basic McKenzie exercise from my Ebook on a frequent basis (use the position that best centralizes symptoms – as explained in the ebook – for about a minute at a time up to 3 to 4 times every hour you are awake) for a few days and see how it goes. If there’s no significant improvement, then I would suspect the sacroiliac to be more the problem and for that I’d suggest seeing a chiropractor or osteopath who does spinal manipulation to get the joint working again.

      Good luck!

      Dr. Best

  • Teri Planning

    Reply Reply January 3, 2012

    I have sciatica from disk herniation. I wore shoes that had a higher heel and sole one evening and it made my sciatica worse and my ankle and foot started to swell. I find that I have to wear flat shoes only from now on. I guess that is part of management too. I am willing to try everything you suggest in order to get relief from this problem. Thanks for the information.

    • Dr. George Best

      Reply Reply January 3, 2012

      Hi Teri,

      You may be able to handle heels later on when things are more stable, but when you are already having symptoms, it doesn’t take much to irritate things.

      Repetition of the things that help is key to getting better as quickly as possible. For example, while the McKenzie exercise helps when done a few times per day, it works even better when done a few times every hour. Cold packs work best when applied for about 15 minutes every 2 hours. While this frequency of self-treatment is not always possible, I always recommend doing the treatments as often as possible for at least a few days and then when the symptoms begin to decrease, you can start to cut back on the frequency of the treatments. Once the pain is mostly gone, you can stop the cold packs and go to a preventive schedule with the exercises, doing them a few minutes each day.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Valiant Lee

    Reply Reply January 4, 2012

    Hello Dr Best, please hear me out.

    I had been experiencing lower back pain since early December.(although almost every year, such back pain visited me once or twice since I had a back sprain lifting heavy loads many years ago). It was not as worse current though and it usually will recover after about 2 weeks of care. At this moment, my back pain and further strain brought me to this condition. Please read on.

    Currently having numbness in my right foot and expecially the last two smaller toes and infrequent tight muscules and minor cramps with some burning sensations in my right leg when I walk, I previously started with lower backache and very minor tingling feeling in my right leg since early December 2011.

    It was almost recovered untill I did the hamstring stretch on my right foot, it turned chaos and left me with terrible pain and cramps in thight and my leg when I tries to stand or sleep with both legs straight. That was around 30th December.

    Somehow the nerve or mascule that connect my hip with my thight would cramp my leg if I am in a lying or standing position with both legs straight. It made me felt restless not able to put my leg in any position. I had two options for pain relief from clincal doctor. 1,DICLOFFINAC SODIUM and 2, CRPHENACDRINE. Although did not took together as not advise to, both medicine couldn’t ease the pain and cramps.

    The pain went worsen after a sneeze when I was lying on my side in bed 1 night. This sneeze cause a rush of pain from my lower back to my buttocks and hip, all the way to my right leg, 1 sided. The pain was so horrible, words could not discribe…. After few mintues, the pain subside and since then, I only experienced numb toes with occasional spread to my foot and minor cramps and what was discribe above as my current condition… Sneeze was the new year sneeze….sadly.

    I have since saw your videos and ebook. What worries me is, since your methods is to reverse the cycle to turn the pain back to where it first occured. As my condition now is bearable but wonder if it is the worse or it will gratually recover with less pain or none to be experienced further. I am in hesitation of weather to follow your guide and do the stretches or just leave it be and focus on neutritions and activities. Right now, I am still experiencing back pain and with some irritation on my joints connecting my thight and my hip (the outer side battock where my hand are stationed at) when sitting, other than the numbness (current symptoms).

    I would like to hear your suggestion and advise?

    • Dr. George Best

      Reply Reply January 5, 2012

      Hello Valiant,

      I think you’ve somewhat misinterpreted the concept of centralization with the McKenzie exercises. It is not a matter of returning the pain to where it first occurred, but of reducing irritation of the nerve caused by a bulging disc. As nerve irritation decreases, the typical pattern is for the symptoms to ease beginning with the point of pain furthest from the spine. In some cases, the pain closer to the spine may temporarily increase somewhat as the pain furthest from the spine decreases, but this is a normal sign of nerve recovery and is unfortunately a necessary part of healing.

      Most people find the exercises helpful, so my suggestion is to give them a try and see how it goes. You might also benefit from massage therapy at this point, because oftentimes there are residual knots of contraction in the muscles that can continue to cause pain for quite some time.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Pat McCarey

    Reply Reply January 25, 2012

    I started your Sciatica Management yesterday and I am hoping and praying that it will help in some way. I have had this Chronic Sciatica for several years and it finally cost me to retire early from my good job in which I hated to do and I am 58 years old. I have tried everything known to man kind, I guess. (acupuncture, therapy many times, exercise, swimming, stretching, strengthening programs and 17 ESI’s and the last 3 where injected thru the tail bone) Also I have had two lower back surgeries in the last 21 years. This sciatica has me so limited in so many ways. (walking to far, stairways, standing on my feet to long or sitting to long) And my only relief is lying down in my bed. I use both ice paks and heating pads to help also pain relief and muscle relaxers. I have always been a dedicated hard working active man and this almost a physical shutdown has made it hard.
    Thank you for your information. I am willing.

