All About Sciatica

8/12/2019 All About Sciatica

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4.$hysical&herapy5.)edical $ractitioners

All About Sciatica and A!oac" To T!eat#ent

The term sciatica or Sciatica has been used to describe thesymptoms of numbness, tingling, burning and achy soreness alongthe sciatic nerve path, a nerve which extends from the buttock areadown the back of the leg to the foot. One major cause of sciatica is adisc herniation which has placed pressure on the sciatic nerve. Thediscs are composed of a spongy-type cartilage material with a liuidfilled center. The discs separate the vertebrae and thereby allowroom for the sciatic nerve to properly exit through the sacral portion ofthe pelvis into the leg. The discs will cushion the spine from

compressive forces, but have weakness with regards to the pressureapplied during rotational movements. That is why a person whobends over to one side at a bad angle to pick up a piece of papermay be more likely to herniate the disc than a person falling off aladder and landing on their back. !ompression of the sciatic nervefrom a disc herniation occurs when the center of the disc bulgesoutward, tearing the outside ring of fibers and ballooning itself ontothe root and thus causing sciatica. Other compressive spinal type ofcauses include Spinal !anal Stenosis, a condition in which the canalthat the spine runs through narrows to compress the cord itself. This

canal narrowing can lead to a decreased space for the sciatic nerveto exit, and thus cause a pinching and friction irritation. The sciaticnerve runs through a muscle in the buttocks region called thepiriformis. "hen the muscle shortens or spasms due to trauma, itcan compress the sciatic nerve. This cause of sciatica symptoms isknown as #iriformis Syndrome. The approach to treating Sciatica isto reduce the compressive forces that are causing the pressure onthe nerve. This can be accomplished through traction andrealignment therapeutic procedures in the case where it is spinal

related. $anual muscle stretching, massage and mobili%ationtechniues should be utili%ed when it is piriformis related. &eneralgoals include helping the muscles to loosen up and thereby lessenthe pain and to minimi%e any inflammation. The listed Therapies,#roducts and 'ctivities section will give more information on how tohelp your condition, however, as each Sciatica condition is different,
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always consult your doctor to determine what treatment is right foryour particular situation.

&herapies, $roducts, and Activities to Help 'our (ondition6

(hoosing the (orrect )attress

' good mattress will protect the back for the many hours that you arein bed. ' mattress that properly supports the body will also be a veryimportant element in helping relieve stress on the muscles and jointsof the back. The most important information needed for finding acorrect mattress to support the back involves knowing what positionyou sleep in. The menu below will help you to search for a mattressthat is right for you.

Choose a sleeping position:

inding the +ight (hair or Seat nsert (ushion

"hether you sit for minutes or hours, you can(t underestimate thevalue of proper posture while sitting. )t has been demonstrated thatat times there can be as much as six times the amount of stress onyour back when you sit than while laying down. *ortunately you canlower the amount of stress placed on the spine with proper backsupport. To accomplish this, first you must decide whether the chairyou use presently is adeuate for your needs. ' good chair will beable to provide your lower back with proper lumbar pressure. Thispressure will keep the curve of the spine in this area supported in thenormal position. "hen a proper lumbar support is not provided withyour chair, an insert lumbar cushion can accomplish this. The si%e of

the cushion is very important, as too much lumbar support cancompress and irritate the spine. ' good working ergonomic type ofchair can be adjusted to allow tilting and height control of the seatand chair back. +ere are some tips for adjusting your chair properly

'djust the height of the chair to allow your feet to rest comfortably onthe floor. 'djusting the tilt angle of the seat will change the positionof your pelvis, thereby shifting the back towards or away from the


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seat back. Tilting the front of the seat downward will bring your lowerback into extension and thus increase the lower lumbar curve. Tiltingthe front of the seat upward will bring your lower back into flexion andthus decrease your lumbar curve. !ombine the seat angle tilt withthe seat back tilt for optimal support of the back. )f the seat backheight can be adjusted, make sure the small of your back fits with thepart of the seat back which curves outward to support the lowerback. )f these adjustments still do not support the spine properly, youwill definitely need a lumbar insert cushion or more ergonomicallycorrect chair. )nsert cushions will need to have height adjustability tofit correctly. This is usually achieved with a strap that allows you toset the height of the cushion to the thickest part against the small ofyour back. ach person(s spine curves differently, so anotherimportant feature that some back support cushions provide is the

ability to adjust the si%e of the lumbar thickness to customi%e the fit."e found two different types of backrest cushions that meet the strictcriteria of what we look for when helping patients to properly supporttheir posture while sitting see link below/.

