Sciatic nerveWhat is Sciatica?
The sciatic nerve is the largest nerve in the body. It starts in the lower back at lumbar 3 (L3) and runs through the buttocks and along the back of each leg. Sciatic pain can be severe and debilitating. Symptoms might include pain in the buttocks and/or leg. It can also cause burning, tingling, numbness, or weakness anywhere along the length of the buttocks, leg, foot, or toes.

Common causes of Sciatica:
Lumbar herniated disc – A herniated disc has protruded from its normal position in the vertebral column and is putting pressure on the nerve root.

Lumbar spinal stenosis – This condition involves a narrowing of the spinal canal and is more common in older adults. However, it can be congenital and may affect younger adults.

Degenerative disc disease – Disc degeneration is a natural process that occurs as we age. In some cases it can lead to severe pain along the sciatic nerve. Piriformis syndrome – The sciatic nerve can become irritated if the Piriformis muscle (which lies deep within the buttocks) becomes tight and compresses the underlying sciatic nerve.

Diagnosis:
If you still have sciatica after a few weeks, your doctor might order an MRI (Magnetic Resonance Imaging) scan. The scan shows both the soft structures as well as the bones of the spine. This will indicate whether a disc is squeezing a nerve or if something else is causing the nerve to be irritated.

Treatment:
Sciatica can be very painful. Most pain syndromes are a result of inflammation and will get better within two weeks or a few months. Many people are confused as to the type of treatment or health professional they should seek out for this type of condition. There is no one answer. Manual treatments would include physical therapy, acupuncture, chiropractic, neuromuscular therapy, and osteopathic medicine. Medical treatments include NSAIDs, oral steroids or epidural steroid injections, to relieve inflammation. A good biomechanical evaluation along with a combination of treatments can be very helpful.

Physical therapists, chiropractors, and osteopaths are trained in biomechanics. Neuromuscular massage addresses the trigger points and spasms associated with sciatica. It can also address some of the muscle spasms and pain associated with biomechanical distortions and sciatica. Acupuncture is an effective and conservative tool to control the pain and calm down an aggravated sciatica nerve.

Surgery, such as microdiscectomy or lumbar laminectomy, helps relieve both the pressure and inflammation that may be warranted by a severe disc abnormality or stenosis. Many advances have been made in this area, and progressive surgical techniques now have patients sitting and walking almost immediately after surgery. In many cases, with time, patience, and consistent treatment, sciatica caused by disc abnormalities can be relieved with conservative treatment in up to 6-12 months.

Prevention:
Regular exercise, stretching, and good body mechanics are among the ways you can prevent a recurrence of lower-back pain and sciatica. Sleep on a firm mattress on your back or side, lying with a pillow between your knees. Adjust the height of your chair so your feet are flat on the floor. Make sure your chair has firm back support, and sit with your buttocks against the back of the chair. Don’t slouch or slump. Always use proper lifting techniques.

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