    • Dr. George Best

      Reply Reply January 25, 2012

      Hello Pat,

      It sounds like you have a more complcated case than many of my members, so if you have questions or would like me to look at your imaging results to see if there’s something else that may benefit you, let me know.

      Good luck!

      Dr. Best

  • Len Muller

    Reply Reply January 27, 2012

    Have rcvd. your info and appreciate its completeness. I have had sciatica last 12 weeks; have been using your exercises diligently for past 4 but no improvement. Early morning is brutal. Usually ok after 3 or so hours of exercise and walking. Early morning pain worst in left buttock but nerve pain extends to ankle. Do you have any suggestions or can you recommend anyone in the Duvall, Redmond, Bellevue, WA area? Thanks

    • Dr. George Best

      Reply Reply January 28, 2012

      Hello Len,

      Unfortunately I don’t know anyone to recommend in your area. At this point regardless of who you go to, I think it’s time to get an MRI to evaluate the situation. Your primary care doctor (if you have one) can order it. If you don’t, a chiropractor or other doctor will likely be willing to order it just based on your history. If you don’t have insurance, before you schedule the MRI be sure to check around with different MRI facilities as to what their “cash” (payment at time of service) price is. In most cases, this will be 50 to 70% less than their regular (insurance) price.

      In cases where the pain is worst in the morning, the problem is often inflammatory swelling that builds up while you’re lying in bed and not moving much. While I’m not a big fan of steroid injections as a long-term management strategy, they can be helpful in these situations to break the cycle of inflammation. While some doctors will do steroid injections without an MRI, the chances for success are much better when they know specifically where the problem is. If cost is not an issue, imaging guided injections (the injection is actually done with live-action imaging to guide the positioning) has the best chance for success.

      Given the severity and duration of the problem, my guess is that the problem is inflammatory swelling related to a disc herniation, but the other situation where pain is worst in the morning is with piriformis syndrome and/or gluteus minimus trigger points. Trigger points are knots of contraction in the muscles that tend to be very sensitive to circulation. When you are sleeping, the circulation through the muscles decreases due to the lack of movement, and this sets off the trigger points. The piriformis and gluteus minimus stretches an/or application of a hot pack to the buttock area for about 15 minutes done just before bed usually help reduce the morning pain in this situation. The other thing I would suggest is finding a good massage therapist and try a few sessions to see if that helps.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • julia phyllis izzo

    Reply Reply August 20, 2012

    Comments nice, however I need to know what exercise is best at this time. Should I walk? even tho walking is painful! Help! please DrBest!!!!!!!!

    • Dr. George Best

      Reply Reply August 20, 2012

      For fastest recovery, it is usually best to walk if you can tolerate it. I suggest being up and walking as much as you can and to avoid sitting as much as possible. When you need a break from walking, it is best to lie down rather than sit. With the other exercises shown on this website, you want to focus on what centralizes and/or relieves pain (don’t force yourself to do things that increase symptoms or cause symptoms to spread further from the spine). With those exercises that are helpful, the more frequently you do them, the faster the recovery. For most individuals, doing the exercises that help at least a few times every hour you are awake is good to start with and then you can gradually reduce the frequency as things improve until you are just doing them a few times per day for prevention. Similarly, with applying cold packs, doing that several times per day (for about 15 minutes at a time) will get faster results than just doing it once or twice. Once the symptoms are mostly gone, you can discontinue using cold packs.

      Good luck!

      Dr. Best

  • Mariano

    Reply Reply January 6, 2013

    Thanks for your honesty! it puts the expectations where the ought to be. Also, thanks for explaining. I am learning know to recognize the syntoms and to manage them with exercises and loads of care. I have a herniated disk and have suffered sciatica for some time. During my last episode the pain was so strong that I passed out. I woke up unable to move and thought my legs were filled with sand. It took 45 minutes to the parademics to lift me into the ambulance… When a doctor at the hospital scratched my heel. it sent a current of pain through my right leg so intense that I could not stop screaming. I only decreased after I was given IV morphine. I spent 8 days in a hospital, 3 of them looking at the ceiling.

    Like it or not , I know that sciatica is part of my life and is always in my mind. The silver lining: It motivates me to stay in shape. Nowadays the pain is only on my lower back, where the L5 is located. That one never goes away entirely…A constant reminder that I must stay on track.

    Again, many thanks for the information you provide in your site, for your honesty, and empathy towards all sciatica sufferers!

    Regards,

    Mariano

    • Dr. George Best

      Reply Reply January 6, 2013

      You’re welcome, Mariano. Thanks for your comments!

