Sciatica – A detailed breakdown of Causes, Treatment & Prevention

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Let’s be honest, running is an enjoyable personal freedom. All across the world whether done competitively or for leisure, or both, for many it is an awesome feeling of liberation. This relief from stress is an opportunity to reconnect with oneself and the fascinating world around us. Explorers, adventurers, and sightseers the running world is comprised of a multitude of backgrounds, but with this comes an increased risk of encountering various pains which may be the result of running. As important a topic was cowritten by Eddy Mihai and curated by Diana Rangaves, PharmD, Rph. Runners quickly become experts at diagnosing their pain. Why? This is likely because it is a by-product of the activity. Many runners experience a myriad of pains throughout their personal growth in the sport. It can be agreed almost unanimously that should the unfortunate case of pain arise during running, especially pain that is mysterious and hard to pinpoint, it seriously hinders or prevents the full experience. Pain during running may result in a decrease in satisfaction, quality of life, and daily living.  As the pain does not magically disappear after a run— talk about a major bummer, but the point of this article is not meant to discourage. There is a lot of hope in avoiding pain when one is properly educated. So read on as we learn how to address one common source of pain.

 

 

What is Sciatica?

One common pain that athletes complain of is experienced in their lower back. Think of where the belly-button is, now trace around to the back spine and this will be right around where what is considered the “lower back region” is. While there are numerous causes for experiencing lower back pain, one specifically which will be addressed in this article is called “Sciatica.”

What is this sciatica? Well, breaking it down … Research shows that 4 out of 10 people in the general populace will go through this condition in their lifetime. It commonly affects individuals 30-50 years old, where 60% of these patients have such bad symptoms it results in a disability. It occurs when the sciatic nerve is damaged or impinged, where too much pressure is put on this nerve. 

Hamstring-Tendinopathy-sciatic-nerve

 

 

The sciatic nerve, where the condition derives its name, is the longest nerve in the human body. It originates in the lower spine region— hence being associated with lower back pain. This area of the body is the most vulnerable point of injury due to improper heaving lifting positions. From the lower back the long nerve runs through the pelvis, down through the buttock muscle, into the legs, and all the way down to the feet. With such a long way to travel along the body really any one of these points along the sciatic nerve can be irritated by running activities. During running, muscle strain can result causing discomfort by compressing the nerve, spine misalignment might occur, thus causing sciatica.

Apart from direct sciatic nerve compression, sciatica can most likely arise due to the compression of L3, L4, L5 (lumbar nerves) or S1, S2, S3 (sacral nerves).

Symptoms of Sciatica

Several studies have been done on whether or not athletes, in this case runners, experience more symptoms. More studies need to be done to derive conclusive evidence on the subject matter.  For now, most conclusions show that it is not believed runners experience more sciatica than non-runners. Odds are showing that running will actually reduce their chances of getting this condition, pretty cool huh? As with any movement or exercise done in a beneficial manner, it can promote the reduction of inflammation, the conditioning of muscles and body, and create a healthier overall perception of daily living. As previously mentioned, because research studies specifically involving running participants are lacking in prevalence, studies and their conclusions here mostly involve recommendations for the general public.

The symptoms,  where do we start? These generally include:
  • Pain that ranges from a mild ache to severe
  • Sharp or even burning sensations along the lower back, pelvis, and radiating into the legs
  • Numbness, weakness, or tingling sensations
  • Severe pain can lead to loss of proper bowel functioning.

 

 

Commonly it can be described as a “cramp-like” pain. Rare cases are severe enough to cause progressive weakness in the legs, making it difficult to stand for prolonged periods or be involved in activities of daily living. A loss of healthy bowel functioning is also symptomatic when the symptoms are severe. If these symptoms are being experienced already it is recommended to see a medical professional for diagnosis and care.

 

Causes

Photo – http://i.vimeocdn.com/video/447672464_1280x720.jpg



Now that we have discussed the various symptoms,  we can begin to ask the question of how does it happen? Where does it come from? According to studies done it is generally caused by too much pressure or damage on the sciatic nerve which runs along the lower back, pelvis, down the butt and into the legs. So anywhere along these regions are potential points where injury can be sustained. The range of symptoms encompassed by the condition previously mentioned.