Soft #ack #races

0ack braces can be necessary when an injury creates instability tothe spinal column, as it will protect the back from further injury. Softback braces can be useful for support of fatigued muscles and allow

temporary relief to the irritated tissue in the initial stage of injury.+owever, wearing a back brace for prolonged periods after the areahas finished with the initial healing stage can also weaken the backmusculature over time, as the muscles will rely on the brace to keepgood posture. "hile too much movement of the back may causeexacerbation of the Sciatica, completely preventing movement of thearea has been shown to hinder the healing process. The bestsolution is to find a brace that puts pressure directly over the irritatedarea only, thereby protecting the tissue, but also allowing the rest of

the back muscles to still be used. Short term use of a back brace willnot cause any weakening of the back muscles. )f the muscles arecompletely not used for prolonged periods they will weaken overtime. To avoid this, once the injury has healed sufficiently enough,use a back brace only to support the back during any activity thatreuires protection for the spine. )t can be noted that the use of abrace while sleeping should not cause the muscles to weaken, but


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many patients find that overusing the brace can become irritating tothe skin underneath. $ost of the patients we survey tell us that usinga back brace which puts direct pressure over the irritated areaprovides instant relief. The back braces which we believeaccomplishes this the most proficiently is one of the types depictedbelow with the patented adjustable air pressure bladder incorporatedin the belt. )t also offers attachable ice gel pads for direct ice therapysee the )ce #ackssection for more information on ice therapy/.

Traction Devices

!aution should be taken when applying traction to any newly injured

area, and should not be performed in these cases unless specificallyrecommended by your doctor. 1umbar low back/ traction can beaccomplished through various products which keep the pelvisstationary while using gravity to force separation of the vertebrae andthereby open the spinal canals that the nerves exit through.+owever, the multifidous muscle which attaches to the lumbarvertebrae may not allow the separation of the vertebrae if the muscleis in too much spasm. Some types of traction allow for betterseparation when the multifidous muscle is in spasm. One such type

of traction is performed by doctors of chiropractic through applyingpressure manually to the spine while a flexing table tractions thespine in a downward motion. This is especially true for Sciatica, asflexion traction will produce a pumping motion which can act like avacuum to pull any protruded disc material inward while opening anycompressed canals between the spine known as the foreman wherethe nerves exit. )n the earlier stages, light traction can provide anunloading of the spine, thereby releasing the nerve pressure betweeneach segment created from a decrease in circulation and an increaseof inflammation within the joint space. )n later stages, tractioncombined with body movement may also help to break up scar tissuebuild up between the joints. "hen the muscles are in too muchspasm to allow for this type of traction, upright types of traction unitscan enable a person to move their body during the therapy to avoidfurther muscle spasm, while providing a relieving therapy to thespine. +ome traction units may be beneficial, but caution should be
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taken not to apply too much traction too uickly to the back, as thismay initiate a spasm to the surrounding musculature. Therefore, onlytraction units which can gradually increase the separating of thevertebrae and allow unloading of the spine without reaching too muchdrastic pull would be recommended. *or home use we recommend aseated traction therapy where a person is able to move the body tohelp avoid any muscle spasm of the back while taking pressure offthe spine see link below/.

Electric Stimulation Devices

lectric stimulation is an effective way to reduce pain. This isaccomplished though blocking the same pain receptors that causethe nerves to irritate due to the Sciatica. $icro-current is a specifictype of electric stimulation which has been shown to stimulate healingto the injured tissue. Some electric stimulation units can charge themuscles to contract when the intensity is raised or it is placed over amotor point of the muscle. 't times, this contraction causes themuscles of the back to loosen up by fatiguing them, while other timesit may cause further irritation to the tissue. +ome electric stimulation

devices may not always be as effective as the more costly typeusually found in a health practitioner(s office.

