Posts Tagged ‘Sciatica’

Sciatica symptom relief has been hard to come by for many sciatica sufferers, but a new treatment option is now available that brings fast relief with a minimal risk of side effects to the vast majority of sciatica sufferers.

Sciatica (commonly misspelled as syatica) is an irritation of the sciatic nerve which is formed by nerves that arise in the low back. Most cases of sciatica are caused by herniations or bulges of one or more spinal discs. The spinal discs are soft tissue structures that separate the spinal bones (the vertebrae) and act as shock absorbers.

When a spinal disc is damaged through a single injury or multiple small injuries over time, the outer wall of the disc may not be able to contain the pressure from within and the disc bulges outward into the canals where the spinal nerves exit the spine. This results in compression and irritation of the nerves, which often produces sciatica that begins in the buttock muscles and may travel downward across the back of the leg to the bottom of the foot.

The treatment options for sciatica symptom relief vary depending on the case. The first line of sciatica treatment is usually medication to reduce pain and inflammation. Muscle relaxers may also be prescribed to reduce muscle spasm. Medication may be effective enough to provide relief short-term until inflammation subsides and/or the disc stabilizes. In more severe cases, oral medication may not be effective, and some patients may not be able to tolerate the common side effects of anti-inflammatory drugs and/or the diminished mental alertness seen with pain killers and muscle relaxers.

Steroid injections are often the next line of sciatica symptom relief treatment, and they are used to try to reduce inflammation around the discs and spinal nerves. While steroid injections often provide relief short-term, the long-term effects are less favorable. Due to the fact that the main effect of steroid injections is to reduce inflammation, once those effects wear off, inflammation and the resulting pressure on the nerves often builds up again, and symptoms return. Steroid shots come with a number of side-effects including bone thinning, damage to soft tissues, and suppression of immune function, so doctors limit the amount of steroids used in order to avoid adverse health effects from the treatment.

Surgical treatment is often suggested for sciatica sufferers, and in a few cases it may be the only real option. Surgery has a poor track record (about a 50% success rate overall), and in some cases, symptoms may worsen following surgery. Complications of surgery include problems from post-surgical scar tissue formation and increased stress on adjacent spinal discs which may result in additional problems with other discs in the years following surgery.

Fortunately, there is a new option in sciatica symptom relief that has a high success rate and a very low risk of side-effects. Spinal decompression is a new, advanced form of spinal traction that uses special computerized traction motors to gently and slowly apply a decompressive force to the spine, reducing pressure in the spinal discs. Spinal decompression systems can comfortably create negative pressure (suction) within the spinal discs that can pull disc bulges and herniations back in and away from sensitive nerve structures, as well as increase disc hydration and nutrition to help with disc healing. Unlike the old forms of spinal traction which could be painful due to the traction pull triggering muscle spasm, spinal decompression systems monitor and respond to the body to keep muscles relaxed so the treatment is comfortable and effective.

Preliminary studies have shown a success rate for spinal decompression of 80 to 90%, with the beneficial effects holding up well over the long-term. The one-year recurrence rate post-treatment is less than 5%. While spinal decompression is not appropriate for everyone with sciatica and is not effective in every case, it does represent a big improvement in sciatica treatment.

A large amount of confusion and misunderstanding exists concerning the conditions sciatica and piriformis syndrome. There are some who insist that the two conditions are actually the same thing, but even though they can have symptoms that are very much alike, the underlying causes differ.

Sciatica refers to irritation of the sciatic (often mis-spelled as syatic or psyatic) nerve, that arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation, or “true” sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region. Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve comression and inflammation, may extend down the entire leg to the ankle and foot.

Piriformis syndrome, also known as “pseudo-sciatica” (meaning “false sciatica”), is actually referral pain and other symptoms (tingling, numbness, etc.) caused by tightness and knots of contraction in the piriformis muscle, which runs from the upper femur bone to the edge of the sacrum, the triangular pelvic bone that is below the lumbar spine. The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica.

In some cases, piriformis syndrome may cause true sciatic nerve irritation, as the sciatic nerve may run underneath or even through the middle of the piriformis, so contraction of the piriformis may produce sufficient compression of the sciatic nerve to produce actual nerve symptoms. This is one of the main sources of confusion when it comes to distinguishing true sciatica from piriformis syndrome.

As mentioned earlier, the symptoms of true sciatica are very similar to piriformis syndrome. Both cause pain, tingling, burning, “electrical shock” sensations, and/or numbness down the leg, often all the way to the foot. In addition, both sciatica and piriformis syndrome tend to be at least partially related to biomechanical functional problems in the joints of the back and pelvis and they may even be present simultaneously in the same person, so it an be difficult to tell them apart.

