Muscle Imbalance

by Marian
(Leeds)

I have been suffering from gradually worsening sciatica symptoms; I have tried physiotherapy,acupuncture,osteopathy and so far I have had no improvement. I am currently awaiting an appointment with a neurologist.

I have found an American website which attributes most back problems to muscle imbalances,and advises a programme of exercises after a personal assessment to address these imbalances -I am still experimenting with this - do you have any views?

Hi Marian

I am sorry you are struggling at the moment. Sciatica is really awful isn’t it?

What do I think about muscle imbalance as a cause of sciatica and other back problems? Hmmm…that’s a bit of a big question but bear with me and I will try and explain.

I don’t think that muscle imbalances are the sole cause of lower back pain but I do think they are worth looking at. Sciatica is most commonly caused by a disc bulge which irritates the sciatic nerve. It can be caused by other serious back problems too such as osteophytes and infection and fractures, but disc bulges are the most common cause by far.

There is no convincing research evidence which tells us why someone develops a disc bulge but we do know that they are quite common and that they don’t always cause a nerve root irritation (sciatica).

There is a great deal of work taking place at the University of Bristol (my home city) looking at the lumbar disc and the causes of its failure. They are also looking at degenerative disc disease and they are finding many causes including genetic and metabolic factors as well as stress and strain. If you want to read more go to Pubmed and type in Mike Adams or Patricia Dolan to see some of their published work on the spinal disc.

So I don’t think that a muscle imbalance is the sole cause of a disc bulge. I do however think that it is certainly worth looking at if someone has a back problem, in particular non-specific back pain.

Most people have non-specific lower back pain (95% in fact) less than 5% have true sciatica. Some studies have shown a reduction in muscle bulk at the level of the back problem (in particular the multifidus muscle). I feel that a programme of stretches and core stability exercises can be very beneficial for these individuals.

I do not however, think that one thing in isolation is the way forward. Other factors such as postural stress and strain, fitness levels, flexibility, strength and lifestyle need to be addressed along with any unhelpful thoughts and beliefs about back pain.

There is no magic cure for back pain; no one size fits all answer. If there was we would be back pain free by now instead of having a back pain epidemic. Everyone has different needs and different presentations and while you can follow basic principles for treatment there is no holy grail of back pain management – back pain is much too complicated for that.

I am pleased to see the website you saw suggests a personal assessment, that is essential, but make sure that this is done by a qualified health care professional who can take other factors into consideration.

In the meantime you may be cheered up to read this latest research about sciatic nerve pain that shows that a good percentage of disc bulges go away on their own without surgery.

Hope you start to feel better soon

Paula