ltrasound

2ltrasound is an extremely effective way to stimulate proper tissuehealing. Sound waves are generated from a crystal vibrating insidethe head of the ultrasound wand and then transmitted through soundconducting gel to the tissue. This allows the sound waves to break

down unwanted scar tissue, increase circulation to the area, and helprelax the musculature. This can be extremely beneficial in the casewhere a Sciatica has caused soft tissue irritation to the back.2ltrasound can only be used in the presence of a licensed healthpractitioner.
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ce $acks

)ce can be used in the initial 34 hours of an injury to reduceinflammation and numb the pain associated with Sciatica. Onepotential problem with ice is that temporarily it will tighten themusculature even more. 'lso it should be noted that ice should notbe used for longer than 45 minutes to an area, as it will cause areversal reaction which will allow the tissue to become moreinflamed. *or low back inflammation we recommend using acombined brace and ice gel pad to put a more firm pressure over theirritated area. This will also provide support over the injured areawhile providing ice therapy. #atients we surveyed feel that the braceand ice gel pad combination below works extremely well see Soft

0ack 0racesection for more information on bracing/.

Hot $acks

+ot packs are useful for increasing circulation and thereby looseningup the muscle tissue. "aiting to use heat therapy until three daysafter the onset the Sciatica first occurred will give the swelling a

chance to go down, as heat increases the inflammation to themuscles. )t is believed that moist heat is better than dry, as there isless possibility for dehydration to the musculature. "e found asimple to use moist heat pack depicted below/ which contains beadsthat activate upon being heated up in a microwave to give off moiststeam without adding water. This occurs from a natural process bywhich the beads retain moisture from the air. The ease of use,combined with the comfort of this product, make it a very populartherapy with the patients we surveyed.

/hirlpool and 0acu11i /ater &herapy's previously mentioned, moist heat therapy is useful for increasingcirculation and thereby loosening up the muscle tissue. )n the caseof a heated whirlpool, the heat will completely surround the area.

'dd to this the jet massaging action of a 6acu%%i and you have agreat way to relax the muscles of the back. "aiting to use heat
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therapy until three days after the onset the Sciaticafirst occurred willgive the swelling a chance to go down, as heat increases theinflammation to the muscles.

)echanical )assage Devices

$any of the same benefits seen with regular massage can beaccomplished with mechanical massage devices that penetratedeeply through a tapping action called percussion, and therebydisperse lactic acid in the soft tissue and increase circulation, givingan overall relaxing effect to the musculature. This can be veryeffective for the 7knotted up7 type of musculature. $ore superficialmassage devices that just vibrate may serve to increase circulation tothe tissue, but lack the other aforementioned benefits. )t should be

noted that the stretching of the muscular fibers will not occur like itdoes in manual massage. #ercussive massagers should be used onslower speeds when the soft tissue is very inflamed, as it is lessirritating to the area. "e found an extremely effective, yet affordablevariable speed percussive massager that can be used on the neckand back pictured below/ and feel that it meets every criteria we lookfor in a home massager.

&opical Analgesics for $ain +elief

Over-the-counter sprays, sports creams and ointments that haveanalgesic properties can be useful for pain control of the Sciatica,without any intestinal side-effects. $enthol is the active ingredientwhich works to block pain receptors and help relieve pain in the softtissue and joints. The higher the menthol percentage, the strongerthe formula. Some companies use as much as 89 percent menthol,

but that much is not necessary to achieve results and can causeburning side effects. $enthol can be derived naturally frompeppermint or be synthetically produced. :atural menthol penetratesthe skin more effectively. Other ingredients such as capsaicin,peppermint and eucalyptus can also help to block pain. ;eep in mindthat capsaicin or capsicum are responsible for the burning


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stop attackers. 2se of these !ayenne pepper derivatives can leaveresidual numbness and tingling in an area for days after each use.Some companies are also using other herbs believed to have naturalhealing, relaxing and mild anti-inflammatory properties such as )S)methylsulfonylmethane/ and 7lucosamine, but most only add trivialamounts. &lucosamine and $S$ are usually taken in oral pill form.=osages usually range between 8,555-8,>55 mg a day.&lucosamine is currently undergoing many trials to determineeffectiveness for helping cartilage repair. Studies have demonstratedthat patients with deterioration of joint cartilage halt and evenregenerate the tissue after taking &lucosamine for at least sixweeks.

