By Matthew Solan
One day 25 years ago Candy Doran, an avid cyclist and competitive runner, bent over to pump a bike tire and was struck by lightning. Not literally, but that's how she describes the searing pain that shot through her lower back and leg and made her collapse to the ground in agony. The pain quickly subsided, and she resumed her routine of training for half marathons and vigorous cycling competitions like the California Death Ride, for which she biked through five mountain passes in a single day. Over the years, the pain would return, sometimes not as severe; sometimes she just had trouble getting comfortable while seated. It always went away and didn't interfere with her regular activities, so she just "ran and cycled through the pain," she says. When it was gone, it was forgotten. Eventually, after hearing her running and cycling buddies complain about sciatica and reading about the condition in fitness magazines, she put two and two together and realized that she too was suffering from inflammation of the sciatic nerve.
When she tried to address her pain, the results were discouraging. A chiropractor and physical therapist weren't helpful. So she consulted her running magazines and tried the back exercises they recommended. Her hope was that strengthening the muscles of the lumbar area would lessen the frequency or severity of the attacks. But it didn't, and at times the exercises made matters worse.
It wasn't until a knee operation ended her running career a few years ago that she became determined to control her sciatica. "I was physically deteriorating and I knew I needed to preserve what I had left," says Doran, who still cycles about 100 miles each weekend around San Francisco. "And I knew I had to go outside my Western experience of physical therapy to do it."
She found solace at the Iyengar Yoga Institute and with her teacher, Kathy Alef. For the past four years, her twice-weekly practice has taught her to stretch correctly, concentrate on proper alignment, and focus on her overall physical needs. This has been a departure from her physical therapy exercises, which she says are often designed just for specific areas. Now she fights the entire fire instead of individual flames. "Yoga has taught me to pay attention to how my body moves and how it relates to my sciatica," Doran says.
For the first time in decades, Doran's sciatica is almost nonexistent. Besides an occasional flare-up, the equivalent of a 24-hour cold, she is practically pain free. Best of all, at 55, she's able to stay active at an age when most people have to slow down. "Now when my sciatica does occur, I know what to do to ease the pain—stretch and strengthen like crazy."
Of All the Nerve
The sciatic nerves are the body's two largest nerves. They are about as thick as your pinkie and emanate from the lower lumbar spine. They thread through the buttocks down the back of each leg to the soles of the feet and big toes. Pain strikes when a root that helps form one of the sciatic nerves, or when the nerve fibers, become pinched or irritated. You can feel it anywhere along the nerve's branch: low back, buttocks, leg, calf, or foot. It can be felt down one leg or both.
Sciatic pains are like snowflakes: no two are ever the same, and their severity can change throughout an attack. The pain can feel like a dull soreness, numbness, or tingling, or more like an electric shock, throbbing heat, or stabbing pain. It can begin as an annoying ache that makes it uncomfortable to sit, or turn into a variety of intense, and at times debilitating, sensations that make it nearly impossible to walk or stand. An episode can last anywhere from a few hours to several weeks. Some are frequent and consistent—you can almost set your watch by them—while others may arrive out of the blue after a long hiatus.
A common culprit for sciatic pain is a herniated disk (sometimes referred to as a ruptured disk, pinched nerve, or slipped disk). "Your disks can get fatigued like a wire hanger being constantly bent back and forth. Eventually, a disk may weaken and perhaps break," says Loren M. Fishman, M.D., the coauthor with Carol Ardman of Relief Is in the Stretch: End Low Back Pain Through Yoga. "Or a vertebra can slip forward and the nerve fibers may become compressed that way, much like a kink in a garden hose." This can happen due to an injury or trauma, long bouts of physical activity (as is the case with many athletic people who suffer from sciatica), or simply from years of constant bending or sitting for long stretches. It's possible to ignite pain with the simplest movement, much like what happened with Doran. "People may aggravate their sciatica with a sneeze or reaching for a box of cereal," Fishman says.
