Saturday, October 3, 2009

Sciatica treatment

Sciatica diagnose and treatment

How is sciatica diagnosed?

Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health-care practitioner to diagnose sciatica. Sometimes, x-rays, films, and other tests, such as

CAT scan or MRI scan and Electromyogram, are used to further define causes of sciatica.

How is sciatica treated?

Sciatica Treatment / Pain Relief
*Always consult a physician to diagnose the cause of sciatica and rule out any serious conditions that may require immediate surgery.
Treatment consists of treating the pain and the condition that is causing it. Anti-inflammatory medication, analgesics, and usually some form of physical therapy are prescribed.

Medications: Non-prescription NSAIDs (anti-inflammatory drugs) such as aspirin and ibuprofen treat both pain and inflammation. Analgesics such as Tylenol treat pain but not inflammation, but may be preferred by some people. In cases of severe acute sciatica, physicians may prescribe codeine preparations and/or muscle relaxants.

An injection of corticosteroids, a powerful anti-inflammatory, into the spinal fluid around the affected area delivers a high dose of medication to the spinal nerves.
A couple of days of bed rest may be necessary with acute, severe sciatic nerve pain. Bed rest will not speed up recovery, and it can actually hinder it. Not using the muscles causing them to weaken very quickly. Muscles – back and buttocks muscles - are what supports and protects the joints of the spine. Exercise also increases circulation and promotes healing.

*Depending upon the cause of sciatic pain, certain exercises may have to be avoided. Always consult a doctor as to the safely of exercises for your particular condition.
Stretching exercises are usually recommended to relieve sciatica. Stretching exercises loosen tight muscles and increase spaces between the vertebrae, allowing more room for the spinal nerves. Stretching muscles in the back and buttocks and even the hamstrings (muscles in the back of the thigh) can relieve sciatica.

For details See Exercises.

*A physical therapist can create an individualized exercise program for a patient’s particular condition. Depending upon the cause of sciatic pain, certain exercises may have to be avoided.

Severe Acute Sciatica: Though bed rest does not speed up recovery, in the case of acute sciatica lying down on a firm surface often relieves the pain. Applying ice for the first couple of days of acute sciatica may also help.

Treating Muscles Spasms:
Muscles may spasm in a reaction to sciatica, intensifying the pain. Sciatica may also be caused by muscle spasms that irritate the spinal nerves. Massage therapy may be helpful. Stretching exercises also loosen up tight muscles. Heat also relaxes tense muscles. Moist heat may be more effective.

For details see “hydrotherapy”.

Support/ Posture: Sitting on soft surfaces aggravates sciatica - adequate support is necessary to prevent slouching, which places excessive stress on the lower back. A chair that tilts back slightly shifts your weight onto the backrest of the chair to take stress off the lower back. Support is necessary while lying down too. A saggy mattress causes the lower back to sink into the mattress and can irritate the spinal joints and aggravate sciatica. Any increase or decrease in the normal curve of the lower back increases stress on the spine and aggravates sciatica.

Avoid heavy lifting, which places extreme stress on the lower back. Use proper body mechanics.

Avoid prolonged sitting or standing, which can aggravate sciatica. (Your lower back supports the majority of the body weight)

Other Pain Treatments:
The use of Heat and Cold are often used to relieve pain. Traction is not recommended for acute sciatica but is commonly used to relieve chronic lower back pain, especially sciatica.

Invasive Treatment

Spinal Injections: Before considering surgery, but after conservative, non-invasive treatments have not provided adequate pain relief, an epidural steroid injection may be given. This minimally invasive procedure involves injecting a combination of corticosteroids and a local anesthetic into the epidural space.

If conservative treatments do not bring adequate pain relief, surgery becomes a consideration. If there is progressive weakness or difficulty in walking (possible progressive nerve damage) surgery is may be necessary. Immediate surgery is required if there is or loss of bladder or bowel function.

*If you currently have sciatica, consult a physician who can diagnose the cause and recommend appropriate exercises.

Keeping the back muscles strong and flexible reduces the risk of a herniated disc, the most common cause of sciatica. Low impact aerobics increase circulation and promote healing. Walking, swimming, and riding a stationary bike are good low-impact aerobic exercises. Strengthening the muscles that support the spine (back and abdominal muscles) help maintain proper posture, which takes stress off the spinal joints. Strengthening exercises may cause the muscles to tighten up so stretching exercises are important. Stretching exercises that increase the spaces between the vertebrae and create more room for the discs may relieve pressure on nerves. Exercise can help prevent or slow down age-related degenerative changes in the spine and can help prevent sciatica from recurring.

Bed rest has been traditionally advocated for the treatment of sciatica. But how useful is it? To study the effectiveness of bed rest in patients with sciatica of sufficient severity to justify treatment with bed rest for two weeks, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for this period.

To gauge the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and 12 weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.

The results, reported in the

New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the bother sameness of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers concluded that: "Among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes conventional wisdom is not as wise as research!


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