*or a topical pain reliever to work effectively it needs to have a good

transport mechanism ability to let ingredients be able to pass throughthe first layer of skin down to the deeper tissues below/. )n theory,supplements such as 7lucosamine Sulfate and )S) have smallenough molecules to pass through the skin barrier and not just affectthe top of the skin, but rather penetrate deeper down. 0ecause&lucosamine and $S$ absorb so well, they also make great skinconditioners. "here as taking &lucosamine and $S$ will affect yourwhole body, placing it over an area can add 4? times more than a pillwould provide over a specific area. Topical pain relievers with oilsand waxy substances like glycerin, strearic acid and cetyl alcoholwould make a poor transport mechanism for ingredients like&lucosamine and $S$, yet some companies continue to use thisingredient. "hile methyl and propyl paraben are preservatives thatoffer an indefinite shelf life, they also lessen the penetration of atopical pain reliever.

Therefore, the best type of topical analgesic is one that combinesgood powerful natural ingredients, with a good transport mechanismthat has no preservatives, but also no oils to block penetration or

eventually turn the formula rancid. Therapain #lus shownbelow/ meets the above criteria and has proven successful with thepatients we surveyed.


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2itamin, )ineral and Herb Supplementation

!ertain vitamins and herbs can be used as supplementation for thebody(s natural healing and defense system. The @=' recentlyincreased some of its recommended daily values for certain vitamins,and has listed tolerability ranges See @='(s website for furtherinformation/. )t has been a long standing debate as to how muchextra supplementation can be utili%ed by the body, and manycontributing factors may play a part in this process. These factorsmay include weight, smoking, exercise, stress, pregnancy, anduality


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)edications

One of the most freuent uestions our health experts encounter iswhether medication should be taken, and which one would be rightfor them. )t is important to remember that medications are aimed attemporarily reducing pain, inflammation, and relaxing the body, buthave not been proven to increase healing to the area. +ere are someof the most commonly mentioned medications

*or over-the-counter medication, )buprofen has been indicated fortemporary pain relief. Studies have also shown that in higheramounts, )buprofen can act as an anti-inflammatory, but a medicaldoctor(s prescription is needed for this dosage. 'spirin and

acetaminophen are also indicated for muscle pain relief, but do notshow anti-inflammatory properties in prescription dosages.

'cetaminophen does not have warnings about adverse reactions forpeople with aspirin allergies, as it is not an aspirin derivative. )t hasalso been demonstrated to be better tolerated by people with weakintestinal systems. "hile 'spirin is known to be more abrasive onthe intestinal system, it may have other side benefits such as bloodthinning that prevents the blood clots which can lead to strokes andmyocardial infarctions.

's these medications work to block pain and inflammationtemporarily, it stands to reason that the need for these medicationscan occur when a person can no longer function due to the pain orwhen it hinders sleep and thereby impedes the body(s naturalhealing process. ' person on pain medication should consider thatthey may more easily overdo it during the temporary relief period,which could cause further injury to the muscles.

C's side effects can occur, always consult your medical doctor todetermine if and what medication is appropriate for your situation.C

-3ercises and Stretches for the #ack

'll general exercises and stretches listed will can help to increaseback stability and flexibility. +owever, as each type of Sciatica


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condition is different, always consult your doctor to determine what isright for your particular situation.

!lick on the *ollowing #icture to go to the section on general backexercises

'oga and )editation to +ela3 the #ack

@egardless of the current situation your back is in, relaxing could bekey to helping it heal. "hile meditation can always be useful forachieving this, Doga can at times be irritating if caution is not taken.Doga is a series of slow movements combined with stretches andmeditation to allow for an increase in flexibility and relaxation to themuscles and joints, as well as to help optimally integrate theconnection between the mind and body. +owever, what might seemto be easy maneuvers should still be treated cautiously, as your

individual situation may prohibit certain Doga moves. One simplemeditation practice that is usually met with good success is to closeyour eyes and visuali%e yourself in the most happy and relaxing placeyou know of. Sometimes just taking the time to do this can be whatyou need to begin the healing process.

