Low Back Pain

The Top 12 Burning Questions for Low Back Pain and Sciatica

1. What exactly is Sciatica and how did I get it?

Sciatica is simply pain in the leg that comes from the back. It may appear as pain, numbness or tingling that can go on the outside, back or inside of the leg. The pain, numbness or tingling may go to the hip, knee, ankle or foot area.

A big mistake that is made is assuming that the sciatica MUST be caused by a “pinched” nerve. That is a mistake for two big reasons:

First, if one falsely believes they have a pinched nerve they will seek out the wrong Treatments and likely be worse off because of it. They will also have excess worry and fear. Often this worry and fear makes the pain worse AND makes people fearful of seeking help.

Second, getting treatment for a “Pinched nerve” will keep you from getting to the real reason YOU are having trouble. You see there are FOUR MAJOR reasons why you might be having back pain and sciatica. Getting treatment for Sciatica based on a pinched nerve without knowing the real cause will cause you unnecessary misery, wasted time and money, and possibly worsen your pain. All of these only keep you from the activities you want to get back to.

Don’t get me wrong, it would be nice if you knew your back and leg pain are caused by “Pinched Nerves”. But if you get the wrong type of care for your sciatica believing you have pinched nerves you will likely spend a lot of time and money on solutions that don’t get you feeling better and back to your family, work and your active lifestyle!

The cause of YOUR SCIATICA problem may be from “irritated” and not “pinched” nerves. Irritated nerves result from many causes. Some of these are:

  1. Lower back Discs that are irritated
  2. Stiff and immobile spine joint from arthritis
  3. Lack of the correct muscle balance-that is muscles that are too weak or muscles that are always tight.
  4. Irritation of the nerves themselves from inflammation and tightness.
  5. Hips that are too stiff and loss of natural movement.
  6. Loss of good posture
  7. Poor muscle control of your legs and “Core” support muscles.
  8. Poor flexibility of your body in general
  9. Being out of shape
  10. Too much stress on the spine at work or at home….you would be surprised that this stress may come from being still like in sitting the car, sitting on the computer or couch surfing!

2. Don’t I need X rays or MRI to “Really know what is going on?”

We hear this question all the time and we love to answer it.

Yes, there are times when it is Essential and you must get an MRI or X ray to find the cause of your problem!!!

At Physical Achievement Center we are specialty trained to make sure you get an MRI or X ray recommendation ONLY WHEN IT IS NECESSARY! We use specific questions and tests on EVERYONE who comes to us for help. We also have special follow up tests we use on everyone to determine you definitely need and MRI. IF there are any concerns for worrisome findings we always ask for further testing.

In the end, VERY FEW people need these tests! And, when you get an MRI when you don’t really need one it only causes trouble. Unnecessary MRIs lead to excess worry, fear, and likely lead to needless and costly: injections, surgery, and with the possible horrible side effects from long-term medications (think of the dangers of some medications we hear about in the news-opioid medication and risks with NSAIDS with our heart. Liver and kidney damage.

You see the modern MRI and XRAYS are awesome at seeing every small detail inside your body. The problem is NO ONE has perfect insides!

In other words these tests often telling us there are big problems inside our body when the body is really NORMAL. This can become a big problem when it comes to treating YOUR low back pain and sciatica problem.

Back experts all around the world now agree that MRI and X rays when done for the wrong reasons are actually causing more people to have NEEDLESS surgeries, pain, and disability.

The good news, especially if you are seeking natural ways to heal your pain and get back to the life you enjoy, the experts at Physical Achievement Center have effective treatments that don’t rely on medications, injections or surgeries-even when nothing else has worked!

3. Will I get better with Sciatica and Lower Back Pain?

When you feel the nagging effects of back pain and sciatica it feels like it will NEVER get better! The pain, tightness, inability to stand upright, restless nights, and missing out on life (family, home, work, sport) takes it’s toll physically AND mentally.

Good news though…….Nearly everyone we work with at has gotten better with their back pain and sciatica. This is especially true if they follow through with ALL three phases of healing from lower back pain and sciatica.

These three phases are:

  1. Pain relief and inflammation control
  2. Restore full flexibility and strength
  3. Train the body to get back to all of your activities at home, work, and sport/exercise
  4. In fact, it is extremely rare for someone not to see significant benefits. If someone doesn’t see predictable improvements we will be sure to have them get the follow up care they need for continued improvement.

