Severe low back is often due to psoas and iliacus muscles spasm. These muscles are often referred to as "hip flexors", however they also bend and rotate the spine. A spasm of these muscles can recruit other muscles into spasm such as the abdominal muscles.
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This type of spasm often occurs after an injury, after overworking the low back muscles and also after sitting for an extended period of time such as in a car or plane. Typically, a person with a psoas spasm will feel better while sitting, then when they arise from a chair they may need two or three steps before then can straighten to standing. Often a patient will have one side that is in spasm. These patients will either be flexed laterally or have their shoulders quite dramatically off to one side in relation to where their hips are.

About 60% of severe low back pain that I see in my Chiropractic office is due to low back muscle spasm. The psoas muscle is attached to the front of the vertebra and discs and can pull them out of place causing severe pain. A low back spasm can become chronic, so it is important to relax the muscle then improve core strength. 
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Psoas and Iliopsoas Muscle Spasm Home Protocol
1.) Avoid Sitting especially long drives in car or on plane - If you must, don't drive and lean passenger car seat back as far as possible.
2.) Avoid walking long distances except around the house
3.) Wear a back brace if it helps 
4.)  Stretch Hip Flexor Muscles: Leg off side of bed, remember to bend opposite knee to protect/flatten low back curve. 
5.)  Do these Home Exercises to Align Your Sacroiliac Joints (2-3 x per day) to your comfort level.
6.) Gentle Core Exercises (2-3 x per day

• Do these on the floor at first, it will be easier than on the bed. 

7.) Bike on a cruiser type bike (not racing bike) for 20 - 30 minutes 1- 2 times per day. 
8.) Heat on Low Back and/or Lower Abdomen: 

• A spasm is a neurologically overactive muscle. It is not generally inflamed. However, you can have more than one thing going on so if you have increased pain after applying heat, discontinue.
• Heat: On 10 minutes, Off 10 minutes, On 10 minutes  2-3 times per day OR
• Heat 10 minutes, Ice 10 minutes, Heat 10 minutes OR
• If you prefer ice to heat: Ice: On 10 minutes, Off 10 minutes, On 10 minutes  2-3 times per day

9.) Chiropractic - Follow up every 2 -3 days until muscle spasm releases
10.) Try Muscle Relaxers:

• Not all muscle relaxers work for all people. That is true for natural muscle relaxers as well as perscription. You may need to try 2 or 3 before you find one that successfully releases the muscle spasm.
• You can be sensitive or allergic to any of these.  Discontinue if you have a negative reaction and seek medical help if the reaction is severe.

Natural muscle relaxers

• Magnesium (Oral supplement, and/or Epsom Salts bath, and/or rubbing wet Epsom Salts on your skin)
• Formula 303 (See attached for ingredients and potential drug interactions)
• CBD oil. Emory University Medical Center recommends Lazarus Naturals to their patients. I also recommend this product:  High Potency Full Spectrum CBD Tincture for muscle spasm. Side effects seem to be minimal and it is a central nervous system suppressant (it makes you relaxed and sleepy). I suggest starting with a 100 mg 1 to 2 per day and increase it to the point where it helps up to a maximum of 500 mg / day for 2-3 days. If CBD oil works as a muscle relaxer, you should not drive.

Prescription Muscle Relaxer

• Chiropractors do not subscribe medication so you will need to see an M.D. for these.
• We recommend Doctors Care in Bluffton or Sea Pine Circle Urgent Care
• As noted above, some patients do not respond to certain muscle relaxers and have to try 2 before they find one that is effective.
• If you find one that is effective take it for 2 - 3 days.
• You should not drive while taking a muscle relaxer.  

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Kelley LeBlanc, D.C.
Kelley Chiropractic and Wellness
Village at Wexford
1000 William Hilton Pkwy, Ste K100
Hilton Head Island, SC 29928
(843) 321-8119
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If your pain is in buttocks and back of thigh, but does not go below the knee you may have Piriformis Syndrome. This happens when the piriformis muscle (one of the major buttocks muscles) presses on the sciatic nerve. Piriformis syndrome can be caused by the piriformis muscle being
     a.) Too tight OR
     b.) Overstretched OR
     c.) Sprain/strained
 
1.) Reduce inflammation

• For 24 hours use this icing protocol: 10 minutes on painful-side buttocks / 10 minutes off / 10 minutes on again every 2 hours
• Use an over the counter anti-inflammatory treatment, i.e. NSAID and a topical anti-inflammatory
• After 24 hours use heat on the painful buttocks for 10 minutes 1-2x/day to interrupt the pain signal and increase blood flow. However, don't use heat more than this, it can cause inflammation.

2.) Gently Stretch

• It is difficult to tell yourself if the muscle is too tight or to overstretched. When doing the stretched listed below, shoot for the middle ground...a gentle stretch not an intense stretch. 
• Stretch both sides
• Do these stretches first: Gentle Knee to Chest Stretches for Low Back Arthritis  2 - 3 x per day or more.
• If your body says "I need more stretches"  Try this PT's 5 Best Sciatica Stretches for Piriformis Syndrome .  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.