(orrect Shoes for Avoiding #ack $ain

"hile walking is one of the overall best exercises for your health, theshoes you choose to stroll in may just be the difference betweenhurting your back and helping to keep it strong and loose. +igh heelshoes put your spine in extension, which can impact the joints furtherwhen the vertebrae are already in a compressed state. 1ack of shockabsorption will further impact the joints with every step you take.Shoes that contain proper arch support can help take the pressure off
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those tired feet and add to increase overall shock absorption. Shoeswith pressuri%ed air or other cushioning chambers are necessary toprotect the spine during the much harder impact a person willexperience during exercise.

/hen to se a Heel 4ift

=uring standing a proper balance is needed between both hips tokeep the back in correct alignment. "hen one leg is slightly longer,or the hip becomes fixated in a higher position, it may be necessaryto supplement the lower side of the hips with a heel lift worn insidethe shoe. "hen the spine is tilting to the lower hip side, a lift may

allow the spine to realign properly, and thus take pressure off theback. )f one leg actually grew shorter than the other, a lift may beneeded on a permanent basis to prevent the spine from moving backto its incorrect position. ' health practitioner should be the one toevaluate the situation and assess the correct si%e heel lift needed.

Deciding on the best health care for you

(hiropractic (are

!hiropractors have the level of education befitting their title asdoctors. Their focus is primarily on diagnosing and treatingdysfunction of the muscles, nerves, and skeletal system without theuse of drugs or surgery. 's a particular back condition may at timeswarrant more aggressive forms of treatment, many chiropractorshave developed good working relationships with medical doctors toenable a system of cooperative care to optimally benefit their

patients. !hiropractic care helps increase the flexibility of the softtissue of the spine and reduces the pressure that occurs from anyrestricted and minor misalignments of individual vertebral jointsegments. This in turn helps to eliminate any nerve interferencecreated from the dysfunctional area. This can be achieved bybreaking down scar tissue through techniues which adjust thespine, re-aligning the attached vertebrae, as well as performing


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release techniues to the fibrous portion of the soft tissue. $anydoctors of chiropractic also use therapeutic measures such asultrasound, electric stimulation, and heat therapy. ' doctor ofchiropractic should take the time to diagnose your condition and helpdetermine its cause.

)assage &herapy

$any chiropractors have recogni%ed the benefit of working inconjunction with massage therapists to loosen their patient(s musclesas a precursor to treatment. This relationship works so well becausethe patient can be treated after becoming more relaxed and euphoricdue to the natural release of endorphins, as well as the loosening of

the musculature due to all the benefits of massage. Other benefits ofmassage depend on the type of massage being given.

Swedish massage is usually a more superficial, relaxing form, andtherefore is less likely to break down scar tissue and trigger a releaseof spasmodic musculature as a deeper type of massage wouldaccomplish. )t should be noted that due to the increase in circulationand release of lactic acid a natural chemical irritant that is abyproduct of muscle utili%ation without oxygenation/ with massage, itis possible that the area can feel more inflamed and tender

temporarily.

Acupuncture

astern philosophy proposes that acupuncture utili%es needles tostimulate energy points and are referred to as meridians. The"estern scientific explanation is that the stimulation from the needlepuncture triggers natural pain relieving chemicals from the brain, areduction in inflammation to the area through an increase incirculation, and a relaxation response to the musculature. 's no scartissue is being broken down from the injured tissue, increase inflexibility will be less likely than with a manual tissue and jointmobili%ing type of therapy.

$hysical &herapy


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#hysical Therapy utili%es a variety of modalities such as ultrasound,electric stimulation, massage, and thermal therapy to help relievemuscular spasms. $anual tissue and joint mobili%ing types oftherapy can be used to help increase tissue flexibility. #hysicalTherapy excels in the use of muscular strengthening exercises tobuild stability to weaken tissue. )t should be noted that irritatedmuscles can become further damaged with strengthening exercisesthat are premature to the healing of the area. ' prescription from adoctor is often needed prior to treatment with a physical therapist formost health insurances to pay for any care rendered.

)edical $ractitioners

' doctor of medicine can take the time to evaluate your condition andconfirm your specific diagnosis. $edical doctors prescribe either overthe counter or prescription only medication. They can prescribemedications that temporarily relieve inflammation, temporarily relaxmuscles, and temporarily relieve pain. $any medical doctors workwith physical therapists and chiropractors to provide conservativemanagement for the many back pain conditions a patient canexperience. Orthopedic doctors have extended training in joint-related conditions such as this. "hile Orthopedic doctors canperform back surgery, this drastic step should only be used when all

other treatment options have been exhausted, as back surgerycarries many risks, and not usually recommended for mostconditions.