4. What Exercises are good for back pain and sciatica?

First off, specific exercise training is one of the two proven approaches to heal your back pain and sciatica naturally. But here is the problem.

It just took 0.72 seconds for GOOGLE to find precisely 615,000 (yes, I mean exactly 615,000!) selections for sciatica exercises when I did a search today. Wow!!! Modern technology is impressive indeed!

Wow, wait!!!!!

Now, which ones to start with?????

This reminds me of how to fix my car. I will confess that I am not very good at mechanical stuff, like fixing cars. When I was in my 20s I bough one of the best Sears Craftsman tool sets I could afford with over 132 tools. I thought I was going to be able to fix anything. I was all jazzed about this and started to do a complete tune up on my 1982 Buick Park Avenue.

To save myself the embarrassment, Let’s just say it didn’t end well! AFTER, I had gas spraying out of the gas line I realized I used the wrong force on the wrong part with the wrong tool. ……..it wasn’t at the time, but now it is a funny story!

I ended up calling my expert mechanic friend to save the day….. and we both had a good laugh!

You see, my 132-piece Craftsman tool set could have been a 2,032 part tool kit, but I didn’t know the proper tool for the proper part with the proper force to make the tune up an easy process.

The same can go for exercises to solve lower back troubles. There are so many exercises that you hear that are good for lower back and sciatica-in fact, I just found over a half a million of them with my quick internet search!

The thing is each exercise MAY be helpful. (just like all the tools I used for the tune up were perfectly good tools.) An exercise needs to be carefully selected at the right time, in the right direction, on the right part, with the right force, and changed/updated as time goes on to get any real progress toward healing!

There are some general exercises that may be beneficial, but first you gotta know the causes for your back pain and sciatica, or else you may be doing one of three things:

  1. The wrong exercise may delay healing or make it worse.
  2. The wrong exercise may be not be causing any harm, but may be a waste of time.
  3. The exercise may be helpful at correct stage of healing but stop being helpful at the next stage of heeling.

My advice is simply this in regards to exercise with lower back pain and sciatica: Be as active as you can, and take frequent breaks. If your back and leg pain isn’t getting better week by week and your aren’t getting closer to the pain relief and activities you need to……. you have to do what I did with my car … get help from a professional.

5. What can I do about lower back and sciatica by myself to help?

Some straightforward questions we are asked about include the following:

Bed rest? Rarely, if ever. Stay reasonable up and active as you can. Frequent short, rests may be helpful (think minutes, not hours), but inactivity for long periods of time will likely make it worse. The damage that occurs on muscles, bones and joint with bed rest take a LONG time to recover from (if you recover at all!)….. and delay healing response.

In over 25 years seeing people recover form debilitation back pain I have NEVER had anyone successfully rest their pain, weakness, and stiffness away!

What about Over the counter medications and heat rubs?

Heat rubs may be quite helpful to ease the pain somewhat, but won’t get you anywhere near full recovery. On the bright side, heat rubs won’t likely cause the problematic underlying problems in the tissues to flare up.

Anti-inflammatory over the counter pills can be helpful for some people but carry some serious risks for everyone if used long term, and for some folks even short term. ( recent medical studies have verified this as well!)If you decide to use them use, use them sparingly and only as a way to get to other lasting approaches to your back and leg related pain problems. Remember, No one has back and leg pain because they didn’t have enough “Natural IBUPROFEN” in their body!

Heat or ice? Most people love heat and shy away from ice. Staying away from Ice may be a mistake. As I discussed above most of the time there is an inflamed nerve involved in sciatica. Ice calms inflammation down while heat may make it worse. If you are unsure of which to use, use ICE. If you don’t like ice try it for at least five times (be sure you use a layer or two of cotton between you and the ice pack or ice) for 15-20 minutes every hour up to 8 times daily.

Fancy new mattress for lower back and sciatica pain? I’m going to “cut to the chase here. “ Spending BIG money on a mattress isn’t the best use of your money……unless your mattress is really bad and worn out a reasonably priced new mattress that feels comfortable when lying on in the store is the best!

Look everyone, has a preferred type of mattress. Established research proves this. I am going to pull in some very technical research here to help guide you (well maybe just entertain you at this point) Dr. Goldilocks summed it up nicely: “Some beds are too hard, some too soft, and some just right.”

