Sleeping With Severe Leg Pain From Sciatica
Living with Sciatica during the day can be bad enough. The searing pain you will be experiencing down your leg is enough to drive the sanest person to distraction. However, that compares to nothing if you are one of the unfortunate ones who is suffering at night as well.
I have often had patients say to me it is as if as soon as they want to go to sleep, their sciatica chooses to wake up!
This can create a multitude of problems:
i) The lack of sleep makes you tired.
This is a problem, as it has been proven that our perception of pain is increased and our pain tolerance decreased, the more tired we are. Consequently, if you are experiencing pain which is preventing you from sleeping, it is going to make you more tired. This in turn will increase your perception of pain & decrease your pain tolerance. What is that going to do? It's going to make sleeping more difficult, which will make you more tired... and so on. I am sure you can see how a vicious cycle results which can be difficult to get out of.
ii) Night Time is prime healing time.
It is during the night, while we are at rest, that the body's fantastic healing process gets to work and aims to heal and replenish all that needs to throughout your body. Your sciatica will be at the top of the list for healing. However, if you are not sleeping at night, tossing & turning, this healing process is going to be interfered with. This creates yet another vicious cycle similar to that given above.
So what can you do?
If you are struggling to sleep of a night, let me firstly say do not replace your bed! Well, not yet anyway. More often than not, it is either the position you are sleeping in or what you were up to before going to bed which is the problem - not the bed itself. I shall discuss the latter here...
This may sound like I am stating the obvious, but it is important to avoid any particular activities you know aggravate your pain. Let's use sitting as an example. Sitting tends to be a classic aggravating factor for sciatica (although I except it will not be for everyone). Therefore, if you are like most of us and tend to spend much of your evenings sitting down, there is a fair chance you will be aggravating your sciatica during that time.
This may express itself as forcing you to fidget regularly just to get comfortable, forcing you to stand up because of the increasing pain or your pain may feel OK while you are sitting down, but you experience increased pain and discomfort when you go to stand up from the chair.
If you are familiar with any of these, then sitting down is an aggravating factor for your sciatica.
Consequently, if you are stirring your pain up just before going to bed, it should come as no surprise that the pain is keeping you awake at night. This may not express itself immediately, sometimes it can be an hour or so after getting to sleep that you pain rears its ugly head.
In such circumstances, I would ask you to firstly think about the chair you are sitting in:
Is it the best for your sciatica?
Maybe it should be a little firmer?
Or possibly you need some support for your lower back?
Just have a think as to how you can make things a little more comfortable for your sciatica. It could well be that you need to try a completely different chair for a while.
In addition to this, I would also suggest you try to avoid sitting for any longer than 15-20 minutes without standing up. This doesn't need to be an extensive break, a few steps up and down the room will be more than suffice, just give your body a chance to straighten up for a bit. If you are watching TV, when the adverts come on is a good reminder.
By doing this, it will help alleviate some stress from your sciatic nerve before going to bed, which in turn will decrease the pain perceived and therefore give you a better nights sleep and your body more chance to heal itself. This in turn will begin to set up a positive cycle, where more sleep will promote better healing, which will help you sleep more... and so on.
The example I have used here of sitting, is just one of many which may be aggravating your pain. It is important you gain a good understanding of your body and are able to tell what your sciatica does and does not like with regards to its healing process.
In addition to this, I have provided a link below which will discuss the best sleeping positions for you to sleep in order to gain a good night's sleep.
Having a Pain in Your Butt – It May Not Be Sciatica
Feeling good about yourself because you finally decided to clean out the garage, but you're so sore the next day you can't move - particularly in your butt muscle? Many patients see us for emergency treatments this time of year because they did something out of the ordinary, such as: golfing; cleaning out the garage; raking leaves; or camping and sleeping with a rock underneath them. And now they are experiencing pain in the butt.
Many times these patients come in thinking they have sciatica. What they are actually experiencing is called piriformis syndrome. This common muscle injury can result from repetitive motion and over use of your piriformis muscle. Pain is often felt in the buttocks first, resulting in referred pain into the legs. This is commonly mistaken for sciatica.
What is Piriformis Syndrome?