      Dr. Best

  • Stefanie Veal

    Reply Reply January 28, 2013

    Thank you for all the informative info you have been providing, I have a question that hopefully you can help answer, I am a dedicated runner and was preparing to run the cowtown marathon and February but pulled a hamstring and I think that is what caused a siaticia flare up now I can’t run without being in terrible pain the next day. So I had to put my training off and possibly the marathon too. I was wondering if I will ever be able to run competitively again? The pain has been going on for about a few weeks now and has settled down a little, but it still hurts quite a bit. I have been doing your stretches often. They do help but how long till I will return to “normal”. Thanks for your time.
    Stefanie Veal

    • Dr. George Best

      Reply Reply January 29, 2013

      Hello Stefanie,

      The time it takes to get back to normal varies considerably depending on the severity of the underlying cause. With moderate to severe cases, it is not unusual for it to take several weeks for most of the symptoms to subside and in severe cases it can take quite a bit longer than that to be able to handle activities like running. Since you’re still having significant pain, given the time frame I would suggest skipping the marathon in February even if you are feeling 100% by then. In most cases, even when the symptoms are gone, it is very easy to start them up again with excessive stress on the low back, and a marathon definitely counts as excessive stress.

      Running is definitely not the ideal activity for people with sciatica, but with good management of the underlying problems, most people can tolerate running reasonably well and even competitive running is not out of the question, but it is important to allow time for things to heal up. Trying to run when you’re still having some problems is usually a bad idea and typically just prolongs your recovery to a point where you are actually competitive.

      Especially since you are a runner, I would suggest getting checked out by a chiropractor in addition to doing the self-treatment, as runners commonly develop joint dysfunction issues that can place undue stress on the spinal joints and discs. Correcting any such dysfunctions usually speeds up the recovery process considerably.

      Good luck!

      Dr. Best

  • chris harvey

    Reply Reply April 6, 2013

    Doctor Best,
    the bottom of my spine looks like case three, and not much flexibility at the bottom!
    is it all up for me, I have a mixture of piriformis syndrome and sciatic nerve irritation. I am 73 and cycle a lot, 1000 miles a year. Walking is a pain in the butt!

    • Dr. George Best

      Reply Reply April 6, 2013

      Hello Chris,

      Even with advanced degeneration, you’re not necessarily stuck with being in pain. Some cases of moderate to severe degeneration can even be managed effectively with exercises (usually flexion works better than extension) cold packs (when needed for inflammation) and perhaps traction/inversion/decompression. I suggest you at least give the flexion position of the McKenzie exercises and cold packs a try (see the ebook or members area for full instructions). If you can find a place that will allow you to try a traction or inversion unit before you buy, that would probably be a good thing to try as well.

      If those methods fail, you may be a candidate for “minimally invasive” surgery. There are different methods but all are done through smalll incisions using a view scope and they trim away the disc, bone, and other tissue that is impinging on the nerve(s). Compared to the more aggressive “open” spine surgeries, the recovery time for minimally invasive is much shorter (most people are able to resume normal activities within a week or so) and there are fewer post-surgical complications such as excessive scar tissue formation.

      If you have further questions, let me know.

      Good luck!

      Dr. Best

  • Mike

    Reply Reply July 1, 2013

    Hi: First, I want to thank you for all the information you have provided. My question is….In the second video you show crossing your leg and pulling up towards the shoulder exercise and I need to know is that I can do that but afterwards the pain comes back almost at the severity of when this started.

    Is this normal? Am I suppose to fight through it for a few weeks or rest. When I walk the pain gets worse so I think I have the nerve sciatica. I fell off a ladder 20 years ago and have a compression fracture of T-11 & T-12. I have had no issues until a few weeks ago and the pain is unbearable. My doctor gave me a prescription of an anti-inflammatory drug but I still have the paid.

    REST OR DO THE EXERCISE???

    Rest helps but I still have the pain. Not as bad as the first day but it makes it uncomfortable.

    Thank You Very Much and Have A Nice Day!!

    • Dr. George Best

      Reply Reply July 1, 2013

      If the piriformis stretch is causing the pain to intensify afterwards, it’s probably not a piriformis problem. Most likely you have a disc protrusion. I suggest you stick with the McKenzie method and apply cold packs according to the instructions in the ebook. It’s best to avoid positions and activities that de-centralize the symptoms (see the ebook for a full explanation of centralization), but try to minimize full bed rest as much as possible. It’s alright to lie down periodically for a few minutes, but laying in bed all day tends to prolong recovery considerably.

      Good luck!

      Dr. Best

  • Khalid

    Reply Reply January 8, 2014

    Hi, I feel pain at left side of my back when i sit on the floor more than 10 minutes. If i sit on chair with back support i dont feel it. also i feel pain in both foots when i wake up in the mornings. Please advice.

    • Dr. George Best

      Reply Reply January 8, 2014

      Hello,

      The back pain could be due to a mild disc protrusion in which case the exercises in my free ebook should help. If the pain is only in the feet and not running down the back of the legs to the feet, the problem could be from the low back (and again, the exercises should help if that’s the case), but there could be some direct problem in the feet, such as poor circulation. If you do not get any improvement with the exercises within a week or two, I’d recommend seeing a doctor to have things checked out. Good luck!