Unless a back pain and sciatica expert has advised you getting an expensive bed isn’t the first place to start or the best use of the your money. I wish it was the case as it would make my job more simple!

Foot orthotics helpful? Some individuals may be helped with orthotics. You don’t need to spend a lot of money though, unless you one of the specific problems identified by one of our experts at Physical Achievement Center. You can easily try a 20-30 dollar orthotic from the store and see how you respond-BUT DON’T spend hundreds from a store of salespeople. When orthotics have been helpful for people with lower back pain and orthotics it is always with an expert who considers a custom orthotic AND with the correct hands on and exercise prescription.

6. How can I get a good nights rest from lower back pain and sciatica?

We hear all the time: “ I could stand the pain during the day, it’s just frustrating that I can’t get a restful night’s sleep!!!” Here are some tips on this:

  • First, there is no RIGHT sleep posture, and there is no WRONG sleep posture. You read that correctly, there is no rule when it comes to sleep posture other simply: “Does your sleep posture help you to sleep?” There are far too many rules in life that stress us out and make us worry. Getting restful sleep is your goal. You WON’T do any damage to your spine or body if you sleep in a position that is comfortable for you. (exception is there are positions you may want to avoid if you are pregnant, but you are already getting good advice for that already!)
  • Second, if you are looking for a good sleep posture with lower back pain and sciatica chose the one that keeps the aggravating symptoms closer to the center or your back if possible. The experts at Physical Achievement Center can help you discover that comfortable sleep posture.
  • Third, if you would like to try a sleep position to see if it will help use laying on one of your sides with your knees slightly bent up toward your tummy and a nice size pillow between your legs. Test this, or any sleep position out first. If it works to help relieve your pain then use it!
  • Fourth, don’t worry if you wake up in another position than when you went to bed. Human beings naturally move around in our sleep and this is almost always health and good. If the position you wake up in is aggravating then simply get back to your comfy position.
  • Fifth, you can use ice, exercise, heat rub prior to sleep-especial if those are helpful during the day.
  • And sixth, if sleep comfort remains an issue for you we got you covered….just let the back pain and sciatica expert at Physical Achievement Center know your sleep isn’t good and we will help you get to sleeping sound and deep again, without pain. We want you to get back to all your favorite things…everyone’s favorite things includes getting restful sleep.

7. What can professionals do to help me with lower back pain and sciatica?

Simply put three things:

“First Do No Harm!“

You think that would be a no brainer, but unfortunately some health professionals do harm. They do this by going too quickly to unnecessary prescription, injections, MRIs, X rays, and endless treatment plans that don’t help you reach your goals. A true lower back pain expert who has your best interest in mind will avoid these common traps so you don’t get the wrong treatment.

Incorrect treatment will keep you from getting back to your favorite activities, may make your pain worse, may cause very harmful side effects, and can increase your sense of fear. Fear and lack of correct treatment can immobilize you into doing nothing at all to get relief. ALL OF THESE ARE TERRIBILE Consequences of treatment that aren’t proven or from outdated recommendations.

Second, they should spend A LOT of time finding out about YOU, and can never ask too many good questions.

No too back and leg problems are the same. Yeah, I know your friend, co-worker, aunt, and next-door neighbor all tell you they had the “same thing.” By the same thing they mean they had pain and difficulty that kept them from doing the activities they enjoyed. A back pain and sciatica expert should listen carefully to “YOUR STORY” and hear about what is bothering you. They should ask you when you have the problems: pain worse at night vs. the day; sitting vs. standing; moving vs. Standing still, and so forth. They should understand clearly by listening for (in YOUR words) what your major concern is. And most importantly, the back and sciatica expert should know day one what YOUR goals are. It is in this way that the back expert can get valuable information on knowing not only what is causing your problems, but more importantly, what is the solution to getting you back into the activities you desire.

Third, they should outline a program where you are improving week by week towards your goals AND eventually to a point where you need only occasional assistance!

Back and sciatica experts should usually use some hands on techniques and approaches at first. Starting very soon in the process of treatment, however, the back and sciatica expert should be teaching you how to use your posture, activity, rest, exercises, etc. to guide you towards greater levels of pain control, muscle strength, activity, and self care.

Ultimately they should be a TEACHER of how YOU can take care of yourself. IF THEY DON’T TEACH YOU HOW TO CARE FOR YOURSELF YOU NEED ANOTHER BACK AND SCIATICA EXPERT TO HELP YOU! You won’t be rude to change….you will only be rude to yourself if you don’t!