To put it in a list, the common causes include:

Disc herniation, disc prolapse, or slipped disc are all conditions of the spine which can impinge on a nerve and cause sciatica. All of these aforementioned spinal conditions can be a result of a single, traumatizing incident such as a car crash or forceful impact to the spine, or it can be the result of multiple aggravating factors such as smoking, eating a lot of animal-derived products, overuse, age etc.

Diagnosis is put with the help of imaging tests such as X-rays, CT scans, MRIs, alongside palpation and physical examinations.

Treatment includes biomechanical education, physical therapy, non-steroidal anti-inflammatory drugs, steroids, weight control, spinal manipulation, and surgery.

Isthmic spondylolisthesis is a spinal health issue in which a vertebral body slides forward because of a microfracture in the small piece of bone called pars interarticularis which holds together the two anterior spinal joints. The stressed/overused bone usually develops such a fracture in the early stage of life (5-7 years old). Although the stress fracture forms early, the symptoms usually manifest themselves in adolescence or adulthood. The most common spine level for isthmic spondylolisthesis is in the L5-S1, between the lumbar and sacral area. At this level, nerve impingement is very probable, causing sciatica, pain, and neuropathy in the buttocks and knee, weakness when standing on toes, numbness in the leg, outer leg, and radiating towards the sole and heel.

Diagnosis setting usually involves imaging techniques such as X-ray, alongside various physical exams. Depending on the amount of vertebral disc slippage, it’s graded 1 to 4:
Grade 1 means that 25% or less of the vertebral body has slipped forward.
Grade 2 means that 26% to 50% of the vertebral body has slipped forward.
Grade 3 means that 51% to 75% of the vertebral body has slipped forward.
Grade 4 means that 76% to 100% of the vertebral body has slipped forward.

Treatment involves pain medications such as NSAIDs and acetaminophen, ice and/or heat therapies, physical therapy concentrated on stretching the hamstrings, chiropractic manipulation, epidural steroid injections, and ultimately, surgery.

Degenerative spondylolisthesis is a type of spondylolisthesis which involves the slippage of a vertebral body because of the general aging process. The condition is most commonly found in individuals over 50 years old and affects women three times more than men. It usually involves one or more levels of the lower spine, mainly levels L4-L5 and L3-L4.

A slippage at level L4-L5 causes pain and neuropathy starting from the lower back towards the outer part of the leg such as the tight and knee. The symptoms may progress to the inner lower leg and middle part of the foot.
A slippage at level L3-L4 is still very common and can cause pain and neuropathy in the lower back, leg, and calf area.

Diagnosis is put upon inspecting the patient’s medical history, performing several physical exams, and after some imaging tests, usually X-ray and MRI scans.

Treatment consists in activity modification such as avoiding standing or walking for too much, avoiding active, high-impact exercise and bending backward. Other treatments include chiropractic manipulation, epidural steroid injections, and surgery.

Lumbar spinal stenosis is an age-related condition is a degenerative spinal health problem in which the facet joints (vertebrae stabilizers) increase in size, compressing the spinal nerve root, usually in the lower back. Pain increases when standing up and decreases while sitting.

There are three types of lumbar spinal stenosis:
1. Lateral stenosis is the most common type in which the nerve root is compressed outside of the spinal canal by a bulging or herniated disc, or by a bone protrusion exceeding the bony hollow archway called the foramen.
2. Central stenosis occurs whenever the back canal is constricted. This can also lead to more severe symptoms such as Cauda equina syndrome (CES).
3. Foraminal stenosis occurs whenever a nerve root is compressed and confined by a bony spur in the foramen opening.

Diagnosis is put upon various physical exams and imaging techniques such as an MRI scan or a myelogram CT scan.

Treatment involves activity and dietary modification, exercise, epidural steroid injections, and NSAIDs pain medication, if necessary. More so, this condition rarely warrants surgery but can be successfully deployed upon patient’s request.

Degenerative disc disease is technically not a disease, but a natural aging process in which certain spinal elements, including the discs, lose some of their functionality, causing pain, sciatica, and other symptoms. Mainly, the misnomered condition implies an erosion of the cartilaginous end plate, disc desiccation/dehydration, annular tears, disc bulges, and a reduction of the space between the discs, causing inflammation and abnormal micromotion instability.

Diagnosis is put upon imaging investigation and physical exams.

Treatment includes pain control through various invasive and noninvasive procedures, exercise, lifestyle and diet modifications, and other alternative therapies.

