What is sciatica?

Sciatica pain is felt along the sciatic nerve, which is the body’s longest nerve. Sciatica pain usually occurs when a bone spur or herniated disc compresses a spinal nerve root in your lower back, causing intense pain in your back, leg, and buttock.

Sciatica is more common in the elderly due to the normal wear and tear on the spine that occurs with age.However, younger people can have sciatic pain as a result of a fall, or an injury.

When you have sciatica, knowing what to do is as important as knowing what not to do, and by following these tips, you will reduce your chances of experiencing sciatica symptoms.

If you have sciatica, you may have tried everything to stop your pain, including physical therapy, and other drugs, but did you realize that every day there are several things that can aggravate your condition?

The do’s for recovering from sciatica

• Remain active and mobile: Severe pain may make bed rest essential for some time but retaining mobility as much as easily possible is essential as bedrest alone can be counterproductive. This is supported by research evidence and old days of absolute bed rest are only reserved for some specific conditions such as spinal fractures.
• Regular stretching: Stretching on a daily basis can be beneficial as can be yoga. However extreme stretches are best avoided when experiencing a flare up episode (increased pain).
• Strengthening exercises: Gentle strengthening activities are essential for future prevention and can work wonders in long term.
• Use heat or cold packs: While many people suffering with sciatica want to grab for an over-the-counter pain reliever, using either heating or cooling packs is an alternative option for pain relief. Heating pads might help relieve aching muscles that are tense. Cooling packs, on the other hand, can help reduce swelling/inflammation.

The don’ts for recovering from sciatica

• Stay away from complete bed rest: You can stay in bed for as long as you need to if you are in severe discomfort but try to maintain as much mobility as possible.
• Avoid Lifting heavy objects: You must follow your doctor’s advice, but in general, avoid lifting anything heavy especially during the acute phases of sciatica.Avoid bending and lifting objects from the ground as this places extra stress on the spine which our muscles and ligaments bear. When this is paired with the weight of the object you’re lifting, your ligaments, bones, and discs may get overloaded, causing injury. Combining twisting motions with other movements like forward or side bending should especially be avoided.
• Warming up before exercises is essential: Certain workouts with a lot of resistance can worsen your sciatica if you don’t warm up your muscles first.
• Sitting for long periods should be avoided: While many of us have professions that require us to sit for lengthy periods of time, sitting down can worsen or increase the frequency of pain. Standing desks/ variable height desksare an alternative to consider.
• Avoid taking long car trips: Of course, this isn’t always possible, but if you’re on a long trip, take frequent rests with regular change of position and stretching.
• Be mindful of your posture and ergonomics: prolonged unhealthy postures can cause increased strain of back and worsen the pain in long term.

The final word about sciatica. . . .

The majority of sciatica patients do not necessitate surgery. Usually, time and self-care therapy are all that are required. However, if basic self-care methods do not reduce your pain, interventions such as injections (nerve root blocks, epidural) can be considered. Feel free to get in touch with us for further information. 

How a pain management specialist can help with your sciatica pain

If you are suffering with sciatica pain and not getting relief, make an appointment right away with Dr. Amod Manocha, the best pain management specialist in Delhi and Gurgaon, to receive the best of his expertise and world-class treatment options.

The post Know The Do’s And Don’ts To Recover From Sciatica appeared first on Dr Amod Blog.

Symptoms. Most patients complain of a sharp, burning, electric shock like pain in one or both legs and back pain/ stiffness. This is often accompanied by tingling sensation, numbness and/or leg weakness. Movement, coughing and sneezing may intensify the pain.

Treatment

Pain management specialists focus on holistic management and use a combination of injections, medication and physiotherapy in most cases. Injections are safe, effective, non-surgical interventions and the options include nerve root blocks and epidurals.

Injections for Sciatica/ Slipped Disc

These involve placing needles under x-ray guidance, close to the site of actual problem. Once in the correct place, a mixture of medicines is injected to reduce the pain and inflammation. The resulting pain relief is generally quicker and can be long lasting, giving time to patients to engage in physiotherapy and strengthen the supporting muscles. As these injections deliver the medication close to the problem site, more drug reaches where it is required thereby increasing the chances of successfully reducing the leg and back pain

For more information on sciatica please follow the link below
All You Want to Know About Sciatica

For more information on injections please follow the link below
Epidural Steroid Injections can provide quick relief in cases of pain originating from the spine

The post Slipped Disc/ Sciatica Treatment: Non Surgical Pain Relief appeared first on Dr Amod Blog.

Sciatica is term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to disc bulge in the low back. This is most commonly seen in middle-aged adults and men are more susceptible. The term sciatica originated from the sciatic nerve, which is the single largest nerve in our body. This nerve is responsible for a significant proportion of leg sensation and movement. Sciatica represents pain in the area supplied by the sciatic nerve.

Radicular pain/ radiculopathy are medical terms which doctors use when describing this condition. There are numerous reasons for having leg pain and every leg pain is not sciatica. Commonly people misinterpret sciatica as a disease and need to be explained that it is a symptom of the underlying problem.

2. What are symptoms of sciatica?

The severity and symptoms many vary considerably. In severe cases the affected individual may find it difficult to walk or even stand up straight.

Some of the commonly observed symptoms include

• Sharp, burning, stinging, shooting, electric shock or cramps like pain in one or both legs often as far down as the foot. Movement, coughing and sneezing can intensify the pain
• Tingling, pins and needles and/or numbness in leg or foot
• Muscle weakness with difficulty in weight bearing or walking.
• Buttock/low back pain and stiffness.

