Physiotherapy in Action

Physiotherapy In Action: SCIATICA

by: - January 16, 2017
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By: Dr Lucia Corriette

SCIATICA
Sciatica is a condition that describes pain that is felt along the path of the sciatic nerve. This nerve runs from the low back through the hips and buttocks and down each leg. Most often, sciatica tends to be felt on one side of the body. It is seen in 40% of adults.

 

 

Causes

Sciatica is the result of nerve compression and is usually due to a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis). A herniated disc is a protrusion of disc material that causes compression of nerves located nearby. A bony spur is a protrusion of bone from the bones within the spine. Sciatica is most likely to occur between the ages of 30 and 50.

In rare cases, cauda equina syndrome may occur. This happens when a herniated disk compresses nerves and causes loss of control of the bladder or bowel. If this happens, there may also be numbness or tingling in the groin or genital area. This is an emergency situation that requires surgery and you should see your doctor immediately.

 

 

Risk Factors

  • Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
  • Increased stress on the spine from excess body weight can contribute to the spinal changes that cause sciatica.
  • It is thought that repeated twisting of the back, carrying heavy loads or driving a motor vehicle for long periods may be contributing factors to sciatica, but this has not been proven conclusively.
  • People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people.
  • Diabetes affects the way your body uses blood sugar, and increases your risk of nerve damage.

Signs and Symptoms

  • Pain (especially with movement, sneezing, or coughing). The pain can vary from a mild ache, to a sharp, burning or severe pain. It may also feel like an electric shock.
  • Numbness of the affected leg
  • “Pins and needles”
  • A burning or tingling sensation down the leg
  • Weakness of the affected leg

Medical Management

Imaging tests

These tests may not be requested at the first doctor’s visit since most people can be effectively diagnosed without them. Therefore, doctors may not order them unless your pain is severe, or does not improve within a few weeks.

  • X-ray. An x-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
  • Magnetic resonance imaging (MRI). This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks.
  • Computed Tomography scan (CT). When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
  • Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Nonsurgical Treatment

Most cases of sciatica are successfully managed without surgery. Early diagnosis improves the chances of having good results with treatment. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants help with pain relief. Use of heat or cold on painful muscles may be of some benefit. It is important to stay as active as possible, since too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as you can. Movement helps to decrease inflammation. It is likely that the symptoms will improve within a few weeks. If needed, your doctor may inject your spinal area with a cortisone-like drug (steroid).

Surgical Management

Surgery is usually needed when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when there is pain that progressively worsens or doesn’t improve with other treatment. The surgeon can remove the bone spur or the portion of the herniated disk that is compressing the nerve.

Surgery for the herniated disc (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.

Physiotherapy

Physiotherapy treatment includes pain relieving techniques and exercises specifically designed to address sciatica. Once your acute pain improves, your physiotherapist can formulate a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility. It is important to note that sciatica may recur. Therefore, preventative measures are helpful. Here are a few suggestions:

  • Exercise regularly. The abdominal and lower back muscles make up the core muscles. They contribute to proper posture and alignment. Their strength can be improved through specific exercises.
  • Maintain proper posture when you sit. Good lower back support, armrests and a swivel base are important characteristics for chairs that you spend several hours sitting in. The use of a low back roll or rolled towel in the small of your back helps to maintain proper posture.
  • Use good body mechanics. If standing for a long time, rest one foot on a stool or small box from time to time. When lifting heavy objects, let your lower extremities do the work. Keep your back straight and bend at the knees. Hold the heavy object close to your body. Avoid lifting and twisting at the same time and get help if the object is heavy or awkward.

 

References

  1. American Academy of Orthopedic Surgeons. Sciatica. http://orthoinfo.aaos.org/topic.cfm?topic=A00351
  2. Do you know sciatica pain is not helped by medication?

http://www.chiropractorfreehold.com/know-sciatica-pain-not-helped-medication/

  1. Ergun T, Lakadamyali H. CT and MRI in the evaluation of extraspinal sciatica. The British Journal of Radiology. 2010;83(993):791-803. doi:10.1259/bjr/76002141.
  2. Haugen AJ, Brox JI, Grøvle L, et al. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskeletal Disorders. 2012;13:183. doi:10.1186/1471-2474-13-183.
  3. Mayo Clinic. Sciatica. http://www.mayoclinic.org/diseases-conditions/sciatica/basics/definition/con-20026478
  4. Using medicine for back pain. https://otuafi69shirley.wordpress.com/2016/09/22/considering-seeing-a-chiropractor-review-these-tips-first/