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.

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• Persistent or worsening back pain. Back pain often goes away in a few days or weeks but if it is persisting or progressively increasing then its reason to seek medical attention. 
• Back pain associated with progressive numbness, tingling, or weakness. This could be a symptom of pinched nerve, slipper disc or narrowing of the space in the spine (slipped disc) and requires medical attention
• Inability to control your bowels or urination (incontinence) Spinal nerve compression can have an impact on one’s ability to control bladder and bowel function, leaving to incontinence. This is a severe symptom and requires immediate medical attention. 
• Back pain starting after an accident. If your back pain began after a fall, accident or an injury
• Back pain that is worse at night
• Back pain associated with unexplained weight loss. .
• Back pain with Fever. This could be a sign of infection or ongoing inflammation
• Back pain in extremes of ages (too young or too old patients) or in high risk individuals such as those with severe osteoporosis or prolonged use of steroids or drug abuse history

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• Narrows blood vessels, reducing the blood flow to the muscles, bones and other body parts
• Impact on brain circuitry
• Impact on immunity and slow healing
• Increased fatigue
• Increase blood pressure

The incidence of chronic low back pain among smokers compared to non-smokers is higher, and smokers experience more severe pain. This is true irrespective of the sex and nature of work (manual laborers Vs white-collar). Some studies have reported former smokers having a higher prevalence of back pain than never smokers and other studies have reported that those who smoked more cigarettes per day had higher prevalence of back pain.

For those with back pain, it is important to know about the link between smoking and back pain as smoking is known to

Impact on Discs

One of the most important factors responsible for increased back pain is the impact of smoking on the discs. The disc is dependent on the surrounding tissues for its nutrition and when we smoke, the pores through which the nutrition goes, start getting blocked, negatively affecting the healing and regenerating capacity of the discs. Nicotine can alter the size of the blood vessels and the ability for the body to adapt, increasing the chances of damage. The flexibility of discs suffers and they can degenerate quickly, leading to early disc problems.

Impact on Bones

Your bones also become weak due to smoking because smoking increases osteoporosis.

Impact on Pain Sensitivity

Another factor due to which the pain can increase is pain sensitivity. When you smoke your pain sensitivity increases which means that the pain which was less troublesome before increases in severity.

Impact on Muscles

So when you smoke, your muscles become weak. Muscle mass, flexibility, and strength decreases and this can become a reason for the pain arising from the muscles

Impact on Tendons & Ligaments

The stability and the strength of ligaments and tendons reduces due to which the instability of the spine can increase.

Other Effects

Besides the above effects, smoking has many other adverse effects such as causing inflammation and impairing immune function affecting the healing capacity of the body.

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Myth #1: Discs slip out of place

The name slipped disc is a misnomer as the disc does not slip out of place. It is firmly supported in its place surrounded by strong ligaments on both sides. The discs have a tough outer layer that surrounds a jelly-like material in the centre. Slipped disc is used to refer to a condition where the disc looses its shape and/or consistency and either the central jelly-like material of the disc leaks or bulges out. In medical terminology other terms such as degeneration, bulging, protrusion, extrusion and sequestration are used to refer to varying magnitudes of the problem.

Myth #2: Slipped discs are always caused by injury

Slipped disc results from a magnitude of factors causing weakening of the disc such as genetic factors, age related wear and tear, lifestyle including physical activity, body weight, smoking etc. They may however come to light after a sudden movement/ injury but the predisposition is already present and sometimes even trivial activities can trigger the symptoms.

Myth #3: Slipped discs always cause excruciating pain

Whilst slipped discs can be quite painful, this is not the case always as the severity of pain can vary. It is possible for a person to have a slipped disc and feel no pain or show no symptoms. For most people, a slipped disc will cause some pain and discomfort, and this generally reduces with time.

The pain from a slipped disc may be felt in the back and/ or the arms/legs. This may be accompanied by other symptoms such as numbness, tingling and muscle weakness.

Myth #4: My x-ray is fine so I cannot have a slipped disc

X-rays of the spine are not good at looking at discs. Although they may show problems such as reduced disc height, they are not good for evaluating slipped discs. MRI scans are better at looking at the spine anatomy in detail. X-rays are used more for evaluation of bones.

Myth #5 : MRI imaging will show the cause of my back pain

Technological advancements have enabled us to identify minute changes in disc structure using investigations such as the MRI. A significant number of normal individuals with no symptoms, when scanned will show disc abnormalities on the MRI. This emphasises the point that not every slipped disc causes pain and the findings need to be interpreted in relation to your history and examination findings. Discs normally wear down as we age, so just because the MRI showed a disc problem doesn’t mean that it is the cause of your pain.

Myth #6: Slipped discs require Surgery Sooner Or Later

In an overwhelming majority of cases the problem will NOT require surgery and can be managed conservatively. Disc bulges are NOT forever. A recent study revealed that spontaneous regression of disc injury can occur with conservative care.

Understandably the idea of being under the knife can be terrifying for most people and this option is required only for severe/ non resolving cases. Experienced, knowledgeable medical professionals always try less invasive treatments first. Non surgical interventions, such as medications, physical therapy and injections, can help in reducing the symptoms. Spinal injections such as nerve root block can sometimes play a key role in controlling symptoms and speeding up recovery. Such injections are administered under x -ray guidance to ensure accuracy.

Myth #7: Movement will make my disc problem worse

Whilst extreme pain episodes may require rest, continued activity is generally advised. Simple activities (such as walking, mild stretches) as recommended by your specialist, can reduce the loss of muscle strength and endurance. It can reduce deconditioning of muscles which in itself can be a source of pain. It may be sensible to avoid certain types of activities such as heavy lifting, impact sports etc whilst the body attempts to repair itself. Movement can plan an essential role in the healing process.

Myth #8: Slipped disc is a permanently disabling condition

Many believe that once they get a slipped disc it’s a lifetime problem and they will never be able to return to normal activity. I have seen patients with normal spine who have not bent forwards for years as they were advised not to do that during a back pain episode. Such strongly embedded negative beliefs are disabling and dealing with them can be challenging. With patience, correct knowledge and timely treatment most individuals can return to 100% prior level of function without pain.

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