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Sciatica

*If you are experiencing back pain, see a doctor who can determine the cause. If the pain spreads down your leg or is accompanied by tingling, numbness or weakness, see a doctor immediately. Occasionally, sciatica may be caused by a serious condition that requires immediate surgery.

Sciatica refers to pain along the path of the sciatica nerve. It is usually caused by pressure on the sciatic nerve. Fortunately, most cases of sciatica are not serious and usually resolve within six weeks.

The sciatic nerve branches off nerve roots at the lower end of the spinal cord, its two branches run from the lower back through the each side of the pelvis, buttocks, back of leg to the foot. The sciatic nerve is the longest nerve in the body and its diameter is the diameter of a finger.

Sciatica Symptoms

Sciatica is a term for pain that radiates along the sciatic nerve, anywhere from the lower back, buttocks, down the back of the leg, to the foot. There may also be weakness, numbness, tingling, particularly in the leg and/or foot. The location of the pain and/or numbness varies according to the location that the sciatic nerve or nerve root is affected. The pain can range from burning to aching and can vary in intensity. The pain may be intermittent or constant. Sciatica usually occurs on only one side of the body. Prolonged sitting or standing, sneezing, coughing or lifting aggravates sciatica. Sciatic pain may be acute but often develops gradually.

Causes of Sciatica

Sciatica is caused by inflammation or compression of the sciatic nerve or nerve roots in the lower spine. It may also be caused by damage to nerve roots. Sciatica is not a disease in itself and its causes are various.

*Compression of a nerve is often referred to as a "pinched nerve." A "pinched nerve" in the lower spine causes sciatica.

The most common cause of sciatica is a herniated disc in the lumbar spine (lower back) that puts pressure on the sciatic nerve or a nerve root. A herniated disc can occur suddenly and cause acute pain or it may develop gradually.

Spinal stenosis is a narrowing of the spaces in the spinal column that causes compression of the spinal cord or nerve roots. It can cause sciatica if it occurs in the lower back.

In advanced osteoarthritis of the spine, bits of cartilage may break off and float around inside the spinal joints. This causes irritation and inflammation and if it occurs in the lower back may put pressure on the sciatic nerve.

Spondylolisthesis: when one vertebra slips over another occurs most often in the lower back where the misaligned vertebrae may place pressure on the sciatic nerve.

A less common cause of sciatica is Piriformis syndrome, a disorder in which a muscle located in the buttocks (the piriformis muscle) contracts and irritates the sciatic nerve. In this case, the pain starts in the buttocks and radiates down the leg. Piriformis syndrome is generally treated with stretching exercises, massage, and anti-inflammatory drugs.

Something as simple as muscle strain can cause inflammation, which may put pressure on the sciatic nerve.

Sciatica Treatment / Pain Relief

*Always consult a physician to diagnose the cause of sciatica and rule out any serious conditions that may require immediate surgery.

Treatment consists of treating the pain and the condition that is causing it. Anti-inflammatory medication, analgesics, and usually some form of physical therapy are often prescribed.

Bed Rest for Severe Acute Sciatica: Though bed rest does not speed up recovery, in the case of acute sciatica lying down on a firm surface often relieves the pain and may be necessary for the first couple of days.

Cold and Heat

Applying ice for 15 - 20 minutes at a time every three to four hours for the first couple of days of acute sciatica can help to relieve inflammation and pain. Ice can be applied more frequently if desired - wait an hour between applications - but keep each application under 20 minutes to avoid damaging tissue. Use a cloth to wrap the ice - do not apply ice directly to the skin.

Once the pain has subsided (often after four or five days but may be more or less) heat may bring relief. Not only is heat a soothing distraction from the pain, applying heat to the affected area increases blood flow to the area and promotes healing. Heat can be applied for 20 minutes at a time with at least an hour between applications. The application of cold and heat can also be alternated at this stage.

*If you have circulation problems or nerve damage, do not use hot or cold therapies unless recommended by a physician.

