So far I have brought you information about erectile dysfunction, bladder control, Kegel exercises, and what a pelvic physical therapist does that is different from traditional therapy. I think it is time to move just north of the pelvis to the lower back. Don’t worry, I will still have the pelvic spin on things because they are very connected! It is estimated that 80% of us will have some form of back issue in our lifetime, and collectively, these cost some $50 billion a year in treatments.

You are probably wondering what sciatica, disc degeneration, and disc bulging mean. Sciatica is known as pain that runs down the back of the leg to the knee or the toes. Often times it starts in your buttock but can also start in the low back. It can be caused by a number of issues such as disc degeneration, disc bulging, but often I find the culprit to be one of the hip muscles, the piriformis. The piriformis muscle is in a unique position in that the sciatic nerve (a complex mixing of lumbar and sacral nerves) runs right by the piriformis and in some cases runs through the piriformis. If that muscle is tight from years of sitting or standing a certain way it can pinch the sciatic nerve as it passes by it thus causing a nice pain that runs down your leg. The pelvic connection? The piriformis muscles attaches to the side of the hip and the sacrum, one of the pelvic bones that is also the base of the spine. Guess what else won’t move correctly if your piriformis is tight? You guessed it, the sacrum. If the sacrum doesn’t move well then you can have another source of pain at the sacro-iliac joints or even further up the chain into the lumbar spine/low back.

Enough about sciatica….what about degenerative disc disease (DDD)? The bones of the spine stack like Lincoln logs (who remembers them?), one on top of the other, with a fluffy water-filled disc between them. The space between them is critical for the nerves of the spine to get out of the cage of the spinal column and out into the body. DDD occurs when one or more of the discs lose some of their fluid, start to wear out, and get thinner, allowing the bones of the spine to be closer together, leaving less room for the spinal nerves. Stand up. Hands on your hips. Lean back a bit. Any pain? If so, this could be DDD. These are the people at the store you see leaning forward onto their carts because it feels better.

Bulging discs are next on the list. Hydrodynamics tells us that water likes to go from high pressure to low pressure, path of least resistance. Remembering that the discs are 80% fliud. If we are always bent forward we are putting more pressure on the front of the disc than the back of the disc. It is encouraged to glide backward toward the spinal cord. Thankfully we have a fail-safe before it gets to the spinal cord, a ligament, which causes the disc to glide to the left or right, whichever is easiest. When this happens, it can push out a little into the space between the bones where the spinal nerves live. Stand up again. Bend forward this time. Any pain? This could be a disc issue if you have pain with bending forward.

I want to leave you with a few thoughts. A 2018 Canadian study of women with back pain found that over 90% of them also had some level of pelvic floor dysfunction – for instance, general weakness due to stress incontinence or urinary frequency. Most pelvic floor studies are on women as it has been historically treated as a woman’s issue, but I think the numbers are similar for men and transgender people. The nerves of the body are prima donnas: everything has to be perfect or they will complain and won’t work as well whether the pressure is from the hip, the disc, or the bones. In any case, physical therapy can help.

If you have questions or comments, Charles Dudley says, “Feel free to reach out to me,” at charles@dudleypt.com or call/text 443-742-0019.

Your Spine Has Your Back So pay it some mind

So far I have brought you information about erectile dysfunction, bladder control, Kegel exercises, and what a pelvic physical therapist does that is different from traditional therapy. I think it is time to move just north of the pelvis to the lower back. Don’t worry, I will still have the pelvic spin on things because they are very connected! It is estimated that 80% of us will have some form of back issue in our lifetime, and collectively, these cost some $50 billion a year in treatments.

You are probably wondering what sciatica, disc degeneration, and disc bulging mean. Sciatica is known as pain that runs down the back of the leg to the knee or the toes. Often times it starts in your buttock but can also start in the low back. It can be caused by a number of issues such as disc degeneration, disc bulging, but often I find the culprit to be one of the hip muscles, the piriformis. The piriformis muscle is in a unique position in that the sciatic nerve (a complex mixing of lumbar and sacral nerves) runs right by the piriformis and in some cases runs through the piriformis. If that muscle is tight from years of sitting or standing a certain way it can pinch the sciatic nerve as it passes by it thus causing a nice pain that runs down your leg. The pelvic connection? The piriformis muscles attaches to the side of the hip and the sacrum, one of the pelvic bones that is also the base of the spine. Guess what else won’t move correctly if your piriformis is tight? You guessed it, the sacrum. If the sacrum doesn’t move well then you can have another source of pain at the sacro-iliac joints or even further up the chain into the lumbar spine/low back.

Enough about sciatica….what about degenerative disc disease (DDD)? The bones of the spine stack like Lincoln logs (who remembers them?), one on top of the other, with a fluffy water-filled disc between them. The space between them is critical for the nerves of the spine to get out of the cage of the spinal column and out into the body. DDD occurs when one or more of the discs lose some of their fluid, start to wear out, and get thinner, allowing the bones of the spine to be closer together, leaving less room for the spinal nerves. Stand up. Hands on your hips. Lean back a bit. Any pain? If so, this could be DDD. These are the people at the store you see leaning forward onto their carts because it feels better.

Bulging discs are next on the list. Hydrodynamics tells us that water likes to go from high pressure to low pressure, path of least resistance. Remembering that the discs are 80% fliud. If we are always bent forward we are putting more pressure on the front of the disc than the back of the disc. It is encouraged to glide backward toward the spinal cord. Thankfully we have a fail-safe before it gets to the spinal cord, a ligament, which causes the disc to glide to the left or right, whichever is easiest. When this happens, it can push out a little into the space between the bones where the spinal nerves live. Stand up again. Bend forward this time. Any pain? This could be a disc issue if you have pain with bending forward.

I want to leave you with a few thoughts. A 2018 Canadian study of women with back pain found that over 90% of them also had some level of pelvic floor dysfunction – for instance, general weakness due to stress incontinence or urinary frequency. Most pelvic floor studies are on women as it has been historically treated as a woman’s issue, but I think the numbers are similar for men and transgender people. The nerves of the body are prima donnas: everything has to be perfect or they will complain and won’t work as well whether the pressure is from the hip, the disc, or the bones. In any case, physical therapy can help.

If you have questions or comments, Charles Dudley says, “Feel free to reach out to me,” at charles@dudleypt.com or call/text 443-742-0019.

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