7eneral #ack -3ercises

$uscular stretching can be a very important part of the healingprocess for tightened muscles of the back. )t is essential to lengthenany shortened muscular tissue of the back to help prevent furtherpulling on the already shortened fibers. $uscular strengtheningexercises will be important once the back irritation has subsided.0ack strengthening exercises help to build stability to weak tissue. )tis important to note that irritated muscles can become furtherdamaged with strengthening exercises that are premature to thehealing of the area. The exercises below are general exercises toincrease flexibility and can help to stabili%e the back. +owever, it


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should be noted that for most of these exercises, you should not feelthe stretch in the back itself. *or example, the back of the legs havea group of muscles called the hamstrings. These muscles originatein the lower pelvis and insert into the leg. "hen the hamstrings aretight, the back itself can be tightened due to the pulling on the pelvis.Therefore, stretching the hamstrings will not only loosen the legmuscles up but they will take the strain off the back.

ach picture below depicts the exercise being performed properly.The arrows are the direction the body will need to move towards toget the correct angles. The red circles indicate the area of which youshould feel the stretch.

/arning6

CThe following back exercises should never be performed if theycause irritation to your back or any other condition while they arebeing performedE 's each back condition is different, alwaysconsult your doctor before performing any of these exercises todetermine what exercises, if any, are right for your particularcondition. )f you have any discomfort after performing any of theseexercises, discontinue and immediately and consult a doctor toproperly assess your situation.C

Sit8ups

!lick picture to increasesi%e and uality

Sit-up exercises should be done very precisely to avoid any tractionto the spine. #lace your knees up on a chair, with your legs and hipsat a F5 degree angle. Support your neck but don(t pull on it as youraise your upper chest, no more than G5 degrees. 1ook straight upwith your eyes to keep from pulling forward on the head. =o G sets of84 reps, or to your individual tolerance. )t is important to concentrate
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on feeling the strain in your abdominal muscles and not your neck orback. 'ny pain you feel with this exercise should only be a localmuscle exercising sensation to the abdominal area, withoutaggravating your condition.

Hamstring Stretch


Sitting on the ground, with one leg straight and the other onecomfortably bent in front of your body, bend at the waist and leanforward, keeping your back as straight as possible. @each with yourarms towards the foot until a stretch is felt under your thigh. +oldeach stretch for a minimum of G5 seconds, any less than 8> secondsand the muscle will not conform to the new increase in length. =o G

reps, G-9 times a day. 'ny pain you feel with this exercise shouldonly be a local stretching sensation to the back of your thigh area,without aggravating your condition.

#ack le3ion Stretch

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"hile lying on your back, pull both knees to your chest whilesimultaneously flexing your head forward until you reach acomfortable stretch in a balled-up position. =o ?-84 repetitions thisway holding each one for ?-85 seconds at a time. Dou should feel nopain with this exercise, as the stretch is designed to relieve tensionon the back.

-3ercise #all


xercise balls have been around for awhile, but are gaining inpopularity with health practitioners due to the many benefits derivedfrom it(s use. 6ust simply sitting on the ball reuires use of postural

muscles. Therefore, a person can sit on an exercise ball while theyare performing normal tasks such as using the computer and reading,all the while strengthening their spine. Simply bouncing up and downon the ball will help increase proprioceptive input to the spine.#roprioception is what helps keep your muscles coordinated andthereby promotes spinal stability. !urrent research demonstratesthat increasing proprioceptive input can help reduce the likelihood ofinjuring an area. "e highly recommend the xerflex ball packagedepicted below/, as it is the only adjustable exercise ball on themarket, and therefore a perfect fit for everybody.

7luteus Stretch
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1ying down on your back, bend your right knee, and place your leftleg over the right leg, resting the outside of the left ankle slightlyabove the right knee. #lace your right hand around the outside ofyour right thigh and place the left hand around the inside of your rightthigh. 1ock the two hands together. :ow pull forward towards yourchest to achieve a stretch in the left gluteus portion of your buttocks.=o the exact opposite to achieve a stretch of the right gluteus portion

of the buttocks. +old each stretch for a minimum of G5 seconds, anyless than 8> seconds and the muscle will not conform to the newincrease in length. =o G reps, G-9 times a day. 'ny pain you feelwith this exercise should only be a local stretching sensation to theback of your thigh and buttocks area, without aggravating yourcondition.