The Piriformis muscle is a small muscle which originates in the base of the spine and inserts into the top of the leg bone (femur). The sciatic nerve runs through the piriformis muscle. If the muscle becomes tight, often from overuse, it can put pressure on the sciatic nerve and cause pain which may radiate down the leg. The piriformis syndrome often mimics sciatica, the difference is the origin of the pain.
Any muscle that is used repetitively needs a chance to recover. Imagine what happens to your piriformis muscle every time you swing a golf club. The repetitive and sudden swinging motion pulls the muscle, which eventually begins to spasm. When the piriformis muscle begins to spasm it will pull the hip bone causing the hip to become misaligned.
Treatment
The treatment for piriformis syndrome is to seek chiropractic treatment for the misaligned hip and a physical therapist/massage therapist for trigger point therapy and light stretching.
The self-treatment for piriformis syndrome is to use a golf or tennis ball (a cold one is best) on your butt or hip area. Sit on the floor and put your weight on the golf ball. Move the ball around until the ball is in the place where it hurts the most. If it's sore and hurts while you're sitting on the golf ball you're doing a great job! Toxins tend to accumulate in tight muscles and putting pressure on this area alleviates the toxins, and also breaks up the pain - spasm - pain cycle.
Other tips: Avoid the use of heat, use ice, and take ibuprofen if you need it. Visit your local chiropractor or physical therapist to help break up the pain - spasm - pain cycle.
Prevention
Regular stretching and strengthening are the best ways to prevent piriformis syndrome. This muscle rarely gets stretched, so a simple stretching routine often works wonders.
Stretch before you do any repetitive activity such as golfing, raking leaves, playing tennis, or doing extra chores around the house such as cleaning out the garage. Warm the piriformis muscle up by running in place, stretching the muscle, and getting chiropractic adjustments.
To stretch the right piriformis:
Lay on your back, bend your knees and cross your right leg over your left so that your right ankle rests on your left knee in a figure four position. Bring your left leg towards your chest by bending at the hip. Reach through and grab your left thigh to help pull towards your chest.
Sit on the floor with both legs extended out. Put your right knee over your left leg. Place the left arm over the right leg, twisting torso and pushing the right knee away from the left leg.
Hold both stretches for 30 seconds, repeat five times on the painful side. If stretching alone doesn't help, check with your chiropractor or physical therapist.
Low Back Pain Or Sciatica in the Morning?
I'm sure you are familiar with it. You wake up in the morning, go to get out of bed BUT are stopped in your tracks by the pain and stiffness in your lower back or sciatic nerve. It can then take a few minutes or much longer to straighten up and become more mobile again... Why is your back so stiff and painful in the morning?
Well, contrary to popular belief, it is more than likely NOT due to the bed / mattress you are sleeping on! That's right, I believe this is a myth well worth busting, as it may save you a fortune by avoiding the unnecessary replacement of your current bed.
There are also those that may say you are stiff and painful first thing in the morning due to the fact you have moved relatively little for the previous few hours. Although I would agree that there is an element of truth in this last statement, once again I do not believe it is likely to be the main cause.
So why is your back so stiff and painful in the morning?
More often than not, it is not due to the bed itself, but rather the position you are sleeping in or what you have been doing the few hours before retiring to bed, it is the former which I am going to be discussing in this article.
So what is the best position for me to sleep in then?
The best position for you to adopt would primarily depend upon what is the cause of your low back / sciatic pain. However, as a rule of thumb, the most comfortable position to sleep in is usually side lying (either side) with your bottom leg fairly straight and your top leg supported by a couple of pillows, so that this top leg is more or less parallel with the bed.
By sleeping in this position, keeping the bottom leg straight is encouraging your lower back to be in a neutral position. Yet with the top leg being supported by pillows, it is preventing it from dropping 'across & down' and twisting your low back and stretching your sciatic nerve in the process.
Some people tend to lie on their side, but forget to support the top leg. This just has a twisting stress upon the lower back which is maintained for several hours while you are sleeping. Therefore it should come as no surprise that your low back or sciatic nerve may feel stiff and painful first thing when you wake up.
As I alluded to above, there are other positions which could be more beneficial, but this depends upon the cause of your pain, but side lying with pillows supporting your top leg is usually a good comfortable position to get in no matter what your diagnosis.