      Dr. Best

  • M. L. A. Mohiuddin

    Reply Reply June 14, 2014

    Hi Dr Best . After waching your recently Mailed video , I am having confidence that I can improve my haelth. I am 57 years old male from hyderabad India. I am having back pain extending to right buttek thigh cough foot from past 5 years . From 18 months burning in both the legs has started. I underwent Fistula operation 15 months back thinking this suffering may be because of fistula. But there is no cure , in addition burning in the “motion passing area” also started, the suffering continues . And during night I am not having proper sleep as the pain extends to lower abdomine. Yesterday onwards I am watching your videos and not able to watch the excersie part video. Sir I need your advice.

    • Dr. George Best

      Reply Reply June 14, 2014

      Hello,

      It sounds like you probably have true sciatica, most likely from a disc protrusion in the lumbar spine, but the abdominal pain could be a separate issue. I recommend that you get X-rays or a sonogram to check for a possible abdominal aortic aneurysm before proceeding with trying to treat the sciatica. If there’s no aneurysm, then I’d suggest you start with the methods in my free ebook. If you have not already, you may download it from the link on the right sidebar of this page. If you do not get improvement within a few weeks, if possible the next step would be to get a lumbar MRI to evaluate the situation and hopefully determine the cause and best treatment options. Good luck!

      Dr. Best

  • M. L. A. Mohiuddin

    Reply Reply June 19, 2014

    Dear Sir Dr Best

    I thank you very much for the suggession . I am going t see doctor right now.

    • Dr. George Best

      Reply Reply June 19, 2014

      You’re welcome.

      Good luck to you,

      Dr. Best

  • Bruce

    Reply Reply August 27, 2014

    It is getting worse- more numbness in my hands and pain. While surgery does present risks I don’t want to get to a point where I’m unable to use my hands anymore. I would literally have to have someone wipe my butt for me.

    • Dr. George Best

      Reply Reply August 27, 2014

      When conservative treatment measures fail, then surgery has to be considered. Cervical spinal surgery has an overall better track record than lumbar spinal surgery, probably because the mechanical demands on the neck are considerably lower. It sounds like you’re at a point where it would be reasonable to at least get a consultation with one or more surgeons to find out what can be done and what the likely outcome of a surgery would be.

      Good luck!

      Dr. Best

  • Phillip Williams

    Reply Reply March 28, 2015

    Dear Dr. Best, I want to thank you for your service to this community of sciatica sufferers. I don’t have sciatica, I stumbled on your site while researching heel spurs of which I currently suffer. However, because of what I am learning from you on this site, I’ll probably avoid ever having to suffer from sciatica at all! God bless you for that! If I new what caused heel spurs before I had them, I very well could have prevented them from happening in the first place. I believe that God’s goodness is manifested in our lives through men and women just like you! If your not a believer…I’m sorry…but I am. Again, thank you for what you are doing! And God bless you and your site!

    • Dr. George Best

      Reply Reply March 29, 2015

      You’re welcome, Phillip and thank you for your nice message. By the way, I happen to also have a book on plantar fasciitis, which you’ve probably found in your research is closely associated with heel spurs. I would be happy to gift you a copy of the ebook version and perhaps if you find it useful you might consider posting a review on Amazon for it. I’m out of town and using my tablet and I don’t have the book file with me, but when I get back tomorrow I can send it to you. Let me know if you prefer a pdf or word document and your preferred email to send it to if you would like me to send it.

      God bless you as well,

      Dr. Best

      • Phillip Williams

        Reply Reply March 29, 2015

        Thank you very much Dr. Best! I’m very interested in your book on plantar fasciitis and your gift of the ebook version will be received with thanksgiving. A pdf document will be fine. Email is williamsph@bellsouth.net

        Thanks again!

        • Dr. George Best

          Reply Reply March 30, 2015

          Hi Phillip,

          I’ve emailed you the ebook. I hope it’s helpful for you.

          Dr. Best

  • Mimi

    Reply Reply June 3, 2015

    Thanks so much for all the great info! I started having dull pain on my entire right leg and lower back about a month ago. (I had sciatica when I was pregnant a couple years ago and symptoms went away after I gave birth.) I think my recent flare up is probably due to holding my toddler (30 pounds) a lot on my right side. Does this sound like true sciatica (nerve pain) or something muscular? I haven’t seen a doctor or anyone yet. Should I go see someone? A doctor or a chiropractor or physical therapist?

    • Dr. George Best

      Reply Reply June 3, 2015

      If there was no specific incident you can think of that initiated the symptoms, it’s more likely that the problem is muscular. The piriformis stretch may be helpful, but if it is due to holding your toddler on one side there may be some joint misalignment/dysfunction that’s precipitating the muscle reaction. I would suggest seeing a chiropractor who either offers massage therapy or who works closely with a massage therapist because the combination of chiropractic and massage will usually be very effective if the problem is what I suspect.

      Good luck!

