Lower back and hip pain that radiates down the leg. Ouch. Many of us experience this kind of pain, and the good news is in some cases there is something we can do about it at home.
Sometimes things are not quite what they seem. If you have ever felt pain in the lower back that shoots down your leg, you have probably heard the term sciatica. It is a diagnosis given by a physician that means you have a pinching of the nerve that runs down your leg. The diagnosis is required in order to really claim that you have sciatica because, as we will learn today, sometimes it's not really sciatica!
Your sciatic nerve comes out of the spinal column and runs down your leg, branching out to all the other little nerves. Anytime it gets pinched you will get tingling, numbness, pain, or even muscle failure of any area "down-stream" of the nerve.
Before we go any further, remember if you have any serious symptoms you need to see a licensed healthcare professional because there are a bunch of other things that could possibly be going on in this case and it's really important that you rule out some of the more serious things that might be blocking the nerve here.
The term "pseudo" means "fake", meaning it is not true sciatica. The terminology here is just a language quibble, but here's what it means: "True sciatica" is the nerve pinch as it comes out of the spinal column, and "fake sciatica" is the same nerve being pinched anywhere outside of the spinal column. The same nerve is being pinched in both terms, but to you the distinction is important: fake sciatica can be treated at home and with massage, stretching, and exercise... whereas true sciatica often requires medical intervention (you are dealing with the spinal column here, don't mess around with it if you don't really know what you're doing!).
One appropriate term we can use is "Piriformis syndrome" because it is often the piriformis muscle (a muscle that helps rotate your hip) that is actually pressing on the nerve.
A quick test that might help you determine whether you have true sciatica: the straight leg test.
You will simply raise (or have a professional assist in raising) the leg why lying down, and see if your symptoms occur/intensify as a result of the movement. If this test is positive (your symptoms are reproduced) then read no further, call your family physician or physical therapist and get a professional evaluation (please).
If that does not reproduce the symptoms, then you can poke around the hip bone and see if it's really tender. If it is, you probably are experiencing tightness of the piriformis muscle. Now let's get to fixing it!
Addressing the cause of the problem:
Pseudo-sciatica often comes from sitting at a desk too long, especially with a wallet in your back pocket. Holding one posture for a long period of time can make the rotators of the hip take on more of a postural role, causing it to tighten. Conversely, too much exercise can result in a type of overuse injury that also causes the muscle to tighten, especially if the exercise is a repetitive movement in the back/forward motion (remember the piriformis rotates the leg in the inside/outside motion) which causes the muscle to take on a postural support role. Similarly, a parent who holds their child on one hip will engage that posture shift, or a dancer who must maintain tone while the leg is extended, each have this feature of overuse in common for this particular muscle. When you know what causes the problem you can start to see the patterns that might contribute to it. For most people the first step is to add more movement to their lower body during their desk-sitting day. For athletes it means adding in some stretching and active resistance in the proper direction (the rotational plane) and regular maintenance of the hip muscles.
One of my favorite self-care tools is the tennis ball. For this trick I like to address all of the muscles that attach to the hip, but for the sake of brevity we will limit the current post to the gluteals and posterior hip rotators (just know addressing the quads and adductors is useful as well... because of the whole newtons 3rd law thing: each force has an equal and opposite reaction- in this case meaning the opposing muscles are contributing).
This self-massage is fairly simple. Place a tennis ball on the wall and lean against it. Or on the floor and lay on it... sideways, back, all around... you are feeling for some of the "X marks the spot" pictured above, and you can expect to feel radiating pain to the areas colored in red (not everyone will). You are going to find the sore spot and I would lean into the tennis ball for 15-30 seconds with moderate pressure, then ease up on the pressure and roll around a little as though you are pushing fresh blood into the area. The picture above shows gluteus medius and gluteus minimus, the one on the right shows the piriformis muscle. In the end the precision of tennis ball placement will come down to where you can feel it working. Sometimes that signal will be a sudden twitch of the muscle (it will withdraw as a protective reflex) or simply the signal will be dull radiating pain that mimics your pseudo-sciatica symptoms.
