Now that we've learned about the anatomy of sciatica and some of the causes and symptoms we can get into the treatment and prevention options.
Firstly, if sciatica is related to low back pain than the general treatment options in this article are useful things to always keep in mind: Low Back Pain General Advice
Treatment of Sciatica will depend on the presenting symptoms and the severity of the symptoms. It was also depend on whether the Sciatica is related to nerve root compression, such as a bulging disk or if it is from another factor, such as piriformis syndrome. This is why it is important to get an accurate diagnosis of the cause of sciatica. The following are just some treatment options that are available. It is advised that you see your physician or physical therapist before trying any of the treatments mentioned below.
If the cause of sciatica is due to sacroiliitis or other inflammatory conditions then a common and effective treatment is non-steroidal anti-inflammatory drugs (NSAIDs). This treatment option should be short-term. While this is a common treatment option, a recent cochrane review has found that NSAIDs are only slightly effective in the treatment of sciatica. Nevertheless, depending on the diagnosis, NSAIDs can be an effective treatment option in the short-term. It should be noted that prolonged use of NSAIDs should be avoided because the damage it could cause to the liver, kidneys, and stomach. analgesics and muscle relaxants may be prescribed for pain relief, but these will not be effective in ridding the symptoms long-term.
Steroid injections may be used in certain cases. Injections are useful in the short-term, but often do not provide relief past 6 weeks. Evidence so far seems to say that injections are most effective in the acute phase of sciatica, but not really after. Nerve block injections have been shown to be effective for pain relief in chronic sciatica, but relief is short-term.
Physical therapy has been shown to be a very effective treatment option for people suffering from sciatica. Studies have shown that physical therapy plus physician care is more effective than physician care alone in treating sciatica. Physical will include exercise and advice like that seen in this article: Low Back Pain General Advice. It will also include more specialized intervention like spinal mobilization and/or manipulation. Depending on the background of the physical therapist one of a couple of approaches will be taken in order to centralize (stop the pain from radiating down the leg) the sciatica. Three approaches are the Maitland method, McKenzie method or Mulligan method. Physical therapist may be trained in one particular method or use a combination of aspects from all three.
You can read more about these approaches here: Rehab Students
McKenzie has also written the great book below, which I would highly recommend to anyone.
Self care for sciatica may help reduce pain and compliment treatment of other sources. For some people, simple self care will be enough to get rid of sciatica pain. It is important that you continue with self care even when the pain has disappeared in order to prevent sciatica from returning.
Aside from the general advice for low back pain, the following self care techniques can help with sciatic pain:
Lifting objects safely. There's a reason why we're always told to lift with our knees. In the simplest terms, get yourself square with what you're going to be lifting, squat or lunge down to the object, keep it close to your body, lift straight up and try to avoid bending your back.
Avoid bad posture while sleeping. Admittedly, this is one that I find most difficult. it's so easy to curl-up in a little ball and sleep, however this puts a huge amount of flexion into the lower back for a prolonged period. Some simple things like putting a pillow between your legs or on your back with a pillow in under your knees can help. lying on your belly is actually quit good for back pain, however, this can cause neck pain because the alignment of your head when sleeping on your stomach.
Avoid wearing heels. Sorry ladies. Wearing heals causes an exaggerated tilt of the pelvis and also requires hip muscles, such as the glutes or piriformis to work harder. This means that these muscles can go into spasm. If you remember from the anatomy, the sciatic nerve runs behind, or sometimes through, the piriformis. Spasm of these muscles and an exaggerated pelvic tilt can cause compression on the nerve.
Exercises for Sciatica
Keeping fit and active is always important, especially since obesity has been linked to sciatic pain. Regular exercise also promotes a stronger core, and better endurance of mobilizing muscles - reducing the risk of spasm. Some common exercises that may help to prevent or reduce sciatic pain are:
Back extensions: lying on your stomach push yourself up on your forearms, hold for 2 seconds and return to lying flat. repeat 8-15 times. It's important to keep your hips on the floor and make sure it is only your back that is extending. This can also be done in standing. This is one of the exercises that proponents of the McKenzie method above will typically teach patients.
Aerobics: walking, jogging, aerobics classes, etc... have been shown to reduce back pain when combined with flexibility or stability exercises by up to 30%.
resistance exercise: resisted lumbar extensions, such as deadlifts will strengthen the muscles of the low back and can help decrease back pain. Following general strengthening guidelines, such as using a moderate/heavy weight and performing 8 reps x 3 sets can be sufficient. It's extremely important that such exercise be performed correctly, therefore it is advised that you been shown how to do these by a professional. Resistance exercise has been shown to decrease back pain by up to 60%.
It has been shown that early surgical treatment is no more effective than conservative treatment 1 year after starting treatment, but relief from pain was much quicker in those who had surgery than those who had not. It's important to remember that everyone is different, and there are times when conservative management will not be effective and surgery will be. This is obviously a subject that has to be discussed with your doctor. Any one of the above interventions may be effective on it's own, but it's likely that a combination of two or more will be most effective. Any decisions should be discussed with your healthcare provider. If you have any specific questions feel free to contact me directly, use my forum, or comment below.
Leggett, S. et al. (1999), Restorative Exercise for Clinical Low Back Pain: A Prospective Two-Center Study With 1-Year Follow-Up, Spine, 24(9), pp. 889
Legrand, E. et al. (2007), Sciatica from disk herniation: Medical treatment or surgery?, Joint Bone Spine, 74(6), pp. 530-535
Kumar, M. et al. (2011) Epidemiology, Pathophysiology and Symptomatic Treatment of Sciatica: A Review, International Journal of Pharmaceutical & Biological Archives, 2(4), pp. 1050-1061
Rainville, J. et al. (2004), Exercise as a treatment for chronic low back pain, The Spine Journal, 4(1), pp. 106-115
Salahadin, A. et al (2005) Epidural Steroids in the Management of Chronic Spinal Pain: A Systematic Review, Pain Physician, 10, pp. 185-212
Wilco, C. et al (2007) Surgery versus Prolonged Conservative Treatment for Sciatica, New England Journal of Medicine, 356, pp. 2245-2256
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