      Dr. Best

  • Cindy

    Reply Reply June 5, 2015

    Hi Dr. Best,

    Thank you for the informative videos and ebook you have freely shared. I started to learn about sciatica when I researched about what possibly my condition could be. I work in the office and sit for long hours in front of the computer. I admit that I have neglected to exercise for a while. I started to feel pain 2 months ago when my friend and I were walking in a mall. The pain is normally on my front upper leg, sometimes I feel it on my buttocks and a few times on the knees and feet. I read that sciatic pain would normally leave after 6 weeks. I went to see a doctor who just recommended me to google You Tube videos and look for stretching exercises. I don’t know which stretching exercise is effective but I started to do the stretching exercise shown here while sitting. Sometimes I feel pain walking. I just wanted to ask regarding some machines that I have read about that may be helpful in managing or improving this condition. What do you think of the Chi machine? Also, is the vibration machine that does pivotal motion good for rehabilitation or is there any particular type that is good? There are some materials online showing that these machines are used as exerciser and could help in circulation and oxygenating the body. Your thoughts would be appreciated.

    • Dr. George Best

      Reply Reply June 5, 2015

      Hello Cindy,

      First of all, since the main symptoms are in the front of the thigh, you do not have sciatica. The sciatic nerve produces symptoms in the back of the leg. Front of the thigh symptoms can be caused by femoral neuritis, which is a condition similar in nature and cause to sciatica, but involving nerves that arise higher up in the lumbar spine, but I think it is more likely that your symptoms are due to tightening/contraction of various muscles in the back, hips, and/or legs. The piriformis stretch from my site may help with the buttock and some of the leg symptoms. With symptoms in the front of the thigh and given the fact that you sit a lot, you probably need to stretch a muscle called the iliopsoas as well. One safe and effective stretch for the iliopsos can be found at: https://www.youtube.com/watch?v=x0j9kHFUZyQ. As you may have guessed, taking breaks from sitting is a very good idea in these situations as well. Even just standing up and walking or stretching for 30 seconds to a minute every 20 to 30 minutes can make a big difference.

      In some cases, dysfunction of the sacroiliac and/or hip joint can be associated with tightness in the piriformis and iliopsoas, so it may be helpful to get that possibility checked out by a chiropractor if stretching and taking breaks from sitting fails to resolve the problem relatively quickly.

      While any machine that induces movement and helps promote circulation is helpful to an extent, no machine that I know of by itself will effectively fix these types of problems for most people. The Chi machine and others can be relaxing and helpful in reducing symptoms and can be a beneficial addition to other self-treatments, but they are no more effective (and in most cases, probably less effective) than appropriate stretching and regular movement to break up the periods of sitting. On the other hand, I have known some people for whom having a gadget of some sort sitting out in their home or office is a good visible reminder to stretch/walk/use the gadget, etc., and that can make it quite worthwhile to have such a device around.

      Dr. Best

  • Sallie

    Reply Reply October 6, 2015

    I like your reasonable statements. All makes sense. Some of us though have exercised all our life, have had a good diet and a healthy lifestyle and yet, as I am experiencing now, are struck with sciatica.

    Could it be that years of marathon running (sometimes 3 in a year), years of backpacking with a very heavy pack for up to 10 days, have actually lead to those problems. Is there a healthy threshold in the amount of physical activity and then when going over that threshold we develop problems down the line? I thin this could be my case. A small frame like mine was maybe not meant for such brutal activity, but I didn’t know it then.

    As you mentioned, it could be genetic, but I do not know of any family members complaining of this or back pains.

    By the way, when I had occasional back pains running would make then go away. And not running would be worse.
    In any case your insights are very useful and reasonable.

    • Dr. George Best

      Reply Reply October 6, 2015

      Hello Sallie,

      Exercise that may be good for muscle development or cardiovascular fitness is not always good for the spinal discs. Distance running does place a lot of impact on the spine and this can contribute to degenerative changes in the spinal joints and discs in some cases. Backpacking with a heavy pack can potentially cause issues with the discs both from simply bending over to load and lift the pack and from hiking with the pack on, particularly if the weight forces you to walk bent forward to some extent to counterbalance the pack (even mild degrees of flexion in the lumbar spine over time can be very damaging to the discs).

      Dr. Best

  • Perry

    Reply Reply November 17, 2015

    Hi doc,
    i have been having lower back pain and a stretching like feeling in my left leg,its been 5 days now.
    started with lower back pain the first day with a little pain on the leg.
    second day left big toe started tingling “pins and needels sensation” and the pain through the thigh and calf got more.
    third day tingling remained with back and leg pain,though could walk drive.
    fourth day leg pain subsided to almost no pain though tingling remained in the left big toe.
    day 5 today slight pain strectching in the thigh and calf with toe still tingling.
    pain in the leg has subsides a great deal,back pain aswell though when i cough does hurt lower back.
    so far what iv done,walking alot more stretching a little,used deep heat cream massage and ice pack aswell.
    had an Xray done acording to the doctor discs look fine.
    what prognosis would you give with what i have mentioned
    thanks
    perry

    • Dr. George Best

      Reply Reply November 17, 2015

      Most likely you have a relatively mild disc protrusion. X-rays are not a very good means of diagnosing the discs since they only show the space the discs occupy and not the discs themselves. X-rays will show disc thinning (degeneration), but are usually not helpful at all with regards to assessing disc protrusions. Since things have improved significantly over the 5 days, things will probably resolve pretty well within the next couple of weeks. Tingling and numbness sensations usually take longer than pain to go away. I would suggest trying the McKenzie method from my free ebook to try to speed up the process. Since your symptoms are relatively mild at this point, it may be difficult to determine the one position that best centralizes your symptoms (as explained in the ebook), and if so, I’d suggest just using the straight extension position. Because disc protrusions have a tendency to flare up periodically, it would be a good idea to use the extension exercise a few minutes per day for prevention, as well as to avoid as much as possible the types of activities that tend to cause problems (which are also discussed in the ebook).