Scoliosis is a genetic spinal condition in which the spine crooked abnormally, placing a great axial load in unadapted places of the spine, particularly the neural foramen. The latter bony hollow archway can eventually collapse, resulting in lateral stenosis which ca compress the various nerve roots.

Diagnosis is quite easily put with the help of an X-ray.
Treatment consists of symptom management, watchful waiting, alongside bracing and surgery.

Other, rarer causes:

Synovial Cyst, or more commonly known as a facet cyst, is a benign fluid sac which forms as a consequence of spinal degeneration, it’s a fairly unusual cause of spinal stenosis in the lower back. The cyst exerts pressure on the spinal canal and adjacent nerves, causing stenosis-like symptoms such as sciatica, pain, radiculopathy, and cauda equina syndrome. The condition is mostly age-related, so it’s rarely seen in patients under 45 years old and often in patients over 65 years old. Furthermore, the most common levels are L4-L5 and much rarely at L3-L4.

Diagnosis includes MRIs, X-rays, and physical exams. Also, spinal instability has to be addressed before an eventual surgery procedure as to avoid a subsequent surgery afterward.

Treatment comprises watchful waiting, activity adaptation, pain medication and injections, ice and heat therapies, rest, and low-impact physical therapy.

Tarlov cyst or perineural cyst is a fluid-filled sac most commonly found in the sacral region, S1 to S5 levels, causing pain, sciatica, radiculopathy, paresthesia, and other, depending on the affected spine level. There a couple of hypothesis being debated in medical circles regarding the formation cause such as trauma, hemorrhage, inflammation, genetic factors, arachnoidal proliferation, and venous drainage breakage.

Diagnosis requires various imaging tests such as MRIs and CT scans.

Treatment methods include cerebrospinal fluid aspiration, partial or complete cyst removal, laminectomy, fibrin-glue therapy, and other surgical procedures.
Epidural venous plexus compression is an obstruction in the epidural venous network causes nerve root compression which can result in sciatica and other symptoms. The most common scenario is the engorgement of the epidural and paravertebral vein system by an occlusion or obstruction, most commonly by a thrombus (blood clot). Other causes include Budd-Chiari syndrome, abdominal malignancy, portal hypertension, intracranial hypotension, and pregnancy.

Diagnosis is usually put after some MRI imaging tests.

Treatment consists of blood-thining medication and surgery procedures such as venous thrombectomy.
Osteomyelitis is an infection in the spine, usually spread via a vascular path. Most of the times, the infection occurs in elderly people, malnourished people, patients with compromised immune system, or because of a faulty, non-sterilized invasive medical procedure. the location of the infection can cause sciatica if the infection spreads to the spinal canal, and other symptoms such as fever, chills, inflammation, weight loss, cauda equina syndrome, and more.

Diagnosis is placed upon studying CT or MRI scans. Oftentimes, further investigation is needed through the help of blood samples or biopsy.

Treatment comprises intravenous antibiotic therapy, supports and bracing, rest, and surgery.

A spinal tumor will usually be metastatic and can cause sciatica by pressuring certain nerve roots.

Diagnosis is put upon image and blood sample investigation.

Treatment consists of dietary and lifestyle modification, bracing, radiotherapy, chemotherapy, and various surgery procedures.

Pregnancy can cause sciatica because of the fetus pressing on the sciatic nerve.

Epidural fibrosis is a post-operative scar tissue which can compress the lumbar nerve root by binding to it, causing sciatica. Also called failed back surgery syndrome, it’s a somewhat common condition after spinal decompressive surgeries.

Diagnosis is established after studying the patient’s history and complex imaging investigation.

Treatment consists of a combination of stretching and physical therapy, chiropractic manipulation, spinal cord stimulation, injections, implantable drug pumps, and surgery.

Muscle strains in the lower muscle groups can cause inflammation and/or spasms which can compress the nerve root.

Diagnosis is sometimes rather easily established after studying the patient’s medical history and upon visual observation of the affected area which usually presents bruises, swelling, and other clear identification signs.

Treatment consists of P.R.I.C.E., nonsteroidal anti-inflammatory drugs, blood thinners, anti-spasmolytics, and platelet rich plasma injections.

A broken back or a spinal traumatic fracture can cause sciatica symptoms, among others, because of the structural and molecular changes in the spinal column which may press against a nerve root.