For this self-massage you don't want to over-massage the area, it will cause more harm than good (even though it might feel like you can keep going), limit yourself to 15-30 seconds in a particular area, then move to the next area around the hip joint. Wait a few hours before repeating the self-massage.
For all stretching and exercises I highly recommend employing the expertise of a Personal Trainer or Physical Therapist. Even as a therapist myself, I often find it very useful to get assistance from a colleague. So when you approach new stretches do so with caution. There are several variations for each stretch, for example if you can't do the stretch laying down, you can do it seated in a chair by crossing your ankle over your other knee, and leaning forward to stretch the hip.
Cross body stretch should only be done if there are no symptoms of lower back spinal injury. Even if you are injury free, remember you want to feel the rotation coming from the hip, do not let your lower back twist too much.
If you have a resistance band at home you can get some awesome stretches that are better than body weight alone. Again, exercise caution you don't want to pull too hard and injure the muscle. For this one you start with the band fixed to something (you can place it in the doorway if you don't have something to tie it to) and put your leg through the loop of the band, move away from the fixed point until there is some tension, then let the leg relax into the stretch.
Variations of the figure-4 stretch or pigeon pose: lying down, sitting, lunging, or even sitting in a chair. The main thing is that you get the ankle across your body while your knee rotates out. You should feel this in the back of the hip.
I hope this helps some of those frustrating instances of pseudo-sciatica! Please let me know if you have any questions or comments!
The neck can be a particularly annoying place to get that nagging ache and feeling of tightness. It can be distracting and hard to work out. I personally get frequent headaches as a result of neck tension, and have tried many things to help relieve the tension that builds up in the neck as a result of posture, stress, and just living life. Today I'll go through a few of the self-help tricks you can use to loosen up your neck, with a focus on the base of skull muscles, the suboccipitals, and the other muscles that also connect to the area.
As always, I really really recommend seeking out a professional if this is an ongoing problem. Some of the techniques here I am passing along as they have helped others, but they don't work for everyone, and I often find myself going to a well-trained therapist in order to finally find relief from this problem. Additionally, it's good to screen for other, more serious problems. If your neck is so tight you can't move your head and you have a bad headache with it, you need to hop a ride to the Emergency Room, meningitis isn't something to mess with.
We'll start with a look at the muscles in the neck, then a few tricks on how to find some relief for neck tension. If you need to, you can review my post on "How Muscles Work", and we will be talking about some of the Trigger Points in the neck if you need a brief review see my post on "Trigger Points".
The suboccipital muscles lie just beneath the base of the skull, you can feel them when you run your hand along the underside of the bony back of your head.
The pattern of tension can develop from the posture a lot of us use every day: looking down. When you jut your head forward and look down at your phone, your book, your computer, it really puts strain on the suboccipital muscle group. To help correct this, we will use a combination of direct self-massage, some mobility stretching, and a few exercises to help diffuse the tension and allow some of the other muscles to do their job if this area is being a little overactive.
If you have a lot of tension here, it may take a lot of pressure to get into the deep layer of the suboccipital muscles. While you can try massaging these muscles with just your hand, it will certainly be a lot more comfortable to use a rounded tool, such as the knobbler, or a tennis ball. Laying face up, move the tool just below the base of your skull, to either side of the spine (not ON the spine) and let the weight of your head gradually increase pressure on the neck muscles. You can press and hold on a particular spot, or rock back and forth slowly to loosen up the neck. As you become more familiar with the feeling, you can apply more pressure safely to help release the tension, but I don't recommend pressing for more than 30 seconds at a time at this pressure.
Another phenomenon of pain in the neck is that sometimes where you feel it doesn't necessarily mean that's where it's tight. Pictured above is the trapezius muscle, and it is common for the tension coming from your mid back to actually create enough tension to "pull" all the way up to the neck (the red spots in the image show the referral zone- the pain felt some distance from the trigger point). When you are working your neck, don't leave out these spots, also accessible with a tennis ball (what a versatile tool)!