8. How can I get a find the best professional to help me with back pain and sciatica?

Many professions tell you they can fix back and leg pain. Most of them can fix SOME back and Problems. Most only use one or two approaches….that’s the problem. I know this, because that used to be me early in my career. You see early on I used to chase the ONE TECHNIQE THAT WOULD CURE EVEYRONES BACK PAIN. I learned many amazing approaches that helped some people. However, I soon found out that some approaches work for some people, but no approach works for everybody. Let me explain.

So what if you called over someone to your house to fix your refrigerator. And what if all they showed up with in their toolbox was a small hammer. You would be pretty worried wouldn’t you? When someone shows up to fix your refrigerator they should have a tool box full of different stuff-electrical testers, pliers, screw drivers, and so forth. This would be best because No ONE tool fixes all problems on your refrigerator!

Well, there are a lot of “back and Sciatica experts” who show up for work with only have one or two tools. They look at each person’s problems as the same as the next person’s. That is they try to fit their limited tool selection on YOU—- no matter if that is the right tool or not. Some only use forceful exercises that hurt. Some ONLY use “adjustments” and manipulations and don’t teach you how to keep progressing on your own. Some only use massage. Some may only use hard-to-do-gym exercises. I think you get the idea. Your back pain and sciatica expert shouldn’t just have you on a conveyer belt using the same treatment on everyone who comes in to see them.

Since the causes of back pain and sciatica are so different for each individual you need an expert who has many different tools, AND knows how to use each tool.

So here is a test for you to know if the person you are seeking care from is a back and sciatica expert who TRULY can help you with your unique problem. You call the office and speak to the expert themselves, or their secretary, and ask them this ONE simple question:

“For back pain and sciatica are you skilled AND do you use each of following for some patients: Manipulation, Dry Needling, Massage, Soft Tissue Mobilization, Traction, Directional Preference Exercises, Stretching, Strengthening exercises, Nerve Glide Exercises, and Pain Science education?”

AND then you listen to the response VERY CAREFULLY…..

If they say NO to ANY ONE OF those approaches they are not a back and sciatica pain expert! They are NOT using the latest proven approaches to help you over come your problem.

If they don’t know and regularly and use all of those approaches they likely aren’t able to keep you improving week by week to get you back to your active lifestyle doing such as:

  1. Caring for and playing with children, and grandchildren
  2. Shopping trips, Gardening, golfing with friends, and exercise
  3. Walking with friends, yoga class, pickle ball, and dancing

9. What does successful treatment look like for back pain and sciatic?

Successful treatment starts with a lower back pain and sciatica expert finding out about you with a thorough interview. This interview should be relaxed and be done with asking questions to find out about how your problem: started, reacts during daily activities, has changed over time, responded to different types of help, etc. The interview should be done so you can tell your whole story.

The next part of the process is a detailed and skilled physical exam. That part can sound worry some. This part of the process isn’t typically painful and includes only a few necessary tests and measures if done properly. When the interview is done by a back pain expert thoroughly the expert can plan the testing to only use the necessary measures and tests in order to keep you as comfortable as possible while they gather data for the next steps.

The next part of the process is the explanation of the findings and outlining which of the many very helpful approaches will be used. You will be educated on your treatment options thoroughly in an unhurried way. We invite you to ask whatever questions you have about your condition and what the course of treatment looks like.

Once you are completely confortable with understanding everything you are ready to start treatment in order to get feeling better right away. Expert treatment typically includes a special mix of these possible things done in the right portion AND ESPECIALLY In the right order:

Manipulation, Dry Needling, Massage, Soft Tissue Mobilization, Traction, Directional Preference Exercises, Stretching, Strengthening exercises, Nerve Glide Exercises, and Pain Science education

The Experts at Physical Achievement center will guide you through all three phases of the healing process.

  • Phase One: focus on getting rid of the pain, numbness and tingling in your leg, and your back.
  • Phase Two: focus on getting normal movement back and full strength of your spine, hips and legs.
  • Phase Three: Get back to previous activities YOU want to at home, work, athletic activity/sport and travel.

10. How long will it take to get better with sciatica and back pain?

A: It depends…it depends on YOU.

In general, it takes to 4 to 8 weeks to go through the first 2 phases of healing (controlled pain, all movement and strength back to normal).

