Coping With Sciatica

By: Terry OBrien

Sciatica is a pain that starts in the back and radiates down one of the legs. It is quite a common complaint and is sciatica is caused by pressure on the sciatic nerve which runs down into the leg. The medical term is acute nerve root compression. The cause of pressure can be varied from a Slipped (Prolapsed) disk to muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths and infections.

A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has 'slipped' out of place. Intervertibral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.
They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting.

However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.

The intervertebral discs are filled with a soft liquid in the middle called nucleus pullouts and when a disc prolapses this liquid squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.

Depending on where the sciatic nerve is pinched will determine where you feel the pain which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged.

Sciatica Symptoms
Acute low back pain.
Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness.
Pain is often triggered by a minor movement such bending over to pick something up.
Pain may be worse by sitting, lifting, coughing or sneezing.
Pain is usually relieved by lying down, often on one side.
Pain is often better in the morning after a nights rest.
Scoliosis or an S shaped or bent spine as seen from behind is often present with the patient bending away from the side of pain.
There may be muscle spasm in the lower back.
Tenderness in the lower back when pressing in.
Pain on the straight leg raise test which is not apparent when just stretching the hamstring only.

Sciatica treatment
A Short Rest in bed if necessary in a position that is comfortable.
A doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen. Should always be taken under the direction of a doctor and do not if the patient has asthma.
Apply heat or a hot bath may help to relieve muscle spasm.
Use a heat retainer or back brace can provide support in the early stages.
See a sports injury specialist or doctor.
Begin extension exercises as soon as pain allows.

What can a Physical Therapist or GP do?
Determine the cause of the sciatic pain.
Prescribe anti-inflammatory medication e.g. ibuprofen or muscle relaxants.
Use sports massage techniques to relax tight muscles.
Gently apply mobilization techniques to the spine.
Use traction or advise on the use of and Inversion Table.
Apply electrical stimulation in the form of a Tens machine or Interferential.
Apply ultrasound treatment.
Operate on a slipped disk if neurological signs (nerve related symptoms) continue or worsen.

After the acute painful phase
Restore pain free movement to the back through mobilization and stretching techniques.
Ensure posture and correct lifting techniques are learned and maintained.
Strengthen the core stabilizing muscles of the spine.

Terry O'Brien
Back Trouble UK

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