      Good luck!

      Dr. Best

  • Perry

    Reply Reply November 19, 2015

    Hi doc,
    Thank you very much for you input.i am using your mckenzie method total of about 20 mins a day 3 days now.
    lower back pain has gone pretty much id say. The stretching in the thigh and calf aswell id say completely gone.
    I have been doing physio,who has used the TENS machine On me twice im not sure if you recommend it as its the first time ever iv done it.
    been doing the TENS for about 15mins massage and stretches.
    what iv noticed after the tens in that a slight awkward feeling in my little toes on the left leg.
    My left shin hurts a little and some pain on the left buttock to the side left buttock not continuos pain,when im lyin down and try to turn or have a cough does hurt a little.
    whats your advise doc.
    regards
    perry

    • Dr. George Best

      Reply Reply November 19, 2015

      Hello Perry,

      That’s good progress for 3 days, so mostly it’s a matter of continuing what you’re doing.

      Actual TENS may not be very useful at this point as it is primarily a short-term pain-relieving therapy. That being said, there are several types of electrical stimulation therapies and they have different physiological effects. Sometimes what’s being called TENS is actually microcurrent, interferential therapy, or electrical muscle stimulation. Any of those three may still have some benefit for you, as they do more than just suppress pain. Microcurrent appears to actually enhance tissue healing, interferential is helpful for reducing inflammation, and electrical muscle stimulation can reduce muscle spasm.

      Pain with coughing suggests that the disc is probably still a bit irritated. At least part of the symptoms may be due to residual muscle reactions though, and the stretching and massage will help get that resolved.

      Like I said before, it sounds like you’re making pretty good progress, so I recommend you stick with what you’re doing.

      Good luck!

      Dr. Best

  • Ivy

    Reply Reply January 11, 2016

    Hi Dr. Best.
    5 months ago I fell on my butt at the park with my son and suffered what was assumed to be a tailbone injury. It would hurt me to go from sitting to standing, sitting for any period of time, and even make sleep feel uncomfortable. I used a coccyx pillow, icing, and exercise along side pain meds to heal it but literally the same day the tailbone pain vanished, an entirely new one appeared. My left leg has scorching pain mainly focused in the back and side of my thigh as well as some numbness. It is excruciating. I cannot stand for long periods of time and it hurts to walk, it hurts to sit, it hurts to bend. I am a stay at home mom to a toddler and I am constantly bending up and down to pick him up. Is this causing more damage? I have had the sciatica pain for about a month now and the dr. I went to see gave me nortriptyline to help me manage the pain enough so i can do exercises but the pain is so intense i want to pass out everytime i attempt them. Is the medication my dr gave me an appropriate one and is the tail bone injury connected to the sudden onset of this sciatica even though it occurred months after the initial fall? Also do you have any tips on how to cough? I swallowed down the wrong pipe last weekend and tried to cough it out and felt as though i was suffocating because i could not cough without black out pain. I wound up in urgent care because my back went out from the coughing and they gave me a 6 day prednisone pack which really helped everything while i was on it, even my sciatica a bit. What are your suggestions for someone who is in too much pain to even do the exercises? I am so frustrated and everything takes so much time meanwhile everyday feels like 1000 years. Thank you so much for any advice you can offer.

    • Dr. George Best

      Reply Reply January 12, 2016

      Hello Ivy,

      My best guess is that you have a disc protrusion and it probably started when you fell. I can’t say for sure why the leg symptoms didn’t start until the tailbone pain resolved, but I have a theory. The brain and spinal cord are covered by tough protective layers of tissue known collectively as the meninges. The spinal nerves branch off from the spinal cord through “sleeves” in the meninges and the meninges are held in place at the bottom of the spine at the coccyx. My theory is that the coccyx was misaligned and somehow corrected itself and when it did, it altered the pull of the meninges on the nerve and this altered the pressure on the nerve from a disc protrusion enough to provoke nerve symptoms.

      Regarding nortriptyline, I am not a medical doctor and pharmaceuticals are outside my scope of practice, but in my experience, anti-inflammatory medications typically work much better with this type of problem. Nortriptyline is approved as an anti-depressant, but because it acts to elevate serotonin levels, it often helps with chronic pain, which is why your doctor most likely prescribed it. The fact that the prednisone helped confirms that you’d probably do better on an anti-inflammatory. Besides medication, I strongly recommend using cold packs per the instructions in my free ebook.