Simply shift the tennis ball (or whatever tool you are using) to the ares indicated by the X's in the above picture and let your body weight sink into the ball. It may help to visualize your muscles slowly releasing or melting away under the pressure.
To find these spots most accurately, note their location to the nearest bony landmark (like the upper edge of the shoulder blade (5), lower edge of shoulder blade (3), just on top of the bone of the shoulder blade (4), and be careful of the bone on number 6).
Exercise and Stretch
As we've discussed in the past, there are two ways movement works in our muscles: we can aim to stretch (lengthen) a muscle, or we can exercise (contract) a muscle. Many people use the word stretch and exercise interchangeably, but they are not the same.
Both can be useful for helping with neck pain, but the most evidence points toward exercise as being a long-term relief strategy.
When beginning new exercises I always always always recommend working with a professional who can guide you through the steps. They will help you to make sure you are going through the motion in a way that will best recruit the muscles we are trying to target, as well as avoiding injury and addressing concerns you may have as they arise. Remember, exercises are specific to the muscle you are working- running won't strengthen your arms, for example. Don't "wing it", learn the correct movements that will target the neck muscles and supporting groups, and the right weight and speed of contraction to get good results.
Look over this helpful guide written by a personal trainer for some of the exercises that are commonly recommended for this muscle group. The goal here is to help strengthen some of the muscles on the posterior neck and upper back. The reason we want to do this is because these muscles are stressed from holding your head up and forward all day!
Think of it like this: as your head leans forward, the muscles in the back get longer, but they still have to do their job of stabilizing your head. So these muscles are already stretched, what we want to do is strengthen them.
The main goal will be to introduce exercises to strengthen them.
I have to emphasize this. Many people find stretching easier, you just relax and let the muscle lengthen. But again, you need these muscles to get stronger to get the best relief. If you just stretch them, all your doing is making a long muscle longer. You need to add exercises.
OK now that I've called stretching nearly useless, I need to walk that comment back- no it's not. You probably need to do them both, it's just that people tend to ignore the exercise portion of this advice. So let's get into the stretching part!
To stretch the suboccipital muscle group, simply grab a towel and fold it up so that you can still get a handle on it. Place it on the base of the skull just under the curvature of the skull, and do two variations:
1. pull forward and down
2. pull forward and up
There is a drawback to doing this by yourself. When pulling up, you are looking to cause gentle traction on the top of the neck. When you do it yourself you are using the muscles that lift your arms, which means you can't fully stretch them because you are also contracting them. A professional therapist can help a lot in this way.
This article has a few other tips for some self stretching for the neck.
The physiotutors have a great video on fixing trapezius tightness that goes along with this very well.
And check out this video for a few more tips on stretching your neck using a towel.
I hope this helps with this pesky problem! Please let me know if you found any of these tips useful, or if you feel like you understand how your neck works a little better!
This post is intended for those who have irritation or discomfort near the shoulder blade without a clear cause (such as posture from being sedentary). If there has been trauma to the back or shoulder, or very sharp pain, I highly recommend contacting a professional. This post will have a few tips for things you can do for self-maintenance at home, from quick pain relief to more long-term techniques to keep the discomfort at bay. I must add extra stress on the long term techniques, especially for those who often are at the computer or looking down at their phone a lot. This pain pattern might also be explained by something called Upper Crossed Syndrome if you are interested in more information.
To see what may be causing the pain at the shoulder blades, I recommend looking over my first post on the topic.
This post is in no way meant to replace professional advice, and please be very mindful that you do not have other conditions going on (such as osteoporosis) before following any of this advice, and for heck's sake get an actual evaluation from a Physiotherapist if the pain is really bothering you. With that being said, here are some things you can do at home to help with mild discomfort of the inner shoulder blade.