Diagnosis is usually easily established through a simple image exam.

Treatment involves pain medication, calcium and vitamin D supplementation, complex bracing, short-term rest, and surgery.

Ankylosing spondylitis is a type of chronic inflammatory arthritis which affects the spine and possibly other joints. Oftentimes, the condition will also affect the sacroiliac joints and cause sacroiliitis. Other times, the sole inflammation will cause nerve pressure, and consequently, sciatica.

Diagnosis procedure consists in analyzing the patient’s personal and family medical history, blood sampling, and physical exams.

Treatment involves pain medication and more complex drugs such as disease-modifying antirheumatic drugs, Tumor necrosis factor-alpha blockers, anti-interleukin-6 inhibitors, Interleukin-17A inhibitor. Various surgery procedures may also be deployed, alongside subsequent physical therapy.

Sacroiliac joint dysfunction manifests the same pain and symptoms as sciatica. A hypermobile or hypomobile sacroiliac joint will most likely result in some kind radiating pain, similar to sciatica. The dysfunction predominantly affects women.

Diagnosis is rather difficult, but it’s usually set upon an anesthetic injection to the SI joint which helps in excluding other causes.

Treatment includes ice and/or heat therapy, pain medication such as NSAIDs and anesthetics, chiropractic manipulations, using supports or braces, engaging in rehabilitating physical therapy, and surgery.

Keep in mind that any situation or injury can potentially cause sciatic nerve damage or impingement with the reality that many causes cannot be accurately diagnosed despite persisting symptoms. It is good to get multiple recommendations from medical professionals of differing expertise and then draw conclusions based on several sources of evidence.


Common Risk Factors

 

 

Risk factors for sciatica vary from person to person. They consist of body posture, positioning, degree of fitness, and overall health factors. In general, runners are in good condition. However, if you are a new runner, sports lover, or only exercise during the weekend, beware of the associated risks with sudden, intense exercise. It is better to go low and go slow. Do not rush, as this is a sport for your lifetime enjoyment. Risk factors include:


Age: the body loses its ability to handle improperly placed stress from daily activities, commonly from bending over and lifting heavy objects.

Pregnancy: this can be a factor because weight increases with pregnancy in areas that the body is not normally used to. It is good to maintain healthy exercise to keep the body conditioned.

Overweight or Obesity: Being overweight can add undue stress to areas that are made weak by overuse or improper form during daily activities. Having a healthy weight will improve the body’s ability to resist stress and heal itself.

Smoking: affects nearly every aspect of body health. The lungs feed oxygen to the blood which is used to transport healing hormones throughout the body, among many other helpful uses. When smoking the lungs are incapacitated, they are unable to fully absorb the amount of oxygen the body needs to sustain homeostasis. As a result, the particulates from cigarettes clog the alveoli, or cells in the lungs and reduce maximal oxygen uptake.

Occupational: j
obs that involve heavy lifting or repeated twisting of lower back. One does not need to be in a primarily manual labor job to injure themselves. Nearly every job out there will at some point require individuals to lift or twist, and move the body. Working at a grocery store for example might seem easy, but many clerks are required to stand for prolonged periods, bend, lift and stock items at the end of the day.

Sitting for prolonged periods: jobs which involve majority computer use may require that one sit at a desk for prolonged periods of time. This can have detrimental effects on the back and body. There are some helpful ways to avoid this, such as taking frequent breaks to stand up, look away, and move.

Recently there have been trends in getting stand up desks as this provides a better mode for movement, posture, and proper blood circulation. Some even have treadmills installed that they can walk on while working. If these are not possible there is no need to worry, actively thinking about and implementing proper posture can be helpful. There are even posture pillows and lumbar supports that can be bought to remind us.

 


Diagnosis

Herniated-Disc-x-ray-imaging

Accurately diagnosing sciatica requires the trained medical professional’s discernment. During the diagnosis process a doctor will run a number of tests to make sure the patient is, in fact, experiencing sciatica. This is helpful to determine what ways it should be treated. When seeing a medical professional for diagnosis here are some common tests that one can expect during their visit:


1. First, the doctor will ask for a detailed medical history with the nature and duration of the various symptoms that may be experienced, as well as what actions keep on setting these symptoms. So if during a day job the individual realizes they are improperly lifting heavy loads or hyper extending their backs, it will be good to know this can likely be attributed to the cause of symptoms. In addition,  symptoms may indicate a ruptured vertebral disc that may require more serious treatment such as surgery— try to come prepared by analyzing potential causes beforehand.