Yet sciatica is not always related to back issues. "You can have back pain without having sciatica, and you can suffer from sciatica without back pain," Fishman says. For instance, osteoarthritis can narrow the opening through which the nerve roots exit the lower spine, injuring the fibers that make up the sciatic nerve. Another cause is piriformis syndrome, in which the piriformis muscle in the buttock compresses the sciatic nerve. "It's commonly caused by overuse and oversitting, and is seen in people with sedentary jobs like bus drivers and office workers," Fishman says.
Sciatica may seem like a pain to treat, but Fishman says more than half of all sufferers can soothe and reduce flare-ups by combining some form of exercise, in particular yoga, to strengthen the back and help relieve the pressure on the nerve root, with the judicious use of nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or naproxen. Many people have also relied on other complementary approaches to manage attacks. (See "Sciatica Strategies,") Of course, more intense pain may need stronger medications to ease the inflammation, such as oral steroids or epidural injections, and severe or recalcitrant cases may even require surgery to remove the portion of the disk that irritates the nerve root. But a yoga mat and a clear plan may be all that a sciatica sufferer needs.
Managed Care
Can you "cure" your sciatica with yoga? The answer is yes and maybe. "It's wrong to say that your sciatica can never be relieved," Fishman says. But it's also unfair to blindly believe that if you simply put in the time and effort, your pain will disappear forever, says certified Iyengar yoga teacher Anna Delury. That's why she recommends a management-style approach, with the intention to keep your pain at bay, which is more realistic and won't set you up for disappointment.
"You definitely can use the Iyengar method to bring your sciatica under control and make flare-ups less and less common," says Delury, who has trained with B.K.S. Iyengar since the early 1980s and now teaches yoga in her home studio in Los Angeles. "But it is also possible to cure your sciatica with yoga." She speaks from experience. Delury suffered from sciatica for years—the result of a series of childhood falls and an active, sports-oriented youth. It wasn't until she fully embraced Iyengar Yoga, however, that her sciatica withered and eventually vanished. She has been pain free now for 11 years.
Delury emphasizes that managing your sciatica with yoga is not something you can accomplish in a few weeks, or even months. "Everyone is different, but it may take, on average, six months to one year to be able to control your sciatica," she says. "The reason is that it takes longer for nerve and spinal-related problems to heal from injury. It can be painful at times, and you may have setbacks along the way, but you'll also feel relief too."
Sciatica Action Plan
There are different approaches to using yoga to manage your sciatica. It depends on your yoga experience and the severity of your pain. "I've found that 80 to 85 percent of the time, sciatica sufferers benefit from this sequence," she says. Since everyone's sciatica is different, Delury has her students follow a three-tier approach, based on Iyengar's teaching, while doing each pose. They are like individual check marks so students can gauge what they need to focus on, how deep they should go into a pose, and how long they should hold it. Here's a look at the steps and how they are connected.
Step 1 Pacify the pain. Take pressure off the sciatic nerve and rest the lumbar spine by using a variety of props common in the Iyengar tradition: straps, belts, blocks, chairs, bolsters, and walls. "Props provide traction, which releases any pain or discomfort, and they also help educate the body and mind about what it's supposed to feel like," Delury says.
Step 2 Understand proper alignment. When the lights flicker in your home, the likely culprit is a loose wire in the wall. You have to go into the wall to examine the structure and evaluate the problem. The same philosophy applies to your sciatica. You need to investigate where your wires are messed up. Your pelvis and spine work together to ensure proper alignment. Misalignment can cause pressure on the sciatic nerve. Using props helps the body understand proper alignment.
Step 3 Build muscle strength to maintain alignment. To build strength, increase the repetitions of the poses, or hold them longer, or both. You can do this while you learn to align your pelvis and spine in step 2. But you may need to just focus on your alignment first—anywhere from six months to a year—before you are ready to build strength.
Baseline Formula
When you use yoga to manage your sciatica, Delury advises that you cut back on all other activities at first. This means taking a break from strenuous physical activities like skiing or running, or even your usual intense yoga practice. "You have to go to the baseline," Delury says. In her case, she gave up running, dancing, and even sit-ups. "All I did was focus on the sequence given to me by Mr. Iyengar for a year," she says.
This is sometimes more difficult to endure than the sciatic pain itself. It's a big psychological hurdle for active people, especially serious yoga practitioners. But it's necessary, Delury says. The reason is twofold: First, any strenuous activities may inadvertently aggravate your sciatica and cause a setback, and second, you need to break any bad habits you may have picked up in how you move and bend, so you can learn proper alignment.