1. Topical Analgesics
One of the easiest ways to deal with aching muscle pain is to just cover it up for a little bit. Of course this won't help in the long run but if it's driving you crazy, or just needs some time to heal, topical analgesics can help.
Some common recommendations:
and a host of others. Some people find pain relief from simple peppermint essential oil. Try one or two out, and see how you respond.
2. Hot/cold pack
The next simple thing to do is add some heat and cold to the back.
Prepare an ice pack in the freezer (or a bag of iced peas) and use a dry towel so the ice does not make direct contact with the skin (and also to hold it in place easier).
For heat, soak a towel in hot water, wring it out, and toss it in the microwave for a minute or until hot.
To alternate heat/cold, simply leave the cold on for 3 minutes, then put the heat on for 3 minutes, and repeat alternating a few times.
The idea behind this: heat causes expansion of blood vessels, cold causes contraction of blood vessels. By alternating them you are expanding and shrinking the blood vessels, and for some this can create a relief from pain.
3. Self-massage and Stretch
You can work on your own back and shoulder blade using a tool such a tennis ball. I have also used a theracane, a curved tool that you hold onto, with good results.
The Painotopia website has as great guide on how to locate the muscles you want to massage.
First you can try some trigger point therapy on yourself. This may provide temporary pain relief but I caution against using this method long term. Since the rhomboids are already elongated, you are effectively making a long muscle even longer. Actually, for most people, the better, longer lasting treatment (that nobody wants to hear), is building the strength of the muscle. (ref: J Phys Ther Sci. 2016 May; 28(5): 1636–1639) Which we will get to later.
Place a tennis ball on the wall and lean your back against it to hold the ball on the wall. Adjust the location of the ball so that it is right at the shoulder blade where the rhomboids attach (as shown in the picture), and check for any tender spots. When you locate the tender spot, lean into the ball to create a deep pressure and hold that pressure for 30 seconds. You want to feel a deep radiating 'ache' but it should not really be painful (if it is, stop). You need to make the distinction between good ache versus burning stabbing pain, the latter meaning you should stop immediately.
Now do the same thing for the spot at the infraspinatus, moving the ball onto the shoulder blade. This one can take your breath away, trust me I know. It can also really help to release this trigger point for a number of issues. You'll look for a really sensitive spot and lean into it for 15 to 30 seconds. The possible locations are marked as X's on the image below.
Next, do the same for the teres major/minor muscles (you'll be hitting part of the latissimus dorsi muscle as well). For this one place the ball on the wall and lift your arm overhead. The ball will almost be in your armpit but don't let it go in the actual pit, keep it on that muscle that makes the back border of the armpit. You might have to roll up and down the muscle slowly til you find that tender spot, then press and hold on it.
Next we will work the front of the shoulder. Go to a wall corner or door frame, place the ball on the upper pectoral near the shoulder, and lean forward. Let your arm hang next to you so that you're not activating or straining it, just relax into the pressure (the area marked by the X below). The reason we use a wall corner here is so you can lean past the wall. This works well in a door frame, so your torso leans forward while your shoulder stays on the frame. Next, remove the ball and position your arm fingers pointing up on the door frame, and lean forward slowly to stretch the pec muscle.
Lastly you can try a self massage for the scalenes. In order to do this safely, start with very light pressure, and if you don't know how to apply a lot of pressure with the finger tips, you will simply use friction (moving the fingers back and forth over the muscle) to help loosen up the area. I highly recommend finding a professional massage therapist or physiotherapist to work on this area for you.
Using the opposite hand, put the fingers on your collar bone (right hand if touching your left collar bone) and move back just a bit so your fingers sink into the groove. Press down slightly, then move your finger tips left to right (not too rapidly) for about 30 seconds. Tilt your head back, your chin going in the opposite direction from your collar bone, to stretch the scalene muscles.
You can also add a passive stretch by simply laying back with something under your back. Use a foam roller or thick pillow, lay flat on the floor with the pillow under your mid-back parallel with your spine, and allow your shoulders to fall back, and lay in this position for 10 minutes or so.
