by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Sciatica is a term that refers to pain that runs along the sciatic nerve that runs from the lower back down the back of the leg.
Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is lumbar herniated disc ("slipped disc".) The discs (or inter-vertebral discs) are the cushions which separate the bones of the spine (vertebrae).
Other common causes of sciatica include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis.
For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be a nuisance. Usually, sciatica only affects one side, and the pain often radiates from the low back down the back of the thigh and leg. Depending on where the sciatic nerve is affected, the pain may also radiate to the foot or toes.
One or more of the following sensations may occur as a result of sciatica:
• Pain in the buttock or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness or difficulty moving the leg or foot
• Unrelenting pain on one side of the buttock
• A shooting electrical shock pain down the leg
Most sciatica pain syndromes result from inflammation and will get better within two weeks to a few months.
Symptoms that constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. Patients with these symptoms should seek immediate medical attention.
The intervertebral disc consists of a tough outer fibrous ring with a softer center. These discs allow for some flexibility between the bones of the spine, and also act as shock absorbers.
The pressure within the discs can be exceedingly high when patients bend or twist, even without carrying a heavy load. If a heavy load is added, the pressures rise even higher.
If part of the fibrous outer ring of the disc is weaker than the rest, the softer center (nucleus pulposus) may push its way out. If this bulge presses against a nerve, it causes symptoms in that leg.
Sciatica occurs when the herniated disc presses against the nerves which make up the sciatic nerve. This is more likely to cause problems when the nerve is squashed between the disc and an adjacent bone.
If sciatica persists, an imaging study such as a CT (Computerized Tomography) or MRI (Magnetic Resonance Imaging) scan needs to be done. These will show whether a nerve is being pinched by a disc, or whether something else is causing irritation of the nerve.
Once the pain of sciatica passes, there are exercises, stretches and other measures that may prevent it from returning. A physical therapist can develop a complete, personalized program.
From the American Physical Therapy Association
Here are some steps you can take in the meantime:
• Practice good posture. Stand up straight with your ears aligned with your shoulders, your shoulders aligned with your hips and your buttocks tucked in. Your knees should be bent slightly.
• Do abdominal crunches. These exercises strengthen the abdominal muscles that help to support your lower back. Lie with your back on the floor, hands behind your head and knees bent. Press your lower back to the floor, lift your shoulders up about 10 inches off the floor, then lower them. Repeat 10 to 20 times, once a day.
• Walk/swim. Walking and swimming can help to strengthen your lower back.
• Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back.
• Avoid sitting or standing for extended periods. If you sit at work, take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day.
• Use proper sleeping posture. Take pressure off your back by sleeping on your side or on your back with a pillow under your knees.
• Stretch. Sit in a chair and bend down toward the floor. Stop when you feel just slight discomfort, hold for 30 seconds, then release. Repeat six to eight times.
• Avoid wearing high heels. Shoes with heels that are more than 1½ inches high shift your weight forward, throwing the body out of alignment.
Other sciatica treatments include:
• Manual treatments for sciatica (including physical therapy and osteopathic or chiropractic treatments) to help relieve the pressure.
• Medical treatments for sciatica (such as NSAID’s, oral steroids, or epidural steroid injections) to help relieve the inflammation.
• Surgery for sciatica may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments or if there is a progressive neurologic deficit.
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Second Opinion Arthritis Treatment Kit
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