3.) Strengthen

• Strengthening exercises help to normalize and stabilize muscle function.
• Do these gentle strengthening exercises first:  4 Exercises for Back Spasm Relief - Stretch and Core Strengthen.  2 - 3 x per day or more. 
  • These are not just for spasm. They gently strengthen the low back, core and buttocks.
  • If these exercises are very easy, increase the intensity to your level of comfort. You can move your body higher, hold your body position longer, and/or do more repetitions. 
  • Always it is most important to listen to your body.

4.)  Balance Exercises

• When a muscle/tendon/ligament is injured as in sprain/strain, the neurological loop with the brain gets out of sync.  The best rehab exercise for a sprain/strain is balance exercise, which strengthens and also resets the neurological loop. 
• NOTE: 
  • If you are elderly, have osteoporosis or have poor balance ability: Be safe and hold on to a counter or door frame while doing balance exercise. Balance ability usually increase rapidly, so don't get discouraged. Do a little bit, at least 3 times a day.
• Do balance exercises for 5 minutes, 3-5 times per day (or more).   
• While doing balance exercise, do not look at your feet. Look across the room or into the distance.
• If you stand on one foot, try to hold your pelvis level.
• Here are balance tools/methods from easier to more difficult:
  • Simply stand on one leg at a time while holding on to a counter or door frame
  • Stand on both feet and/or one foot while using a  balance pad, which provides slight instability.
  • Stand on both feet and/or one foot while using a  balance disc, which provides moderate instability.  
  • Stand on both feet and/or one foot while using a wobble board, which provides a lot of instability.
  • If you use a BOSU ball, stand on the flat side, not the round side. Otherwise you will injure your ankles. This also provides a lot of instability.
• As your balance improves, increasingly challenge yourself by moving your legs, closing your eyes, etc. 
• Always during balance exercises:
  • Be safe
  • Don't look at your feet
  • Hold your pelvis level

The above assumes piriformis muscle pressure on the sciatic nerve.  Here are other common issues that could be causing sciatic-like pain.

• Disc Herniation:  If you pain  is in buttocks, back of thigh and also into the calf and/or foot you may have an inflamed lumbar disc pressing a one or more of the nerve roots that lead to the sciatic nerve. Here is the Home Protocol for Sciatica due to Disc Injury. 
• ITB Syndrome: If you have pain at the lateral thigh and lateral knee you may have ITB Syndrome; Try this PT's IT Band Syndrome Stretches & Exercises.  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.

- 

Kelley LeBlanc, D.C.
Kelley Chiropractic and Wellness
Village at Wexford
1000 William Hilton Pkwy, Ste K100
Hilton Head Island, SC 29928
(843) 321-8119
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Sciatica: What is it and how is it treated? via Web MD

If you have 10/10 low back and or leg pain you may want to visit Moss Creek Orthopedic Urgent Care, (843) 836-7022  for an MRI, steroid injection, muscle relaxers and/or pain medication.

Home Care Protocol for Sciatica:
1.) Avoid Sitting. Laying on your back removes pressure on the lumbar disc, standing is somewhere between.
2.) Don't lift more than 5 lbs. When you cough or sneeze, support yourself by holding a pillow on your stomach.
3.) Reduce inflammation and feed the disc

• For 24 hours use this icing protocol: 10 minutes on low back / 10 minutes off / 10 minutes on again every 2 hours
• Use an over the counter anti-inflammatory treatment, i.e. NSAID and a topical anti-inflammatory
•  Take a disc-feeding supplement such as Glucosamine with Chondroitin Turmeric MSM Boswellia. Tumeric and Boswellia are spices that have an anti-inflammatory effect  

4.) Do NOT use heat on the low back. It might feel good, but it can exacerbate inflammation, making you worse.
5.)  If you have very acute low back pain 9-10/10 try this: Extreme Low Back Pain, Sciatica, Disc Herniation - Gentle Traction  2 - 3x per day or more
6.) If you can do #5 with ease try this: Gentle Knee to Chest Stretches for Low Back Arthritis  2 - 3 x per day or more
7.) If you can do #6 with ease try this for 10 minutes, 2 - 3 x per day or more: Lay with your back on a (cushioned) floor with your feet over an ottoman.
8.) If you can do # 7 with ease try this 10 minutes, 2 - 3 x per day or more: Lay on your back with your feet up the wall...You do NOT need to straighten your legs on the wall. 

#7 and #8 - These stretches gently traction the low back and send fresh healing blood to the area of injury. They are very simple but highly effective. There is no upper limit on how long you can stay in this position, but stay for at least 10 minutes 2-3x/day.

9.) If your sciatica is caused by a disc injury, you might feel better before the disc is healed. Remember reinjuring an already injured disc can get you into real trouble. A disc that might have healed in a few weeks could be reinjured and could take 6 months to a year to recover.

The above assumes a disc injury.  Here are other common issues that could be causing sciatic-like pain.

• Piriformis Syndrome:  If you pain  is in buttocks and back of thigh, but does not go below the knee you may have Piriformis Syndrome:  Try this PT's 5 Best Sciatica Stretches for Piriformis Syndrome .  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.
• ITB Syndrome: If you have pain at the lateral thigh and lateral knee you may have ITB Syndrome; Try this PT's IT Band Syndrome Stretches & Exercises.  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.

- 
Kelley LeBlanc, D.C.
Kelley Chiropractic and Wellness
Village at Wexford
1000 William Hilton Pkwy, Ste K100
Hilton Head Island, SC 29928
(843) 321-8119
Facebook
LinkedIn