4. Exercise for the shoulder
Using exercise for shoulder mobility is going to be the best way to stabilize the shoulder, keep it toned, and keep it from aching from posture. In my experience, the mid back pain most often comes from being immobile or sedentary.
In this section I will recommend a couple different types of exercise, one of which is resistance exercise. The reason this is important is that it helps to cue the muscles to contract against some kind of resistance, which will be important for it to hold that shoulder in place without pain down the road.
What a lot of people don't realize is that you can use a personal trainer for a sort of check-up, like you would a dentist. It is really helpful to have someone there to make sure you're doing the movements correctly, that your mind-to-muscle connection is happening, and that you're using the right progression in exercise. So I recommend finding a good personal trainer who knows the importance of these things to do a session or two with, even if you are a self-motivated person.
These exercises will target the muscles around the shoulder blade using body weight or resistance. There are all sorts of machines you can use for adding resistance, and if those interest you I recommend hiring a personal trainer for a session or two to learn how to use the machines properly, or ensure that you are targeting the correct muscles. For home use, I recommend dumbbells or a resistance band. Either way, start off light and gradually increase the resistance you are using.
Rows are any movement that pull your shoulder blades back together. You can use a resistance band around your feet, you can put the resistance band in the door, or you can lean forward and use a dumbbell. You can adjust your arms to change which muscles you are targeting. For this particular target, keep your arms about shoulder height and pull the elbows back, focusing on pinching the shoulder blades together. It may help to have someone behind you touching your rhomboids- this will help your brain to make sure you feel the contraction occurring in the rhomboids and not just the rotator cuff. It is a common mistake to only rotate the arms instead of pulling the shoulder blades back (the latter is our goal here). While this will target the rhomboids and part of the trapezius muscle, other shoulder stabilization exercises that you might learn from a person trainer will benefit you in many ways to have a well-rounded and stable shoulder.
2. Super man
Lying on the floor, lift your arms up and pinch the shoulder blades together, hold for two seconds, then return to the floor. Don't let your head come back, focus on just pulling your shoulder blades together. Repeat 8 to 12 times and rest.
3. Scapula Push-up
This one is a fantastic shoulder isolation exercise. I have found it to be very useful, just follow the video.
These are just 3 ideas for waking up the rhomboids and trapezius in your back, and if that is the source of your pain, the exercises will really help more than anything in reducing your pain, and helping you to feel like your shoulders and back are more supported.
For more exercise ideas, have a look at a few of these links:
An interesting muscle group that deserves it's own post. This muscle is sometimes involved in lower back pain, leg and knee pain, and causes a forward rotation of the hips. It's often involved in overuse injuries, or when lifting something while twisting the trunk of the body, and can sometimes manifest as a 'twinge' in the lower back.
If you've had a session with me (or another therapist) for lower back pain, you may have heard about this muscle. It's a difficult one to describe without the use of visual aid, so in today's post we will unpack what the Psoas muscle group is, and some tips on how to keep it healthy.
The psoas muscle group is a combination of the iliacus and psoas major, and is generally called the Iliopsoas. I often simply say "psoas" to imply both muscles. The psoas originates at the lower spine, and sort of 'fuses' with the iliacus muscle at the inner thigh (a spot on the femur called the lesser trochanter).
It's a little difficult to explain because it is on the front side of the spine. So to actually palpate the muscle, we have to do so through the abdomen. This can seem fairly invasive compared to other treatments, but can be done safely and effectively with manual therapy. There are even some guides on how to do some self treatment.
The iliopsoas is a hip flexor, which means it helps lift your leg forward, or bring your knee toward your chest. It also has a little role in rotating your leg outward, too. Knowing those directions will help when we want to stretch this muscle, because in order to stretch it we have to move it in the opposite direction to how it normally contracts. In day-to-day life the iliopsoas muscles help us maintain our posture, walk, run, and stabilizes the lower spine. They are innervated by the L1-3 and femoral nerves.