2. Next, an assessment will be given to check the functioning of an individual’s current neurological strengths, or lack thereof because of nerve impingement. An individual’s reflexes will be checked to make sure all sensation can be felt in the legs and that there are no nerves being cut off by impingement.

3. While rare, if a loss of proper bowel functioning has occurred then a rectal examination may be necessary. This will make sure the muscles in the rectum are maintaining their tone and have sensation, basically still receiving stimulus from the nervous system.

4.If symptoms of sciatica persist for several weeks after initial treatment and care an x-ray may be ordered to further diagnose. The X-ray will be used to assess changes in the bone or spine and the pelvis. This is important in order to rule out chances of their being a tumor or an infection causing the sciatica. Note, infections are an incredibly rare source of sciatica as it requires that the infection attack the roots of sciatic nerve in lower back. The presence of a tumor would cause issues if it begins to press and put significant pressure on the sciatic nerve. Thanks to today’s modern technologies it is becoming easier to detect these conditions before they become too detrimental.

5. A Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) may be recommended if symptoms persist several weeks without letting up. These can be used to assess an individual’s nerves, spinal discs, and spine itself in much more detail than initial care can. Electromyography (EMG) can also be used to confirm nerve compression, such that might be caused by spinal stenosis or herniated discs.

During the diagnosis phase, consider asking your health care provider about a referral to a physical therapist or psychiatrist who specializes in physical medicine.



Treatment

 

Hip-Bursitis-Bursae-Inflamed-crutches-treatment

 

Research shows that lower back pain (LBP) is actually one of the most common pain issues experienced by the general public. It is likely that the reader can think of someone in their immediate family who has complained of it. In runners and athletes it can also be a common source of  pain. Sometimes being tough and pushing through the pain is not the answer and usually it worsens the condition.  The problem is that, as pain worsens it begins to become an issue leading to significant time off from training, missed events, and disability during activities of daily living. So, it is important that after diagnosis confirms the presence of sciatica the right treatment is given to the athlete. This must be done in a timely manner, to speed recovery, healing, and prevent the significant loss of training time, and participation.

Here are some common ways to treat sciatica:

1. Hot and Cold Packs:

Research shows that the can help with pain reduction during an episode of sciatica. Heat is a preferred treatment method, where many individuals who experience sciatica may enjoy and benefit from swimming in a heated pool environment.

 

See them here: (Heat and Ice Therapy Packs)



2. Laser therapy,  Low-Level Laser Therapy (LLLT):

 It may sound like science fiction, but laser therapy is a new form of treating sciatica pain. According to recent studies, this shows promising results in relieving symptoms and speeding recovery. It works by using noninvasive light waves that do not produce heat, sound, or vibrations on contact. This therapy is part of a methodology named photobiology or bio stimulation. It has been found to accelerate connective tissue repair, and acts as an anti-inflammatory agent to the site of irritation. Light wavelengths of 632 nanometers to 904 nanometers are used for musculoskeletal disorders.

 

See more here: (LLLT Therapy)



3. Pharmacology and Medications:

Over the counter medications taken orally can be found to treat symptoms as a short-term solution. Commonly these include:
acetaminophen
aspirin
NSAIDS (Non-steroidal anti-inflammatory drugs) such as:
Ibuprofen
Advil
Motrin
Ketoprofen
Naproxen (Aleve)

 

See more here: (Motrin IB)

Prescription muscle relaxers can also be used to relieve muscle spasms. Certain muscles can be in spasm making symptoms worse by  irritating the site of sciatic nerve damage or impingement. Taking a muscle relaxer will help prevent this, but studies show it is not a significant source of treatment. Antidepressants have been used by patients because the pain can change chemistry in the body; therefore, affect overall outlook on life, and satisfaction of daily living. Although this is not considered a significant source of treatment it has been shown to be effective in some people.  Steroidal injections around the spinal nerve. Research shows a modest reduction in pain using this method when sciatica is caused by a ruptured or herniated disc.