      Chances are your child care activities are keeping things aggravated and will probably delay your recovery, so the more you are able to reduce those activities, the better for the time being. \

      Unfortunately, there is no good way to cough in these situations. Coughing increases pressure in the spinal canal and that’s going to hurt when there’s a disc protrusion present.

      You didn’t say what exercises you are trying to do. I strongly recommend sticking to just the ones in my free ebook for now. If you cannot test the positions for the McKenzie exercises, I recommend starting with extension and if you can’t tolerate going all the way onto your elbows, use the modified method of lying with your arms folded under your chest or with a pillow under your chest. Applying a cold pack before and/or during the exercise will usually help too. If you can’t tolerate even the modified extension exercise, stick with using cold packs for a few days before attempting the exercise again. As discussed in the ebook, frequent use of the exercise throughout the day will get the best results and hopefully things will subside substantially within a few days and you can then begin transitioning to more of a preventive program.

      If you don’t get significant improvement within a week or two, I’d strongly recommend getting an MRI to evaluate the situation further.

      Good luck!

      Dr. Best

  • Cat

    Reply Reply March 16, 2016

    HI Doc,

    Thank you so much for the insightful knowledge!

    My first sciatica pain (in the back of right upper leg) occured in April 2014 after long hour of sitting in front of computer with crossing legs ( my left foot put on top of my right leg). I think that is the reason to cause my sciatica. Then I rested for a couple of months, the pain dissappeared in Jun 2014. But in July 2014, when I tried to press the right side by the spines between L4 and L5 with a finger, the pain was back and expended to lowr right leg. Even worse, in Aug 2014, I missed one step when I stepped down a curb, suddently felt several spines of my lower back were seriously squeezed and kind of fluid was out from between my spines and feeling like flew in my lower back. I dared not move for quirw a while, from then on my lower back area including maybe L1-L5 and the sacrum area all felt frozen/glued together. I can’t bend over my back so much any more. When I try to bend over, that whole area was tight and painful( more feeling of tight that something is pulling, maybe everything is glued together.) Till now I still have sciatica pain (not too serious pain but chronic) and this glued problem together. I am trying to practice Yoga and Pilates, it seems improving.

    When I found your website, I thought you are very right that I should solve the root/cause of the nerve compression first. What is your suggestion to solve this sciatica (nerve compression) and adhesion(frozen/glued) problem?

    Thank you!

    • Cat

      Reply Reply March 16, 2016

      right now the scatic pain is sometimes on lower back(butt), sometimes on back of the upper leg.

  • Cat

    Reply Reply March 16, 2016

    The rigid/glued area feels like all the muscles and bones and everyting are glued togther.

  • Cat

    Reply Reply March 16, 2016

    The rigid/fozen/glued area feels like all the muscles and bones and everyting are glued togther.

  • Cat

    Reply Reply March 16, 2016

    How to push the buldging back?

    • Dr. George Best

      Reply Reply March 16, 2016

      From what you’ve said, it sounds like you have not been professionally evaluated. Given the duration and severity of the problem, I would strongly advise getting checked by a chiropractor or other physician who specializes in musculoskeletal problems. While you probably do have a disc protrusion, it sounds like there’s probably some joint misalignment/dysfunction that is contributing to your symptoms, and that is something that would best be assessed and treated by a chiropractor.

      The exercises and other self-treatment methods in my free ebook (available here)are a worthwhile place to start, I think in your case a thorough professional evaluation of the problem is in order. If you do not get significant improvement within a few weeks using the methods in the ebook and/or any initial professional treatment, then I’d definitely recommend having an MRI to assess the situation so that you can get the appropriate treatment.

      Good luck!

      Dr. Best

  • Henry

    Reply Reply June 10, 2016

    Thanks doc for your care.
    I had this pain on my lower back and buttocks for about 2months before it went to my front left thigh. It brought me down that I could not walk for more Than a week.
    I was ok after 7 weeks but now the pain hhas come again. Lower back, front and back left thigh.

    What do you think.

    • Dr. George Best

      Reply Reply June 11, 2016

      It sounds like you probably have a disc protrusion that is irritating the L4 nerve root, as that nerve is a component of both the sciatic nerve (which produces symptoms in the buttock and back of the leg) and the femoral nerve (which produces symptoms in the front of the thigh). The usual recommendations for disc-related sciatica would still apply in this situation, so I suggest you start with the methods for disc issues in my free ebook (McKenzie Method and cold packs). If you don’t get much improvement within a couple of weeks, I’d recommend seeing a doctor and getting an MRI to evaluate the situation. If you have not already downloaded the free ebook, you may do so from this page:

      Good luck!