When the psoas is tight, it can contribute to a number of problems. One of the most common is Lower crossed syndrome, where the pelvis tilts forward, resulting in a curved and strained lower back. In some cases it can show up as locked lower back with the head tilting forward like a hunchback. In both cases, getting psoas work (massage, stretching, trigger point work) can be beneficial.
Testing the psoas muscle can be helpful to determine the cause of knee and leg pain as well as lower back pain. The hip flexor muscles can be indicated in patellofemoral pain syndrome.
Trigger point work and stretching for the psoas can help to relieve lower back pain, groin and leg pain, knee pain, and can help to correct issues further down the leg and foot, as well as the upper back.
The psoas is in a short position when we are sitting, so for many of us it seems that it is no surprise it might be tight. Moderately stretching this muscle group is useful for most people as a form of general maintenance, and massage can be a great way to help keep the muscle in healthy tone. (I always caution against over-stretching)
The psoas can be stretched by bringing the leg back as in a deep lunge, either standing or kneeling down.
“What are Trigger points?”
The introductory version.
Have you ever felt a pinch in a muscle, or a spasm that sent a feeling like a jolt or searing pain? Maybe it felt like you were unable to rotate your head like you should, perhaps you couldn’t reach back with your arm as far as you normally would, or even bend over to pick up something. Well, there are actually many things that could be causing this pain, but today I’m going to break down just one of those many possible causes. Today I’m going to talk about pain originating from a muscle.
Now, pain doesn’t come from muscles, it comes from nerves. That’s the signal system the body uses to convey the things you feel, through a variety of receptors. But when I say pain from a muscle origin, I mean skeletal muscle, not pain coming from two bones pinching a nerve, or from your stomach being irritated.
How does a muscle cause pain? This warrants its own post (coming soon™), but to summarize: in many ways. You don’t have to pull a muscle for it to hurt. You can underuse a muscle and it can cause pain- yes that’s right, you can sit around all day and that could lead to your muscles becoming atrophied or “shorter”, causing pressure to be placed on a nerve. It could be from dehydration, or even a lack of some dietary minerals. It can come from a lack of blood flow getting through to deliver important nutrients. It could be a sudden intense event, or doing one movement many times (overuse injury). It could come from sleeping on it funny, from twisting in a way its not used to… whatever the reason, your muscle can get little “knots” that feel very sensitive. Some of these knots are called “trigger points” and the resulting pain is called “myofascial pain syndrome”.
The painful areas may not necessarily be where the trigger point is. For example you may feel pain or numbness in the hand, but the tight muscle might be in the neck or shoulder. The hand would be considered a “referral zone”. There are many of these zones, where pain is referred, and a therapist who studies trigger point therapy learns many of these patterns.
Why don’t I just ignore my pain and carry on?
Well, there is a certain amount of “tough it out” that is good for you. On the other hand, there are reasons that your body is telling you it’s in pain. Mechanisms kick in that cause your balance to shift, your mobility to change, and these compensation habits can have lasting effects. Some are subtle, but for an obvious example, let’s say your knee is hurting and you shift your weight to the opposite leg. Over time, your weight to the leg that feels fine, and you begin to build stronger muscle on only that side. Perhaps your lower back may start to ache, as the rest of your body stabilizes itself to keep you upright. You could further extrapolate from here that your shoulders might then be affected, and your neck, and who knows maybe even your brain becomes lopsided (probably not)… but it may be sufficient to say that small adjustments over time can lead to imbalances that could have been prevented. You can work on your trigger points at home or with a massage therapist.
The actual mechanisms behind trigger points (what causes them) is a fascinating and debated topic that I will cover in later posts.
What's going on with me, research articles, interesting little blurbs. This blog is an attempt to consolidate research into an easily digestible format.
Alex Moon has been a Licensed Massage Therapist since 2012, did his undergraduate studies at Utah State, and is currently working on his Doctorate in Physical Therapy.