Medications: Non-prescription NSAIDs (anti-inflammatory drugs) such as aspirin and ibuprofen treat both pain and inflammation. Analgesics such as Tylenol treat pain but not inflammation, but may be preferred by some people. In cases of severe acute sciatica, physicians may prescribe codeine preparations and/or muscle relaxants.

Keep Mobile: Though a couple of days of bed rest may be necessary with acute sciatica, bed rest can hinder recovery. Not using the muscles causes them to weaken very quickly. Walking, even a little at a time, helps maintain strength of the legs and the core muscles, which help to support and protect the spine. Movement also increases circulation, promotes healing, prevents stiffness and stimulates the exchange of fluid and nutrients in the spinal discs.

Exercise:

*Depending upon the cause of sciatic pain, certain exercises may have to be avoided. Always consult a doctor as to the safely of exercises for your particular condition.

A physical therapist can recommend the best exercises based on the cause of your sciatica. Gentle stretching exercises done a couple of times per day are often done to relieve sciatica but what exercises to do will vary according to the cause of the sciatica. For example, exercises that involve rounding the back can aggravate sciatica caused by a herniated disc in the lumbar spine yet relieve sciatica caused by spinal stenosis. Piriformis stretches (muscles deep in the buttocks region) can relieve sciatica that is caused by a tight piriformis putting pressure on the sciatic nerve.

Low-impact aerobic exercises such as walking increase the endurance of the core muscles and the legs, increase circulation and promote healing. If walking increases pain, swimming is another option. Core strengthening exercises are usually introduced after pain and other symptoms have subsided.

Support/ Posture: Sitting on soft surfaces aggravates sciatica - adequate support is necessary to prevent slouching, which places excessive stress on the lower back. A chair that tilts back slightly shifts your weight onto the backrest of the chair to take stress off the lower back. Support is necessary while lying down too. A saggy mattress causes the lower back to sink into the mattress and can irritate the spinal joints and aggravate sciatica. The best mattress for lower back pain may be a medium-firm mattress. Any increase or decrease in the normal curve of the lower back increases stress on the spine and aggravates sciatica.

Avoid activities that increase pain and/or other symptoms. Prolonged sitting and standing and bending and lifting stress the lower back and can aggravate sciatica. When the cause of sciatica is a herniated disk in the lumber spine, avoid rounding the back (bending at the waist).

Spinal traction: Spinal traction stretches muscles and ligaments and increases the space between the vertebrae to reduce compression of nerve roots. Lumbar traction is often used to relieve sciatica. There are various forms of spinal traction, both mechanical and manual.

Note: Spinal traction is not recommended for acute sciatica.

Invasive Treatments

Spinal Injections:

Before considering surgery, but after conservative, non-invasive treatments have not provided adequate pain relief, an epidural steroid injection may be given. This minimally invasive procedure involves injecting a combination of corticosteroids (a powerful anti-inflammatory) and a local anesthetic into the epidural space.

Surgery: If conservative treatments do not bring adequate pain relief, surgery becomes a consideration. If there is progressive weakness or difficulty in walking (possible progressive nerve damage) surgery is may be necessary. Immediate surgery is required if there is or loss of bladder or bowel function.

Sciatica Prevention

Core strength and endurance are needed for maintaining proper posture (while still or in motion) which helps prevent undue stress on the discs and joints in the lumbar spine. Exercises to strengthen the core muscles reduce the risk of a herniated disc in the lower back, the most common cause of sciatica.

Low impact aerobic exercise increases core muscle endurance without causing too much stress on the joints and discs of the spine. Walking is a good low-impact aerobic exercise; swimming and riding a stationary bike are good no-impact aerobic exercises. Exercise can help slow down age-related degenerative changes in the discs that sometimes cause sciatica.

Stretching the piriformis can prevent a tight piriformis from putting pressure on the sciatic nerve. Stretching the hamstrings may also help prevent sciatica as tight hamstrings pull the pelvis backward causing uneven compression of discs in the lumbar spine.

Maintain proper posture. The muscles, ligaments, discs and spinal joints are under the least stress when the spine is in neutral alignment.

Use proper body mechanics when lifting. Bending forward with a rounded back and lifting a heavy object places extreme stress on the lower back and can cause a herniated disc.