Sciatica treatment

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SCIATICA TREATMENT
Sciatica is characterised by pain in the lower
back and gluteal region. This pain can radiate
down one or both legs into the thigh, calf,
ankle, and foot. Genuine sciatica occurs when
pain travels below the knee.
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Sciatica Is Caused by Nerve Compression Sciatica
is generally caused by sciatic nerve compression.
Disorders known to cause sciatic nerve pain
include lumbar spine subluxations (misaligned
vertebral body/ies), herniated or bulging discs
(slipped discs), pregnancy and childbirth,
tumors, and non-spinal disorders such as
diabetes, constipation, or sitting on one's back
pocket wallet. One common cause of sciatica is
piriformis syndrome. Piriformis syndrome is named
after the piriformis muscle. The piriformis
muscle is located in the lower part of the spine,
connects to the thighbone, and assists in hip
rotation. The sciatic nerve runs beneath the
piriformis muscle. This muscle is susceptible to
injury from a slip and fall, hip arthritis, or a
difference in leg length. Such situations can
cause cramping and spasm to develop in the
piriformis muscle, thereby pinching the sciatic
nerve and causing in?ammation and pain. Sciatic
nerve compression may result in the loss of
feeling (sensory loss), paralysis of a single
limb or group of muscles (monoplegia), and
insomnia. The cause of your pain determines your
treatment options to relieve sciatica
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DRUGS, MEDICATIONS
Your doctor may prescribe certain medications or
spinal injections to treat your sciatica. The
severity of your pain determines the prescrip-
tion, which could be Epidural Steroid
Injections Steroids, which reduce in?ammation,
can help ease your sciatic pain. With an epidural
steroid injection, you get a corticosteroid
medicine injected near the spinal nerve roots.
These injections can reduce pain for months and
sometimes longer. However, epidural steroid
injections aren't effective for all
patients. Over-the-counter NSAIDs (non-steroidal
anti-in?ammatory drugs) These will help reduce
swelling while relieving your pain. If an
over-the-counter NSAID is an option for you, you
and your doctor have plenty to choose from. You
can use ibuprofen (Advil) or naproxen
(Aleve). Prescription Medications If you have
chronic sciatica, you may need a muscle relaxant
to help ease muscle spasms. As surprising as it
may seem, anti-depressants can be effective drugs
for treating pain because they may help block
pain messages on their way to the brain. They can
also help increase your body's production of
endorphins, a natural pain killer.
As with any treatment, you must follow your
doctor's advice precisely. Never mix
over-the-counter and prescribed drugs without
consulting your doctor. You should also let your
doctor know about all other medications you're
taking (and even which vitamins and supplements
you take) there could be interactions you want
to avoid. The goal of using medications to
address sciatic nerve pain is to provide pain
relief. However, medications are not addressing
the root cause of your sciatic pain they aren't
healing or curing the spinal condition that is
leading to sciatica. While you're experienc- ing
relief from your sciatica, you may be better able
to do physical therapy or exercises that may help
address the sciatic nerve com- pression.
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PHYSICAL THERAPY
Those with lower back pain have historically been
prescribed bed rest in order to offer relief for
aching bones and joints. Research in recent years
has suggested that bed rest alone will not offer
relief for those suffering from nerve pain such
as sciatica. Staying active may be more
beneficial for those who suffer from back pain.
Not to say that you should be running marathons!
Activity means being up and mobile for periods of
time that are not enough to cause further pain
and aggravation to your back. Some physicians may
prescribe specific exercises, or some may simply
suggest walking. Your doctor may refer you to a
physical therapist to help you relieve your
sciatica and restore movement. Physical therapy
includes both passive and active treatments.
Passive treatments help to relax you and your
body. They also prepare your body for therapeutic
exercise, which is the active part of physical
therapy.
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PHYSICAL THERAPY

• Your physical therapist may give you passive
  treatments such as
• Deep tissue massage This technique targets
  chronic muscle tension that could be pressing on
  your sciatic nerve or related nerve roots. The
  therapist uses direct pressure and friction to
  try to release the tension in your soft tissues
  (ligaments, tendons, muscles).
• Hot and cold therapies By using heat, the
  physical therapist seeks to get more blood to the
  target area because an increased blood ?ow brings
  more oxygen and nutrients to that area. For
  example, a heat pack placed on your piriformis
  muscle may help to reduce muscle spasms that
  could be causing your sciatica. Cold therapy
  slows circulation, helping to reduce in?ammation,
  muscle spasms, and pain. Your physical therapist
  will alternate between hot and cold therapies.
• TENS (transcutaneous electrical nerve
  stimulation) You could even use this at home, if
  your therapist thinks it's necessary. A machine
  stimulates your muscles through variable (but
  safe) intensities of electrical current. TENS
  helps reduce muscle spasms, and it may increase
  your body's production of endorphins, your
  natural painkillers. The TENS equipment your
  physical therapist uses is larger than the
  "at-home" use machine. However, whether large or
  small, a TENS unit can be a helpful therapy.
• Ultrasound Ultrasound sends sound waves deep
  into your muscle tissues and creates a gentle
  heat that enhances circulation and helps to speed
  healing. Increased circulation helps to reduce
  muscle spasms, cramping, swelling, stiffness, and
  pain.
• In the active part of physical therapy, your
  therapist will teach you various exercises. Your
  physical therapy program is individualized,
  taking into consideration your health and
  history. It may include aerobic conditioning,
  strengthening exercises, and movements to
  increase ?exibility and range of motion.
• If needed, you will learn how to correct your
  posture and incorporate ergonomic principles into
  your daily activities. This will be done to work
  on preventing future episodes of sciatica.