It may take another 1 to 4 months to get back to all activities you want to do…depending on how active you are. This is the third phase of healing.

Here are 10 variables that determine how fast someone can heal:

  • Overall health habits. Healthy people heal faster. Younger people heal faster.
  • Other health issues such as diabetes, heart disease, high blood pressure, tobacco use, alcohol abuse and body weight all influence healing rates…and make the time to heal longer.
  • Diet. People who consume more nutrients in their calories (Dr. Joel Fuhrman calls this “Nutrarian”) heal faster than those who primarily eat processed foods.
  • Rest levels. Our bodies need sleep and rest to rebuild. A lack of sleep slows healing time.
  • Stress levels. People who have high levels of stress heal more slowly.
  • Sedentary lifestyle. People who sit all day for work or to watch TV heal more slowly.
  • People who follow advice and instruction from top level healthcare professionals heal more quickly than those who do not follow-through with care.
  • People who are highly aware of their daily postures and habits heal more quickly…because they can adjust habits such as daily movements, sitting positions, and sleep positions more quickly.
  • Readers heal more quickly. People with higher attention spans are more likely to be self-educated on a topic and more likely to follow-through with successful treatment.
  • People who think there’s hope tend to be more persistent and won’t let anything stop them. Steven Covey calls this “Begin with the end in mind.” Moving away from difficulties and towards results requires a mental “Will do” attitude. This mindset will help you to follow through on all actions that you need to get better with your lower back pain and sciatica.

11. Will I need any special equipment to recover from back pain and sciatica?

At Physical Achievement Center, we use a minimalist approach…

We don’t use big, fancy, expensive equipment…

The one exception may be for people needing traction. There is a machine (Saunders Lumbar Home Traction unit) which we find very effective for home use…for people who show signs their sciatica may be relieved with traction.

Otherwise, most exercises can be done with on your bed or mat, simple exercise bands, and in the safety of your home or gym.

Our model focuses on world-class hands-on Physical Therapist, a treatment table that adjusts to you and some basic exercise equipment you can do at home, work, or on the road when traveling.

This works best for most people.

12. What can I do to keep my low pain and sciatica away once it is under control, and will it come back?

The best thing to do for sciatica, if you are worried about it coming back again in the future, is to complete all 3 phases of healing.

  • Phase One is where you focus on getting rid of the pain, numbness and tingling.
  • Phase Two is where you focus on getting normal movement back and full strength.
  • Phase Three is where you go back to previous activities YOU want to do.

In our clinic, we find out DAY ONE what activities you have been MISSING OUT on. It is those activities that guide our work right FROM THE START OF CARE.

Some will say this activity is family time, walking, or golfing or gardening…something along those lines.

Your family, work, and active lifestyle can’t wait forever.

And we’ll guide you to take the next month or two and do everything you want to do that you couldn’t do before.

They keep doing their simple, customized-to-them exercises at home to get stronger and stronger.

Most come back for a recheck appointment in 2 months and have no trouble at all.

Some do have a relapse, but that isn’t typically a big problem.

At the two-month follow up we then take a look at the activity and at the program and help them get on the right track.


So there you have it. The answers to 12 top questions regarding low back and Sciatica. You now have knowledge on the possible sources of your lower back and sciatica problem. You have some tips to start managing the pain on your own. If you take the advice you have learned to heart and use the tips you learned in this report you will be on your way to solving your problem. You will be pleasantly surprised that using the tips in this report, when combined together, can get you back to your active life. Your fears worries and concern about increasing pain, stiffness and inability to enjoy your favorite activities can be replaced with confidence in knowing what is going wrong, knowledge about the path to recovery looks like and you have been shown hope as you get back on path to your active lifestyle.

We at Physical Achievement Center want to assist you with the knowledge and skills to help you achieve greater mobility and strength for your active lifestyle in a natural way without medications, injections, or surgery-especially when “nothing else” has worked.

In the next few weeks you will be receiving even more valuable information and tips on how to restore you active and healthy lifestyle. I hope this is the beginning of a great long-term relationship where my friends and I at Physical Achievement Center provide you with valuable knowledge to transform you difficulties and fears into restoring your life!

Dedicated to Restoring your Active, Pain Free Lifestyle,

Dr. Eric Koehler
Back Pain and sciatica specialist
Physical Achievement Center
3475 Omro Road Suite 300
Oshkosh, WI 54904