$iriformis Stretch


1ying down on your back, bend your right leg and pull up your rightknee towards your opposite chest with your left hand. Dou should

feel the stretch in the #iriformis portion of the right buttocks. =o theexact opposite to achieve a stretch of the left #iriformis portion of thebuttocks. +old each stretch for a minimum of G5 seconds, any lessthan 8> seconds and the muscle will not conform to the new increasein length. =o G reps, G-9 times a day. 'ny pain you feel with thisexercise should only be a local stretching sensation to the back ofyour thigh and buttocks area, without aggravating your condition.
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#ack -3tension )c9en1ie -3ercise


"hile lying on your stomach, push up your chest only with bothhands simultaneously while keeping your pelvis flat against the floor.#ush your back up until you reach a comfortable stretch in theextended position. =o ?-84 repetitions while holding each one for ?-85 seconds at a time. This is the same type of exercise developed by$c;en%ie to allow the discs of the spine to shift away from the nerveroots. +owever, this exercise also puts your spine in more extensionand can exacerbate conditions like *acet Syndrome andSpondylolisthesis, where the spine is easily compressed inextension. Therefore this exercise should not be performed unless inthese types of conditions unless expressly recommended by yourdoctor. Dou should feel no pain with this exercise, only a pulling up ofthe spine as the back goes into extension

&4 Stretch

!lick picture toincrease si%eand uality
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Start with stretching the T*1 portion of the left hip and outside thigh."hile standing, hold your left hand securely on a solid surface tosupport your body as you place your left leg past your right until youreach a maximum stretch. *ollow this with tilting your upper back tothe right side while simultaneously pushing the left side of the hip. =othe exact opposite to achieve a stretch of the right T*1 portion of thehip and outside thigh. +old each stretch for a minimum of G5seconds, any less than 8> seconds and the muscle will not conformto the new increase in length. =o G reps, G-9 times a day. 'ny painyou feel with this exercise should only be a local stretching sensationto the T*1 portion of the hip and outside thigh, without aggravatingyour condition.

(alf Stretch


Start with stretching the right &astrocnemius portion of the right calfarea. "hile standing, place your right leg in front of you and your leftfoot directly behind you. #lace the toes of your right forefoot upagainst a door or other flat wall surface, keeping your heel down tothe floor. 1ean your upper body forward to place a stretch on theback of the calf. =o the exact opposite to achieve a stretch of the leftcalf area. +old each stretch for a minimum of G5 seconds. 'ny lessthan 8> seconds and the muscle will not conform to the new increasein length. =o G reps, G-9 times a day. 'ny pain you feel with thisexercise should only be a local stretching sensation to the calf area ofthe leg, without aggravating your condition.
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$soas Stretch


Start with stretching the right #soas muscle. "hile standing, place

your right leg in front of you and your left foot directly behind you asfar as you can comfortably stretch it. Shift your lower body forward,while simultaneously pushing your upper body backwards with yourarms. =o the exact opposite to achieve a stretch of the right #soasportion of your front upper thigh area. +old each stretch for aminimum of G5 seconds. 'ny less than 8> seconds and the musclewill not conform to the new increase in length. =o G reps, G-9 times aday. 'ny pain you feel with this exercise should only be a localstretching sensation to the #soas area of the upper thigh, withoutaggravating your condition.

:uadriceps Stretch


Start with stretching the left Huadriceps muscle. "hile standing holda solid surface for support and bend back your left leg. &rab your left
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ankle and pull that foot to your left buttocks while simultaneouslypulling your left thigh backwards while keeping your back straight.#ulling your thigh backwards is a very important part of this stretch,as it will place the stretch in the mid-thigh instead of overloading thepressure on the knee. =o the exact opposite to achieve a stretch ofthe right #soas portion of your front upper thigh area. +old eachstretch for a minimum of G5 seconds. 'ny less than 8> seconds andthe muscle will not conform to the new increase in length. =o G reps,G-9 times a day. 'ny pain you feel with this exercise should only be alocal stretching sensation to the Huadriceps muscle area of the upperthigh, without aggravating your condition.

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