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ALTERNATIVE TREATMENTS
Your doctor's treatment plan for back pain and
sciatica may include alternative treat- ments
such as acupuncture, acupressure, biofeedback,
and/or yoga. Many patients have reported that
alternative treatments have really helped. You
may want to try ACUPUNCTURE Practitioners
believe your body has an energy force called Qi
or Chi (pronounced "chee"). They think that when
Chi is blocked, you can develop physical illness.
Both acupuncture and acupressure (see below) work
to restore a healthy, energetic ?ow of Chi.
(These Eastern approaches to healing are
different from Western scienti?c concepts. That
doesn't make them better or worse it just makes
them different.)
Acupuncturists insert very ?ne needles
(sterilized and disposable) into precise points
on the body. The points are called meridians.
Each meridian is the same as a channel, acupoint,
or acupuncture point. Because meridians run close
to the skin's surface, it is not necessary to
insert needles deep into tissue. Meridians
correspond to speci?c parts of the body, or a
body system such as the nervous, musculoskeletal,
cardiovascular, or lymphatic system. During an
acupuncture treatment, the practitioner may
gently twirl or heat some or all the needles. Is
acupuncture uncomfortable? No. Even patients who
are averse to needles ?nd acupuncture to be a
painless and relaxing experience. If you want to
pursue acupuncture treatment, look for a licensed
practitioner who uses sterile equipment.
ACUPRESSURE A close cousin to acupuncture is
acupressure. Acupressure is a non-invasive, safe,
and gentle therapy. It unblocks Qi without using
needles. The acupressure practitioner uses his or
her thumbs, ?ngers, and elbows to place a precise
amount of pressure to speci?c body points.
Acupressure therapy includes the application of
consistent pressure to one or more points and
briskly rubbing the acupressure point to
stimulate it. Acupressure points and acupuncture
points are identical.
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ALTERNATIVE TREATMENTS
BIOFEEDBACK This is more than telling your body,
"Stop feeling pain." Biofeedback is a mind-body
therapy that teaches you how to change, or
control a habitual reaction to pain or
stress. Can I simply "think my pain away" with
biofeedback? No, it's not that easymore is
involved. Biofeedback often requires intensive
patient participation and is not for everyone.
Some experts view biofeedback as a controversial
therapy because it's used to treat low back pain
has not been adequately researched. Despite this
view, many patients have bene?ted from
biofeedback. Biofeedback includes the use of
special equipment to measure and provide
"feedback" to the patient about his or her
physiological reac- tions to certain stimuli such
as stress and muscle tension. By teaching the
patient deep breathing techniques, visualization,
and mental and physical exercises, the patient
learns how to control his or her reaction to
stressnin this case, muscle tension that may
contribute to sciatica.
YOGA Yoga stretches may lessen sciatica when the
cause is piriformis syndrome (sometimes a
controversial diagnosis). Piriformis syndrome
involves the piriformis muscle found in the lower
part of the spine. This muscle aids hip rotation.
Gently stretching this muscle may help reduce
sciatic pain. However, certain yoga stretches do
not bene?t sciatica. Poses such as forward folds
and twisting can irritate sciatic nerve pain. Any
exercise that involves stretching the back of the
legs (hamstrings) can irritate sciatica. As with
any exercise, the patient must remember not to
push their body beyond pain limits. Respect your
body, and remember Gently stretch!
WILL ALTERNATIVE TREATMENTS HELP TREAT
SCIATICA? There is no one right to that question
some alternative treatments may help you, but
they may not provide sciatic pain relief to
another patient. If you are interested in trying
alternative treatments to address your sciatica,
discuss the options with your doctor. He or she
may even have recommendations for practitioners.
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CHIROPRACTIC TREATMENT