4. Physical Therapy and Body Manipulation

While it may be difficult to remain active with sciatica pain, bed-rest is not a long term solution. Actually, in recent history it was believed that the best way to treat sciatica was with long term bed rest, but today’s research has long since shown that this method will lead to worse symptoms. Physical therapy is a significant source of treatment for sciatica which may be recommended during diagnosis by a doctor. There are many good physical therapists out there to offer an effective treatment plan.  They will help to find the best movements and exercises to practice daily as a means to heal. When done right the proper movements performed will relieve pain and improve daily living conditions. It can even provide conditioning to prevent, or completely remove sciatica in the future. It is very important to do exactly as directed during these sessions as well.



5. Alternative Treatments

Biofeedback: These therapy sessions have been found to help with a person’s pain management. The patient will learn how to control their bodily processes such as heart rate, blood pressure etc. This method is commonly used to treat anxiety and stress related symptoms. The patient is hooked up to various body monitoring instruments and is given the information on a screen to gauge what their current homeostasis is, or body stability. Once they know what their baseline is they can use it to try out different ways of connecting mind and body. Education and teaching people to consciously take control of their body and improve symptoms of anxiety or stress is an effective treatment.

 

See more here: (Biofeedback)


Earthing therapy: Although more research is needed, earthing therapy seems to provide some symptom relief. the therapy, also called grounding, consists of being in direct contact with the ground or through a conductor device implanted into the ground. The emerging fringe science theory claims that being in direct contact with the Earth will charge the body wit negative-charged free electrons which will provide an array of health benefits. Placebo or not, it is indeed beneficial to sometimes walk barefoot on a plain of grass, for example.

Minimalistic or barefoot shoes: Consider transitioning to low heel-to-drop shoes or barefoot footwear. Studies have suggested that optimal body posture is achieved with such minimalistic footwear.


Acupuncture: Acupuncture has been used in traditional Chinese medicine for several millennia. Three thousand years age it was a means of treating pain and a host of other issues. It is generally regarded as a safe effective treatment to relieve pain. Many people who use this treatment have reported significant positive changes. Fine needles are inserted into specific points across the body which are called acupuncture points. According to Chinese medicine, these points are along meridians or these channels from which Qi, a vital life energy of the body, flows through. The theory is that pain is felt when one or more of these channels becomes blocked, and the needles are used to restore flow and balance throughout the body.  Scientific studies suggest stimulating these nerve points actually produces beneficial results via the central nervous system. This, in turn, allows the body to release helpful chemicals that promote regeneration, healing, and overall peace of mind.  A method of acupuncture called analgesia is becoming better known. It has been shown to release a neurotransmitter called 5-hydroxytryptamine, generating a neuropeptide through the electrical stimulation of different frequencies, having a significant effect on pain reduction.

Alternative medicine is considered by many because surgery is expensive and not applicable to all situations, and pharmaceutical drugs have a host of ill side-effects. 

 

 

6. Surgery

Most cases of sciatica can be resolved within 4-8 weeks. When an individual is experiencing unrelenting pain for longer than this period it is recommended to see a medical professional. In some cases,  surgery may be recommended depending on the diagnosis—it may be needed where cases of non-surgical treatment were unsuccessful. Only 5% of individuals actually need surgery to treat sciatica, all other forms of treatment should be exhausted before considering surgery.

Surgery for sciatica typically aims to relieve the pressure being put on the sciatic nerve causing the symptoms. A herniated, bulging, or ruptured disc may warrant having surgery. One common procedure to treat back pain is called a discectomy, where part of a spinal disc is removed to relieve compression on the sciatic nerve. Again, if symptoms treated by other treatment options persist longer than 6 weeks it is recommended to see a medical professional.

The spinal lamina is a protective bony plate which covers the spinal cord and canal.

A lumbar laminectomy removes the entire spinal lamina portion, decompressing the nerves by expanding the space.

A lumbar laminotomy removes only a part of the spinal lamina.

A discectomy procedure involves the removal of the problematic material or object which irritates and pressures the nerve root.

A microdiscectomy is a less invasive procedure than a discectomy, although the principle remains the same. This procedure creates a very small incision, uses very small instruments, and reduces the recovery time.

Carefully chose your neuro or orthopedic surgeon as the spinal procedures are very complicated and prone to complications.

After surgery, you shouldn’t take NSAIDs as they might interfere with the healing process by causing bleeding. You shouldn’t drive or use heavy machinery for 2-4 weeks, lift objects heavier than 10 pounds, bend or twist excessively, and smoke.