3. What causes sciatica?

• Disc herniation: Spine is formed of many bones called vertebrae arranged one above the other. In between these vertebrae are discs, which are like cushions or shock absorbers. The discs are made up of an outer tough substance and an inner soft jelly like substance. Herniation of the disc can occur if there is splitting or crack in the outer layers allowing the inner jelly like substance to protrude through the crack. This can cause inflammation and compression of the nerve roots in the vertebral column. Slipped disc is a commonly used term for this condition. There is an increased susceptibility to disc herniation as we age because the soft, jelly like substance dries out and shrinks with time, making the disc more fragile.
• Spinal stenosis: Stenosis means narrowing. The narrowing can be of the central canal of the spine or the passageways/ tunnels from which the nerves exit the spine. Besides disc problems, arthritis of the spinal joints or thickening of ligaments can also cause/ contribute to the narrowing.
• Spondylolisthesis: In this condition there is a problem with the alignment of vertebrae, where one vertebra is more forward or backwards, which can narrow the spaces for nerves and produce sciatica as a result.
• Piriformis syndrome: In this condition piriformis muscle in the pelvis is responsible for pressure on sciatic nerve.
• Trauma/ fractures
• Spinal tumors and infections are rare causes of sciatica

4. Can it resolve on its own?

Fortunately most cases of sciatica resolve within a period of weeks to months with conservative treatment. Specialist input and treatment can help. Painkillers, heat or cold pack, altered activity levels and physical therapy may be suggested depending on your condition. An injection of steroids into the epidural space within the spine can provide short-term pain relief in sciatica. Persistent pain can lead to changes in the nerves (referred to as plasticity). This can be a source of persistent pain even if the original inciting event is resolved … hence the importance of managing these sooner than later.

Having seen numerous cases over the years, I would say that it is not easy to predict the course. It can resolve but to what extend depends on numerous factors- some are modifiable and others are not. The recovery period varies from individual to individual.

5. What are the warning signs I need to be watch for?

Some symptoms point towards a serious problem and require urgent medical attention. Ignoring these could lead to permanent nerve damage. Some of these include

• Loss of urinary control/ inability to pass urine
• Loss of control over stools
• Numbness around the bottom
• Worsening leg weakness / loss of control

6. What can I do to reduce my risk of having sciatica?

Though it’s not possible to completely eliminate the risk of sciatica, however adopting a healthy life style can help in reducing the risk. This includes

• Giving up smoking
• Regular exercises
• Right posture and work ergonomics
• Healthy diet and maintaining weight in the normal range
• Using proper manual handling techniques while lifting to avoid back injury
• Stress Management

7. What investigations are generally considered for sciatica?

Your doctor may request for investigations such as magnetic resonance imaging (MRI) scan and blood tests. Sometimes computerized tomography (CT) scans may also be required. X-rays are not as helpful and they can provide only limited information.

Bulging discs on an MRI scan are not an uncommon finding. It is important not to get fixated on the MRI findings. A bulging disc is not permanent and can reverse. The investigation results should be interpreted in combination with patient history, examination findings to assess their significance. A number of patients with severe MRI findings may be asymptomatic and vice versa.

8. What are the other treatment options?

Sciatica is different from common ailments we all suffer and hence taking professional help is recommended. Your doctor can help to confirm that you have sciatica and help identify the cause. A range of different options- non surgical (such as injections- nerve root blocks, epidurals, piriformis injection etc) or surgical may be considered. There is no one solution for sciatica pain and the options are numerous – some with good evidence and others with not so robust evidence.

Generally a multimodal multidisciplinary approach is preferred as this helps in addressing not only the pain but also the impact of pain on one’s life. I ensure that the patient understands the nature or problem and the do’s and don’ts. Time spent in explaining the conditions and the expected course goes a long way in fostering realistic expectations. I generally use a combination of the modalities mentioned below to enhance the chances of quicker recovery.

Pain relief:
Pain reduction achieved by medicines help to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms and individual factors such as co morbidities and allergies. Some of the commonly prescribed pain killers include

• Non steroidal anti-inflammatory drugs (NSAIDs)
  This includes drugs such as DIclofenac, Naproxen, Aceclofenac, Ibuprofen etc. NSAIDs are prescribed to reduce the pain and inflammation during periods of acute sciatica although the evidence supporting their use is not very robust. The risk benefit ratio needs to be evaluated while prescribing any drugs.
• Neuropathic pain killers
  This group includes antidepressants and anticonvulsants both of which are well known painkillers for nerve pain. It generally takes a few weeks for the full effects of these drugs to become apparent. Effects such as reduced anxiety and sedation can be used beneficially by tailored selection to suit individual patients. Their use is supported by the NICE guidelines, UK.
• Opioids
  Weak opioids such as tramadol are often prescribed during pain flare up episodes. It is a good practice to be aware of the side effects of a medicine prior to using it.
• Muscle relaxants
  These are used for short duration to relieve any muscle spasm contributing to the back pain.

Spinal Injections:

The use of epidural steroids/ Nerve root blocks has been shown to have beneficial improvements in leg pain and disability scores in short term. Steroids help by their anti-inflammatory and analgesic (pain relieving) effect. Epidural steroids are preferred to oral steroids as they are given close to site of actual problem and have less adverse effects.

Physiotherapy:

Physiotherapy is an essential component of sciatica treatment. Your physiotherapist can help with posture advice, do’s and don’ts relevant to your condition, understanding the concept of pacing of activities, setting practical goals, teaching strengthening exercises for core, leg muscles and manual handling techniques.

Surgery:

If a combination of above fails to provide adequate relief then surgical options such as discectomy (operation to remove bulging part of the disc or separated disc fragments) and microdiscectomy can be considered for sciatica resulting from disc bulge. Surgical options will vary depending on the cause of sciatica and sometimes may be the first choice, depending on the actual pathology and its severity.

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