      Dr. Best

  • Jaafar

    Reply Reply July 23, 2016

    I have an MRI report sayin that(1) l5-s1 mild posterior disc bulge(2)what happen when L3-4 minimal diffuse posterior annular disc relaxation inclined to right side
    (3)L4-5 minimal diffuse posterior disc bulge smoothly intending the vebtral theca and encroaching upon inferior recesses of both exist neural canals….. i need doctor to tell me exactly what’s wrong with me because i am in real pain i took alot of medication but no result my pain is worse in my glute and thigh

    • Dr. George Best

      Reply Reply July 24, 2016

      Of the things you listed, the main problem is most likely the L4/5 disc bulge, although I would take issue with the description of it as being “minimal”, yet was bad enough to indent the thecal sac and narrow both nerve canals (to paraphrase the radiology jargon). I think sometimes radiologists use pre-written reports to save time and sometimes forget to edit some of the wording that doesn’t apply. Basically what’s happening is that the disc is protruding into both the main spinal canal where the spinal cord would be (at the L4/5 level it is no longer a cord, per se, but a bundle of individual nerves) as well as into both of the canals where the nerves exit the spine on the left and right. This creates pressure and irritation of the nerves. In addition to the direct pressure on the nerves caused by the disc protrusion, there is usually also some contribution from inflammatory swelling adding to the pressure on the nerves.

      The methods in the free ebook here on my site are usually quite effective at treating issues such as yours. If you have not already downloaded the ebook, you may do so here:
      http://www.sciaticaselfcare.com/basic-sciatica-exercises/

      Be sure to read and carefully follow the instructions for using cold packs and the McKenzie method. In addition, avoiding prolonged sitting is usually also helpful. If you must sit for long periods for work or other reasons, it is best to try to take brief breaks to do the McKenzie exercise in the position that best centralizes symptoms (as explained in detail in the ebook) or simply get up and walk for a minute or so every 15 to 20 minutes, or as often as you can.

      With regards to the other findings from your MRI, none are particularly significant and although they may be complicating the issue, they are not likely to be primary causes of your symptoms in my opinion. In fact,the straightened lumbar lordosis may actually be due to muscle spasm and may be an effect rather than a cause of the underlying problem.

      If you do not get significant improvement using the methods in the ebook within 1 to 2 weeks, I would recommend you ask your doctor for a referral to a chiropractor and/or a physical therapist to work with the structural issues that are present. One other option would be a steroid injection to reduce inflammation around the spine, but that tends to be a temporary treatment and unless you also directly address the disc protrusion with the McKenzie method and/or chiropractic/physical therapy, symptoms typicall return at some point.

      Good luck!

      Dr. Best

      With regards to t

  • Jaafar

    Reply Reply July 24, 2016

    (4)straightened lumbar lordosis
    (5)early spondylo-degenerative changes with degenerative discs and multilevel schmorl’s nodes…this is the remaining MRI report hope you can help me doctor.

  • Jed

    Reply Reply December 25, 2016

    I am 55 and have been experiencing sciatica down my right leg for the last 60 days or so. It started after after a particularly strenuous day of work where I walked for several hours. The piriformis is sore on both left and right sides. I watched your video and tried all of the various positions of flexion and extension. All of them felt about the same and seemed to give about the same results, that is I could not find any movement that provided a greater sense of centralization. I decided to try extension movements. I did them for a day and noticed the following day my symptoms were worse. The tingling is now much stronger in my foot and leg now the leg feels weak. So I’m wondering at this point since the extension position made it worse should I try the flexion position? By the way, none of the positions cause me pain.

    Thank you!

    Jed

    • Dr. George Best

      Reply Reply December 26, 2016

      It sounds like you probably have more of a degeneration/arthritis problem than a disc protrusion. In that case, flexion usually works better but you may have some sort of misalignment or joint dysfunction issue that’s contributing to the problem. I suggest trying the flexion position for the McKenzie as well as doing the stretching for the piriformis muscles shown in my free ebook. Applying cold packs to the lower back per the instructions in the ebook may also be helpful. If you don’t get much improvement within a week or so, I’d recommend seeing an experienced chiropractor to have things checked out. If there is something going on with the joint alignment/movement, a few chiropractic treatments will usually be a big help. Depending on what the chiropractor finds, some deep tissue massage may also be in order.

      Good luck!

      Dr. Best

  • Edwin

    Reply Reply March 16, 2017

    Hey i have like an inflated nerv and it like dosent hurt as much as when i berly got it anymore but i cant bend over when i am standing straight any suggestments

    • Dr. George Best

      Reply Reply March 17, 2017

      Without being able to examine you, what I suggest is trying the methods in my free ebook, which can be downloaded from the link on this page.

      If you don’t get any improvement within the next week or two, it would be a good idea to get checked out by a doctor to find out what the problem is and how best to treat it.

      Good luck!

      Dr. Best

  • Ron

    Reply Reply March 29, 2017

    Hi Dr Best .
    Your spot on information has enabled me to manage and maintain a pain free back since I first found you in around 2000.I was still a practicing dentist then and so of course often found myself in a strained seated position. Now I have retired as I am 84 and I still manage my back with your exercises and some Pilates as well.
    THANK YOU SO MUCH for your kind help.!
    Ron in Cape Town South Africa

    • Dr. George Best

      Reply Reply March 29, 2017

      You’re very welcome, Ron! Thanks for the update and I’m glad to hear that my information has been such a great help to you!

      Dr. Best

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