7. Moderate Activity

As mentioned with physical therapy, moderate activity is necessary to prevent the worsening of sciatica, even though an individual might rather stay in bed. This does not mean heavy lifting or exercise, but rather the participation in activities like swimming in a heated pool or walks. Studies have shown that prolonged rest can hinder healing, whereas light physical activity and movement can assist in recovery and reduce inflammation.

Stretching and exercising:

Although it might seem counterintuitive, stretching or self-myofascial release provides beneficiary results in the case of sciatic pain. Inactivity is dangerous and can worsen the symptoms. Here are some pertinent stretches for sciatica:

A. Reclining Pigeon pose

Lay on your back, flex one of your legs at an acute angle while planting the foot firmly on the ground. Rest the external part of your ankle just bellow the knee of the other leg. Grab the planted leg behind the tight with both hands and pull it towards your chest. One of your hand should pass the triangle you just formed with your legs and the both legs should leave the ground when pulling. Hold the stretch for a couple of seconds at the top and alternate sides. Do a dozen repetition per leg, a few times a day.

B. Sitting Pigeon pose

Sit with your buttocks on the floor with your legs extended in front of you. Form a triangle with one of your legs by resting the external part of the ankle just on top of the knee of the extended leg. While in this position, bend forward and grab the tip of the extended leg. Hold the position for a couple of seconds, alternate legs, and complete a dozen reps for each leg.

C. Forward Pigeon pose

Get on all fours. Put one of your legs in front of your torso by resting the top part of your foot on the ground with the knee pointed in front of you. Slide the other leg backward and lie it flat on the ground. Slowly shift the weight from your arms toward your legs by performing the negative part of a push-up repetition. Hold for a couple of seconds and alternate legs. Do a couple of reps for each leg.

D. Knee to opposite shoulder

Lie flat on your back. Bring one of your legs flexed in front of your chest, grab the knee, and pull towards the chest. While holding the knee, rotate the knee internally, towards the other shoulder, and stretch the outer tight, as far as it would go without pain. Change legs and repeat. Do a dozen reps for each leg.

E. Sitting spinal stretch

Sit on the ground with your legs extended in front of you. Cross one leg over the other one and plant the foot outside of the opposite knee. While holding this position, rotate your torso externally with the help of your hands which are placed beyond the legs, externally. Hold the torsioned position for about half a minute and change sides. Do a couple of reps for each side and stretch without pain.

F. Standing hamstring stretch

Find an elevated surface on which you can safely rest your leg on, at around a 90-degree angle. Both of your legs should be completely straight. Proceed to grab the tip of the foot and lower your torso on the elevated leg. Hold the position for a few seconds and stretch the various muscle fibers. Change legs and repeat. Do a couple of reps a leg without experiencing pain.

Exercise and physical activity are very important in stimulating muscle growth that will help better stabilize the spinal structures. Physical activity and stretching will stimulate growth and repair, nutrient absorption, endorphins production, and will reduce inflammation and all-cause mortality.

The patient has to work out his entire body, exercises must revolve around the big 5: squats, deadlifts, over-the-head-press, bench press, and pull-ups.

For sciatica, it’s advised you focus on the lower part of your body and adjacent muscles to the glutes. Meaning, the glutes, lower back, hamstrings, quadriceps, adductors, and abductors.

So, squats and squat variants such as lounges, one-leg squats, box squats etc. The main idea is to use different gait patterns and weight positions. Experiment with different feet patterns to switch the muscle group focus. For example, a large gait will activate more buttocks and hamstrings, a smaller gait will activate the quads more. Same goes for weight positioning. Holding the weight in front of you will work different muscle groups than the same exercise while holding it behind you. Switching up your workout routine will only provide benefits as you’ll constantly keep your body guessing and adapting.

As for cardio, low-impact exercises are recommended if you’re recovering from a surgery or invasive procedure. Try swimming, static bicycle or elliptical machine, and shadowboxing (careful when twisting). Don’t overlook cardiovascular training as it’s extremely beneficiary and anabolic.

8. Diet

Diet is a very important aspect in rehabilitation and disease prevention. For virtually any disease, a plant-based diet is strongly recommended. A diverse, calorie-sufficient strict vegan diet will help in keeping inflammation levels to an absolute minimum, as well as other damaging factors such as hormone imbalances, obesity, cholesterol, cancer, and all-cause mortality. For sciatica, a special focus has to be put on proper hydration, vitamin D, calcium, and K2 levels.