It is also important to realise that it may not necessarily be your sleeping position which is the problem, but rather the things you are doing to your low back before going to bed. If you try different sleeping positions, including the one given here and yet you are still having difficulty sleeping, it is likely what you are doing before going to bed which is your problem. This will need to be assessed before thinking of replacing your bed.
Low Back Pain, Sciatica & the Hamstring Muscles
Muscles play a crucial part in the normal functioning of the lower back & Sciatic Nerve. If any of the muscles in this area become too tight or too weak, they have the potential to cause pain. This is typically referred to as muscle imbalance. The Hamstring muscles are a common culprit for this and it is usually tightness which is the problem.
In a similar vein to which I have mentioned in an article on the Piriformis muscle, tight hamstring muscles can also have an influence over the Low Back, Sacro-Iliac joint and Sciatic Nerve.
With regards to the Lower Back, the Hamstring muscles are attached to the bottom of the pelvis, in a similar area to the bony points you sit on. If this muscle is tight, it will pull on the bottom of the pelvis and encourage it to rotate backwards. If there is also tightness around the low back itself, this backwards rotation movement will be resisted by the back and therefore the increased stress will be taken up in and around the bottom of the Low Back or the Sacro-Iliac Joint. This increased stress is likely to lead to low back pain.
Alternatively, if there is no particular tightness about the lower back and maybe even some weakness, the increased pull resulting from the tight hamstrings may well encourage the lower back to flex too much, this time potentially leading to Low Back Pain as opposed to Sacro-Iliac pain. Either way, Low Back Pain can occur as a result of tight hamstring muscles.
It is slightly different as far as Sciatica is concerned. The sciatic nerve is formed from 5 nerve roots which leave the lower back from the lumbar spine and sacrum. As it does this, the sciatic nerve passes through the buttock region and down the back of the leg to the back of the knee. As it passes down the back of the leg, the sciatic nerve also passes through the hamstring muscles. Consequently, if the Hamstrings are tight, they can place increased stress upon the sciatic nerve, leading to pain.
In either case, the aim of treatment is to gently stretch the Hamstring muscles in order to relieve the stress being placed across the Low Back, Sacro Iliac Joint or Sciatic Nerve.
There are numerous ways of stretching the hamstring muscles. I shall now describe a very gentle way of stretching them. Only when you feel that this stretch is too easy, should you consider progressing on with more aggressive stretches.
While lying on your back with your knees bent, gently hold behind the knee of the side to be stretched and pull your knee towards your chest, stopping when your knee is pointing directly up towards the ceiling.
When in this position, gently straighten the same knee so that your lower leg begins to point towards the ceiling as well.
NB If your Hamstrings are tight, you will not be able to get your foot to point towards the ceiling!
As you are doing this, stop as soon as you begin to feel a stretching sensation at the back of your leg.
Hold: approximately 20 - 30 seconds.
Repeat: 2 - 3 times.
Repeat: 2 - 3 times per day.
As you begin to gently stretch the hamstring muscle it will become more supple. This will result in tension being taken from the Lower Back, Sacro-Iliac Joint and Hamstring muscles, which in turn will encourage correct function of these two areas and therefore healing will take place. As a result, your pain will begin to resolve.
Be careful when performing this stretch, as it is important you do not allow your back to flatten too much into the floor / surface you are lying on. A simple way to prevent this is to keep your low back in a neutral position and then gently tighten your abdominal muscles. These muscles play an important role with regards to stability of the lower back and associated structures, and therefore by gently working these while performing this exercise, you will be helping to provide your lower back and pelvis with more stability as well.
It is unlikely, although not impossible, that your Low Back Pain will resolve as a result of performing Hamstring stretches alone. The chances are you may need to perform one or two other exercises as well, be they stretching or strengthening exercises.
Sciatica – Numbness, Tingling & Weakness
More often than not, the term sciatica is associated with pain which may pass from the low back down through the buttock and back of the leg, passing as far down as the tips of the toes. However, although pain is the most common complaint from someone suffering with sciatica, numbness and tingling (pins & needles) can also be a symptom.
Firstly I would like to clear one thing up and that is with regards to the term 'sciatica'. Sciatica is only a descriptive term, not a diagnostic one. Therefore, two people may be presenting with exactly the same signs and symptoms as a result of sciatica, yet they may have two completely different causes. Consequently, their treatments would also be different.