But since the most effective treatment for the two conditions varies signficantly, it is important to determine the correct diagnosis if at all possible. In most cases there is an easy way to distinguish between sciatica and piriformis syndrome.

Two simple maneuvers will distinguish sciatica from piriformis syndrome in the majority of cases (when the problem is one versus the other and not both conditions at the same time). First, in a seated position, if one straightens the leg on the painful side (so that the leg is parallel to the floor), and the sciatica symptoms increase, this is usually a sign of true sciatic nerve irritation.

The second maneuver is done in two parts. First, from the sitting position one bends the leg and pulls the knee on the painful side towards the same-side shoulder. In all but the most severe cases, there is usually no major increase in pain in this position. The second part of the maneuver is to pull the knee toward the opposite side shoulder. An increase in the sciatica-like symptoms is a strong indication of piriformis syndrome.

It is important to distinguish between sciatica and piriformis syndrome, because the treatment for the conditions varies, and getting the diagnosis right typically leads to more effective treatment.

Sciatica (often misspelled as “syatica” or “psyatica”) is pain that results from irritation of one of the sciatic nerves (one on the right and one on the left), and includes pain in the hip and buttock area that may extend partially or all the way down the back of the leg to the foot. The sciatic nerves start out as smaller nerve roots that branch off from the lower part of the spine. The component nerve roots come together in the pelvis to form the sciatic nerves. Each sciatic nerve then extends down the back of each thigh and divides into two parts below the knee and the two halves continue down the lower leg to the foot.

While there are several possible causes of sciatica, by far the most common source of sciatic nerve irritation is a bulging or herniated disc in the lower lumbar spine. A damaged disc may bulge into the opening where one of the nerve roots exits the spine on it’s way to join other nerve roots as part of the sciatic nerve. The bulging disc may create direct nerve pressure, and/or may trigger inflammation and swelling, which can also cause pressure on the nerve. When this occurs, pain and other symptoms may be felt part along the course of the sciatic nerve, starting in the buttock area and possibly running down the leg, sometimes all the way to the foot.

Besides disc bulges, spinal openings for nerves may be narrowed by bone spurs or other bone formations related to spinal degeneration. In some cases, sciatica may result from direct trauma to the nerve after it exits the pelvis, such as what can happen if there is a direct impact or hard pressure applied in the lower buttock region. Rare sources of sciatica can include spinal tumors, which can compress sciatic nerve roots as they exit the spine. Another rare cause of sciatica is a cyst or tumor that compresses the sciatic nerve in the hip or knee area.

Not every buttock or leg pain that people think is sciatica is acutually sciatica. True sciatica (sciatic nerve irritation) is usually felt mostly in the back of the leg (not the front or side of the leg). The symptoms of true sciatica can take different forms and may be descibed as tingling, burning, stabbing, aching, electric shock, numbness, or heaviness. But even if symptoms seem like sciatica, they are not always due to actual irritation of the sciatic nerve.

One common condition that closely mimics sciatica is caused by knots of contraction called trigger points in a muscle called the piriformis. The piriformis muscles are located on either side of the lower buttock area, running from the upper thigh bone to the edge of the sacrum (the triangular pelvic bone that is at the base of the spine). In addition to causing symptoms that mimic sciatica, tightness in the piriformis muscle may also cause true sciatic irritation, because the sciatic nerve actually runs through the center of the piriformis muscle in some people, and can be compressed by excessive muscle contraction.

Trigger points in other muscles in the buttocks and upper thigh can cause referred pain in the side of the leg that may be mistaken for sciatica as well. It should be kept in mind that true sciatica and piriformis syndrome are associated with symptoms that are primarily felt in the back of the leg. If symptoms are in the front or side of the leg, there’s a good chance that the problem is not sciatica.

Treatment of sciatica is usually associated with treating a bulging disc. The first line of treatment is usually an attempt to reduce inflammation to reduce pressure on the nerve bymeans of oral medications. For more powerful anti-inflammatory effects, spinal injections with steroids like cortisone may be used. A variety of other types of treatment may also be used, such as physical therapy, massage, chiropractic or osteopathic spinal manipulation, acupuncture, or one of the newest forms of treatment, spinal decompression. In some situations, surgery may be recommended as a last resort.

