Sciatica
The
sciatic nerve is a collection of several nerve roots that arise
between your spinal bones (vertebrae). These nerve roots join together
and form the largest nerve in the body, the sciatic nerve. This
nerve travels down from the low back under the buttock muscles all
the way down the legs and feet. Sciatica is a term to describe an
irritation or pressure on the nerve, which is commonly caused by
a herniated or bulging disc (also referred to as a ruptured disc,
pinched nerve, or slipped disc) in the lumbar spine. The pressure
or irritation leads to a complex of symptoms that include sharp,
radiating pain, burning, and/or numbness and tingling. This is a
very debilitating condition that affects thousands of people every
year.
Generally, herniated or bulging discs are the cause of the problem.
The herniated material of the disc will compress or contact the
exiting nerve root producing the symptoms. Sometimes central canal
stenosis, lateral canal stenosis, spondylolithesis, or degenerative
disc disease can cause this nerve compression as well. The problem
is often diagnosed as a "radiculopathy", meaning that
one or more intervertebral discs have herniated or protruded from
its normal position in the vertebral column and is putting pressure
on the nerve root in the lower back, which forms part of the sciatic
nerve. Sciatica occurs most frequently in people between 30 and
50 years of age. On many occasions this condition slowly develops
as a result of general wear and tear on the structures of the lower
spine and discs. Rarely is this condition surgical. Unless there
is a progressive neurological deficit, or cauda equina syndrome,
the majority of people who experience sciatica get pain relief with
non-surgical treatments. Non-Surgical Spinal Decompression is very
effective for these conditions. Physical therapy and Chiropractic
can help sometimes as well.
Understanding sciatica pain
First,
everyone responds differently to pain. For some people, the pain
from sciatica can be severe and debilitating. For others, the pain
might come and go intermittently, and not be so intense. Usually,
sciatica only affects one side of the lower body, and the pain often
radiates from the lower back into the deep buttocks all the way
through the back of the thigh and down through the leg. Sometimes
the person experiences calf or foot pain. It is quite variable.
One or more of the following sensations may occur as a result of
sciatica:
- Pain in the buttocks or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot , with
the
- Leg pain being a little worse than the back pain.
While sciatica can be very painful, it is important to keep in
mind that the main problem may be with the intervertebral discs.
Most likely the discs are dry and weakened due to wear and
tear injuries. Treatment goals should be to minimize pain,
minimize the disc herniation, re-hydrate and re-nourish the discs
and nerve roots, and to strengthen and rehabilitate for permanency
and prevention of re-injury. This is where spinal decompression
therapy can be very effective.
Symptoms that may constitute a medical emergency include progressive
weakness in the leg or bladder/bowel or incontinence. As mentioned
above, this may represent a rare condition called cauda equina syndrome.
You should seek immediate medical attention if you are experiencing
these signs.
In general, patients with complicating factors should contact their
doctor if sciatica occurs, including people who have been diagnosed
with cancer; take steroid medication; abuse drugs; have unexplained,
significant weight loss; or have HIV.
Sciatica treatments
Since sciatica nerve pain is caused by a combination of pressure
and inflammation on the nerve root, and treatment is centered on
relieving both these factors, typical sciatica treatments should
include:
Non-surgical sciatica treatments:
- Non-Surgical Spinal Decompression Therapy
- Physical Therapy
- Chiropractic
- Massage Therapy
- Acupuncture
Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen,
or COX-2 inhibitors), or oral steroids can be helpful in reducing
the inflammation and pain associated with sciatica.
Epidural steroid injections
The goals of non-surgical treatments should include both relief
of sciatica pain and prevention of future sciatica problems. Injections
are invasive and are usually only a temporary solution.
Surgical options
When
reading the medical literature, it is generally agreed upon that nearly
all cases do well with non-surgical management.
For severe cases that just dont respond, the following options
are available for surgery:
Microdiscectomy or lumbar laminectomy and discectomy, remove the
portion of the disc that is irritating the nerve root. This surgery
is designed to help relieve both the pressure and inflammation and
may be warranted if the sciatic nerve pain is severe and has not
been relieved with appropriate manual or medical treatments.
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