The sciatic nerve passes from the lower back, through the buttock and down the back of the leg, providing innervation for the muscles and also sensations back up to the brain. When anyone suffers from an attack of sciatica, somewhere along the length of the nerve (usually in the low back or buttock region, but not exclusively) the nerve is being aggravated, typically by a compressive force.
If this compression becomes quite severe, the electrical signals which usually pass both up and down the sciatic nerve become impeded, and therefore the messages they are sending may not pass fully along the length of the nerve. If these messages are only partially restricted, a tingling or pins & needles sensation may be perceived. This is because some of the messages are getting through but not all of them.
However, if the compression is so severe that none of the electrical signals are able to pass through, numbness will be present in the region of the body which that part of the nerve supplies. With regards to the sciatic nerve, it is typically felt in the toes / feet or maybe calf (although it can be felt higher up).
If you are feeling numbness and / or pins & needles, it is important to have this assessed by a health professional. More often than not it is a just a typical symptom of sciatica which can be resolved, however it is best to have it checked first.
Finally, as well as pain, numbness and pins & needles, weakness can be another symptom of sciatica. If the electrical messages are not able to pass to your brain from the skin correctly, numbness and pins & needles may result as explained above. However, it is also possible the messages may not be able to pass the other way. Therefore, if the messages you are sending from your brain to your muscles are not passing along the sciatic nerve 100%, the receiving muscles are not going to work as strongly as they should be, resulting in muscle weakness.
Low Back Pain – Sciatica & Osteoporosis – How to Treat It
Osteoporosis literally means 'porous bones', resulting in the bones becoming brittle and the potential for fractures to occur. Any bone can be affected by osteoporosis, but the most common site for fractures are the wrist, hip and spine. I have discussed in another article, "Low Back Pain & Sciatica - Is Osteoporosis the Cause?" what osteoporosis is in a little more detail and how it can present if you develop it in the spine. This article is going to look one of the main forms of treatment for those suffering with osteoporosis... exercise.
Exercise.
Exercise is one of the best things you can do to help fight against osteoporosis. I have treated many people suffering with osteoporosis who have mistakingly believed that exercise should be avoided for fear of causing a fracture. This is not true, although you should be sensible and discuss any potential exercise programme you are thinking of starting with a health professional first.
Low Impact Weight Bearing Exercise: This is important for those suffering with osteoporosis as it helps to keep the bones strong. As you perform low impact weight bearing exercise, and this can be something as simple as a nice brisk walk, subtle increased stresses are placed through the bones (primarily the legs, hips & spine) and the body responds to this increased stress by trying to make those same bones stronger.
Stretching & Strengthening Exercises: Strengthening exercises, although not as much as weight bearing exercises, will also place stress across the bones, once again encouraging them to strengthen. By stretching, you will be maintaining / increasing the mobility of your joints and therefore they will be able to fulfill their complete range of motion when required. This will help to prevent them stiffening up which itself can be a cause of pain.
Postural Exercises: One of common signs of osteoporosis is a 'stooped' posture, where the curve in the mid-back region becomes increased and the head / chin tends to 'poke' forwards. It is this posture which can lead to back & neck pain and not necessarily the osteoporosis itself. Therefore exercises which encourage a more upright posture are imperative. These can be performed in conjunction with the stretching & strengthening exercises mentioned above, as it is important to have good stability & mobility in order to maintain a correct posture.
Balance Exercises: This will not necessarily have a direct influence on the osteoporosis itself. However, if you are at all unsteady on your feet you will be at an increased risk of falling. Falls are, understandably, one of the major causes of fractures in those with osteoporosis. Therefore if you can increase your balance reactions, you will be decreasing the risk of falling and therefore the risk of fractures.
NB No exercises should be performed without consulting your Doctor / Health Professional first.
There are obviously other forms of treatment for Osteoporosis, for example prescribed medication (such as Fosamax & Didronel) and Supplements (such as Calcium & Vitamin D). However, I will not be discussing these here and you should consult your Doctor before contemplating taking any medication or supplements.
In summary, not only is exercise good at keeping you generally fit & healthy, but it can also be an important part of your treatment for osteoporosis. Do not miss out on the ability to exercise simply because you feel osteoporosis is stopping you... it is not. Speak to your Doctor or Health Professional and start a gentle exercise programme as soon as possible.
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