In the majority of cases, an episode of sciatica will resolve even without any treatment within a period of several weeks, but due to the intensity of pain, most patients will not wait for it to go away on its own and seek out treatment. Unfortunately, due to misconceptions by doctors and patients alike regarding the nature of sciatica, the necessary steps to prevent a return of sciatica are usually not taken. So, even though most people do recover from a bout of sciatica, nearly all will eventually have problems again at some point. Even sciatica sufferers initially treated successfully with surgery will often have future problems with sciatica.

The good news is that with awareness of how to manage sciatica and a little bit of effort dedicated to prevention, most people can avoid ongoing long-term sciatica problems. The challenge is simply to making people aware of the necessity of a “management” versus “cure” approach to sciatica and getting them to follow-through with preventive exercises and other self-care techniques.

Because of pain and a lack of understanding of their condition, sciatica sufferers may make some costly long-term mistakes when it comes to handling their problem.

The first mistake is rushing into a surgery. Although the vast majority of surgeons are not anxious to perform surgery on sciatica cases, there are a few who do recommend surgical treatment right from the start, and without even attempting any other type of treatment. Sciatica resolves in approximately 80% of cases without surgery. Even when surgery is successful initially, the development of scar tissue and abnormal mechanical stresses on the spine adjacent to the surgery often lead to future problems. Given that low back spine surgery overall has about a 50% long-term success rate and people treated surgically often wind up worse than they were prior to surgery, it should be reserved as a treatment of last resort.

The exception to the rule of considering surgery as a last resort is in the rare case of severe neurological compromise known as “cauda equina syndrome”, which may be indicated by a loss of bowel and/or bladder control, sudden severe weakness in one or both legs, and/or “saddle anaesthesia” (a loss of sensation in the lower buttocks and inner thighs). Except in the rare instance of cauda equina syndrome though, it is generally better to avoid surgery if possible.

The second mistake sciatica sufferers often make is returning to normal activities too quickly once symptoms improve. The vast majority of true sciatica cases are due to bulging or herniation of one or more discs in the lumbar spine, and the inflammation that typically is associated with such disc problems. In many cases, slight improvements in inflammation can result in dramatic symptom improvement. Many sciatica victims mistakenly believe they are back to normal as soon as they feel better, but the reality is that the bulging/herniated disc is far from fully healed, and too much exertion too soon can easily trigger a recurrence of symptoms – sometimes even more severe than they were to begin with. Even professional physical therapists sometimes make the mistake of pushing a patient to do too much too soon, with the result being a return or increase in sciatica symptoms.

The third mistake people, including doctors, often make regarding sciatica is to view it as a condition that can be “cured”. Because most people continue to engage in the activities that caused the underlying disc problems to develop that produced sciatica in the first place, the vast majority of sciatica sufferers will experience repeated episodes, usually becoming more severe and more frequent over time. This is due to the fact that the disc issues that initially produce the sciatica tend to grow worse over time if they are not managed appropriately. Once again, it is not safe to assume that a resolution of symptoms means that the problem has gone away. In fact, what happens in many cases is that the spine and discs gradually degenerate over time, making the person more and more susceptible to sciatica episodes. Eventually, the degeneration can become so severe that there really is no effective treatment, and many people are left with chronic, debilitating pain.

Fortunately, in most cases, sciatica can be managed effectively simply through an awareness of potentially damaging activities and positions and through simple exercises one can do at home. Long-term pain and disability are avoidable, if one makes the necessary effort to perform the necessary exercise regimen on a regular schedule and to avoid movements, activities, and postions that can be damaging to the discs of the spine, such as incorrect bending and lifting, and poor posture (especially sitting posture). Long-term problems can be avoided by putting forth just a small amount of effort to manage sciatica on an ongoing basis over time.

Sciatica exercises are an important part of both short and long-term treatment, but it is critical to choose the right exercises. Even commonly-recommended exercises for sciatica may not be indicated during times of severe acute symptoms, and some exercises may only make things worse.

For example, while commonly recommended to people with sciatica, exercises such as hamstring stretches and the yoga position, “downward facing dog” can be beneficial as part of managing one’s condition once the pain is reduced, these exercises can place tension on the sciatic nerve and aggravate an already inflamed and sensitive condition. In general, any exercise that causes pain to increase in the leg and/or extend further down the leg should be completely avoided during the acute phase of sciatica.

During the acute phase of sciatica pain, McKenzie exercises provide one of the best and safest treatment approaches available – more effective than medication and epidural steroid injections in many people. Though often associated with spinal extension and mistakenly called the “McKenzie Extension Exercises”, McKenzie method may involve any number of spinal positions/movements. The whole point of the McKenzie method is to evaluate different positions/exercises to find what best produces “centralization” of symptoms.