If you find this complete abandonment too difficult, Delury suggests that you take a trial-and-error approach. If possible, eliminate your most extreme activity first, like marathon running or cycling, or a "lopsided" sport like golf or tennis that emphasizes one side of the body, and monitor how your sciatica reacts.
"Sometimes just eliminating the most intense activity is enough. If it's not, and you find your sciatica still flares up, cut back on another activity, and then another, until your sciatica is OK," she advises. Even if you have to stop doing all sports, you can still stay active with gentle walking, Delury says, while you focus on your sciatica yoga routine.
That's what Toby Brusseau, 27, did. In 2003, he fell 15 feet onto a bed of rocks while climbing in Malibu Creek in Southern California. It caused a herniated disk that triggered painful bouts of sciatica, sometimes so intense that the mere pressure of the keys in his pants pocket was too much to bear.
He took up Delury's yoga sequence, with some modifications to fit his experience level and sciatica. He stopped all other physical activities for several months and focused on just the yoga, sometimes practicing several times a day. This regimen meant he could do no rock climbing, cross-country running, weight lifting, skiing, or mountain biking. Brusseau even stopped going to his regular group yoga class. He admits it was hard to suddenly slow to a crawl like that, but after just one month he noticed a difference and within 10 months felt 100 percent cured.
When the pain began to subside, however, he didn't take it as a sign to throw a harness around the nearest boulder and hoist himself up. He literally took small steps. He began with walks, and when that didn't aggravate his sciatica, he began to run again in his old confines of Fryman Canyon near Hollywood. He began with flat surfaces and worked up to steep hills. When that was OK, he added another of his previous adventures but always gauged how his sciatica reacted. Eventually he made it back to rock climbing.
Brusseau's experience may be unusual, but he's an example of what may be accomplished with diligence and a plan. "So many people are looking for the quick fix for their sciatica, like a steroid shot, so they can get back to their life, but I wanted to feel my way through it," he says. "I wanted to test myself and my yoga to see if it could work—and it did."
Pain Strategies
When a sciatica attack hits, there are several ways to naturally soothe flare-ups or prolonged bouts of pain.
Acupressure In this massage technique, the therapist applies pressure with her fingertips or knuckles. There are about 30 to 40 acupressure points. The goal is to release physical tension to the painful area, relax tight muscles, and increase blood circulation. It's possible to learn how to identify the points and massage them yourself when a flare-up occurs.
Acupuncture In traditional Chinese medicine, sciatica, like other physical pain, is considered a chi (energy) stagnation, says Javaharian Mohammad, L.Ac., of the Pacific College of Oriental Medicine in San Diego. Acupuncture treatments use thin needles to stimulate points in the lower back to help unblock chi and ease pain.
Herbs Many herbalists use St. John's wort flowering tops for mild painful conditions, including sciatica and muscle inflammation, says herbalist Karta Purkh Singh Khalsa. Turmeric is another widely used herb. Its anti-inflammatory effects are most likely due to its active ingredient, curcumin, which gives turmeric its yellow color and may be as effective as cortisone in fighting acute inflammation. Or try a strong tea made from gotu kola (one ounce of dry herb steeped in one pint of water), which can help heal chronic conditions if taken daily for several days or weeks, Khalsa says. (Check with a naturopath before taking these or any other herbs.)
Leg stretches Place the foot of the painful leg up on a box, chair, or stair, while standing, suggests Loren Fishman, M.D. "Lifting the leg stretches spastic muscles in the leg, buttock, and lower back," he says. If both legs hurt, lie on your back, bend your knees, and bring them to your chest. "Make sure your movements are slow and careful," Fishman counsels. For unbearable pain, do the poses while in a warm shower, and let the water cover as much of your body as possible: shoulders, back, and leg; or chest, abdomen, and leg.
Ice Old-fashioned ice therapy numbs sore tissue and can slow inflammation. Apply an ice pack or ice wrapped in a towel (never place ice directly on the skin) to the area around your lumbar spine or wherever the pain is most intense
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