• Doctors of Chiropractic (DC) medicine regularly
  treat sciatica.
• The purpose of chiropractic treatment is to help
  the body's potential to heal itself. It is based
  on the scienti?c principle that restricted
• spinal movement leads to pain and reduced
  function and performance. Chiropractic care is
  non-invasive (non-surgical) and drug-free.
• The type of chiropractic therapy provided depends
  on the cause of the patient's sciatica. A
  sciatica treatment plan may include several
  different treatments such as ice/cold therapies,
  ultrasound, TENS, and spinal adjustments
  (sometimes called spinal manipulation). Below
  are more details on these chiropractic treatment
  modalities.
• Ice/Cold therapy reduces in?ammation and helps to
  control sciatic pain.
• Ultrasound is gentle heat created by sound waves
  that penetrates deep into tissues. Ultrasound
  increases circulation and helps to reduce muscle
  spasms, cramping, swelling, stiffness, and pain.
• TENS unit (transcutaneous electrical nerve
  stimulation) is a small box-like,
  battery-powered, portable muscle stimulating
  machine. Variable intensities of electrical
  current control acute pain and reduce muscle
  spasms. Larger versions of the home-use TENS
  units are used by chiropractors, physical
  therapists and other rehab professionals.
• Adjustments (Spinal Manipulation) At the core of
  chiropractic care are spinal adjustments.
  Manipulation frees restricted movement of the
  spine and helps to restore misaligned vertebral
  bodies to their proper position in the spinal
  column. Spinal adjustment helps to reduce nerve
  irritability responsible for causing in?ammation,
  muscle spasm, pain, and other symptoms related to
  sciatica. Adjust- ments should not be painful.
  Spinal manipulation is proven to be safe and
  effective.

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CHIROPRACTIC TREATMENT

• In college and during their training, students of
  chiropractic learn many different adjustment
  techniques enabling them to treat several types
  of subluxations and disorders. Techniques vary
  from a swift high velocity thrust to those that
  combine minimal force and gentle pressure.
  Mastery of each technique is an art that requires
  great skill and precision. Spinal manipulation is
  the treatment that differentiates chiropractic
  care from other medical disciplines.
• CHIROPRACTIC'S LIMITATIONS IN TREATING SCIATICA
• Sciatica can be caused by other disorders beyond
  the scope of chiroprac- tic practice. If the
  doctor of chiropractic determines the patient's
  disorder requires treatment by another type of
  doctor, then the patient is referred to another
  specialty. In some cases, the referring
  chiropractor may continue to treat the patient
  and co-manage the patient's care with the other
  specialist.

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SURGICAL TREATMENT

• Most patients with sciatica respond well to
  non-surgical treatments (such as medi- cation),
  so spine surgery is seldom needed to treat it.
  However, there are situations when you may want
  to go ahead with spine surgery
• You have bowel or bladder dysfunction. This is
  rare, but it may occur with spinal cord
  compression.
• You have spinal stenosis, and your doctor feels
  that surgery is the best way to treat it.
• You are experiencing other neurologic
  dysfunctions, such as severe leg weakness.
• Your symptoms become severe and/or non-surgical
  treatment is no longer effective.

There are several types of surgical procedures
used in spine surgery, and your spine surgeon
will recommend the best procedure to treat your
sciatica. His or her recommendation will be based
on the spinal condition causing your sciatica,
and the entire procedure should be clearly
explained to you. Don't be afraid to ask any
questions you need to in order to better
understand the surgeon's recommendation. And
remember, the ?nal decision to have surgery is
always up to you. You may ?nd it useful to get a
second opinion on the recom- mended spine surgery
before deciding.
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SURGICAL TREATMENT

• Two common spinal surgeries for sciatica are
• Discectomy or Microdiscectomy In both of these
  procedures, the surgeon removes all or part of a
  herniated disc that's pushing on your sciatic
  nerve and causing your sciatica symptoms. The
  difference between the procedures is that a
  microdiscectomy is a minimally invasive surgery.
  The surgeon uses microscopic magni?cation to work
  through a very small incision using very small
  instruments. Because the surgery is minimally
  invasive, you should recover more quickly from a
  microdiscectomy.
• Laminectomy or Laminotomy These procedures both
  involve a part of the spine called the laminaa
  bony plate that protects the spinal canal and
  spinal cord. A laminectomy is the removal of the
  entire lamina a laminotomy removes only a part
  of the lamina. These procedures can create more
  space for the nerves, reducing the likelihood of
  the nerves being compressed or pinched.
• RECOVERY FROM SURGERY TO RELIEVE SCIATIC NERVE
  PAIN
• After your surgery, you aren't going to be
  instantly better. You will most likely be out of
  bed within 24 hours, and you'll be on pain medi-
  cations for 2 to 4 weeks. After the surgery,
  you'll receive instructions on how to carefully
  sit, rise, and stand. It's important to give your
  body time to heal, so your doctor will probably
  recommend that you restrict your activities in
  general, don't do anything that moves your spine
  too much. You should avoid contact sports,
  twisting, or heavy lifting while you recover.
• After surgery, be vigilant. Report any
  problemssuch as fever, increased pain, or
  infectionto your doctor right away.
• WILL SPINE SURGERY RELIEVE SCIATICA?
• The best answer here is that is the goal of
  spine surgery. The surgeon will work to provide
  you with, in general, pain relief and better
  mobility (although the speci?c goals can vary
  based on your symptoms and needs). By removing
  whatever is pressing on your sciatic nerve (a
  herniated disc, for example, or a bone spur), the
  end goal is to decompress that nerve, which
  should relieve your sciatic pain.
• The majority of patients experiencing sciatica
  don't need spine surgery, but if you do, know
  that many other patients have found pain relief
  through surgery.