McKenzie practitioners use the word “centralization” when the pain and other symptoms are relieved in the areas the greates distance away from the spine. To give an example, in a person with sciatica all the way down the leg to the foot, centralization might occur in which the pain left the foot and lower leg and then only extended down to the knee. Or, if sciatica symptoms started out going as far as the knee, centralization would be if the symptoms left the thigh and only went as far as the hip area.

A position or exercise that results in symptom centralization is one that will be beneficial, even in situations where symptoms increase for a time in areas closer to the spine. For example, if you had sciatica and low back pain and tried one of of the McKenzie exercises and the sciatica completely went away but the back pain got worse, the exercise would still be considered beneficial and it would be recommended to continue using it. In the long run, a sciatica exercise that produces centralization will usually eventually result in improvement in all symptoms, even if more central (closer to the spine) symptoms get worse at first.

The simplest of the McKenzie exercises for alleviating sciatica is done by simply lying on one’s stomach on the floor or a firm surface and propping one’s chest up on the elbows. This places the lower spine in a gentle extension, which can help relieve sciatica by pushing bulging spinal discs forward, and away from the nerve roots that form the sciatic nerve, reducing pressure and irritation. Although you can maintain this position for relatively long periods of time, I recommend doing it for short periods of one or two minutes with a rest break of at least a few minutes in between. The frequent breaks prevent the low back muscles from tightening up as much, and yet still allows for good overall results. For more complex sciatica exercises, getting detailed instructions either through an illustrated guide or an experienced health care practitioner is advised.

Sciatica exercises come in many different forms, but the last thing you need when you’re in pain is to have to learn a complicated exercise routine. But using exercise to alleviate sciatica doesn’t have to be difficult. Getting relief can be as simple as doing just one exercise and doing it frequently until such time as the pain is gone or at least much improved.

To figure out what exercise will be of most benefit, it is important to try to distinguish whether you have sciatica from a lumbar disc bulge /herniation, or whether you have a condition called “piriformis syndrome”, which produces symptoms very similar to disc-related sciatica but is caused by contraction of the piriformis muscle in the buttock area.

An easy method to help you determine what the problem is can be done by doing a couple of tests while sitting in a firm chair. In the sitting position, try straightening your knee on the painful side, so that your leg is parallel to the floor. If this increases your symptoms, chances are you have true sciatica related to a disc problem.

The second test is to bend your leg to pull the knee toward your chest. Begin by first bringing the knee on the painful side toward the shoulder on the same side. Then release the leg slightly and pull the knee toward the opposite shoulder. If pulling the knee toward the opposite shoulder increases the pain significantly more than pulling it toward the same side shoulder, chance are you have piriformis syndrome. It should be noted that it is possible to have both true sciatica and piriformis syndrome at the same time.

Once you determine whether you have true sciatica or piriformis syndrome, or both, you can usually get considerable relief from just a single exercise for either condition (two exercises if you have both).

For true sciatica, most people will find relief through the basic McKenzie extension exercise (named for physical thearapist Robin McKenzie). This exercise is performed by lying face down on a firm surface and then propping yourself up on your elbows, creating an increase in the curve of the lower back. Getting into this position may be painful at first, but within about 30 seconds, most people will notice a decrease in the severity or the range of the sciatica, or both. A positive sign is when the symptoms furthest from the spine decrease.

As long as the symptoms are decreasing furthest from the spine, the exercise described is beneficial, even if the symptoms closer to the spine seem to increase at first (they’ll usually improve with repetition of the exercise over time). I suggest you remain in this position for a couple of minutes and then take a break by either just lying flat, or by getting up and walking for at least a few minutes in between the exercise repetitions in order to avoid developing a lot of tightness in the low back muscles.

For piriformis syndrome, you can do a simple stretch of the piriformis muscle. I recommend you do this by lying on your back, pulling your knee on the painful side toward the same side shoulder for a few seconds, then partially releasing the leg and then pulling your knee toward the opposite shoulder. Hold this stretch for about 10 seconds at a time, then carefully release your leg for a a few seconds before repeating the stretch.

Whether you need the McKenzie extension exercise, or the piriformis stretch, or both, the sciatica exercises work best when repeated frequently – up to several times per day while you are having signficant symptoms.

When the symptoms have subsided, it is extremely important to learn what sciatica exercises you can do to prevent the symptoms from returning in the future. Don’t be fooled! Just because the symptoms go away, it doesn’t mean that everything is back to normal. All too often, sciatica sufferers go from one episode of pain to the next, with episodes becoming more severe and more frequent over time, because they fail to manage the problem correctly so you can avoid the common problem of developing chronic pain and disability.