Water is extremely important for the body. Try to remember the 8×8 rule: 8 servings of 8 ounces of water a day, that’s almost 2 liters. Drink more if needed.

Vitamin D is produced by exposing the body to sunlight. So make sure to receive 10-15 minutes of direct summer sunlight each day. Don’t forget to use suncream! You can stand in the sun for more than 15 minutes if the sun rays are not that powerful.

Other vitamin D foods: fortified non-dairy milk, chanterelle mushrooms, oranges, fortified soy yogurt etc.

Calcium can be abundantly obtained from orange or vegetable juice, plant milk, blackstrap molasses, collard or turnip greens, kale, tofu, cereals, broccoli, beans, seeds, dried figs etc.

Vitamin K comes in high dosages from plants, leafy greens, and natto. Absorption is increased with fat, so add some oils, nuts, avocados, and so on to your foods. Avoid frying oils!

 

Other helpful foods and organic substances for sciatic pain:

1. Turmeric has very strong anti-inflammatory proprieties. Administer it by drinking tea infusion, ingestion by cooking it, or topically by forming a paste.

2. Jamaican Dogwood is a renowned tree substance that comes as a tincture or capsules. Avoid if lactating or pregnant!

3. St. John’s Wort Oil comes from a yellow-flowered plant with anti-inflammatory, antioxidant, astringent, and antibacterial proprieties.

4. Garlic has anti-inflammatory proprieties, among others, that can help relieve sciatica pain and improve your immune system.



Prevention


A number of steps can be taken to prevent the onset of sciatica, or the further development of it:

1. Maintaining correct posture during activities, such as walking, standing, sitting.

2. Maintain aerobic fitness, strength, flexibility in the abdominals and spinal muscles.

3.  Practice safe lifting technique:

  • Lift by bending the knees and keeping the back straight
  • The strain should be taken by the legs and hips instead of lower back.
  • Hold the object closer to the body if possible as the further the object is away from the body the more stress it will put on it, and subsequently the lower back region.

4. Ensure lower back is well supported when sitting in a chair. Find a chair that promotes good posture. A lumbar roll or contour cushion can be used to help provide lower back support when seated.

5. Do not smoke. Smoking is a hard habit to quit, but it adversely affects nearly every aspect of health.

Here are steps to begin the process of quitting:

  1. Set a quit date, get accountability by telling friends and family about intentions to quit and be prepared to combat initial cravings.
  2. Know all the reasons support a decision to quit. Write out a list involving health, money, and the impact it will have on others.
  3. Know the personal triggers. What causes the desire to smoke? This can involve physiological addiction, habits, and emotions that need to be resolved using healthy means.
  4. Use patches, lozenges, and gum. There is a number of products created to help with quitting smoking, they contains progressively less doses of nicotine— the main addictive agent in cigarettes— to ease cravings. Not to mention they are much cheaper.
  5. Stay quit. It is helpful to use these 4Ds to deal with desires and cravings: delay, deep breath, do something else, drink water.

6. Maintain a healthy body weight: Maintaining a healthy body weight will help relieve the pressure. In addition, it will improve immune functioning to speed healing and improve perception of life and desires to partake in healthy daily activities. Distance running is a great way to lose body weight as it burns through primary body fuels stored from carbohydrates— primarily found in breads, sugars, and starches— to activate the burning of stored fat as energy. This process is called ketosis.



False Positives

Hip-Bursitis-Bursae-false-positive-stress-fracture

 

There are two main false diagnoses that can mimic the symptoms sciatica.  False or misdiagnoses include:

Lower back pain is commonly attributed to sciatica

Misalignment of the spinal column

Ruptured, bulging spinal disc

In many cases seeing a physical therapist or chiropractor will address the pain being experienced by an individual in as little as 5 minutes by relaxing deep muscles in the buttock, hips, or legs which may be impinging on the sciatic nerve from overuse, or misuse, and improper stretching.

Keep in mind it is always a possibility for a doctor to make a wrong diagnosis when evaluating a sciatica condition due to human error. The parts of the body comprising the back and spine are numerous and complicated, and even if years of study can be misunderstood. While living in the modern age, with the existence of advanced imaging instruments such as CT Scan, X-Rays, and MRIs, one would think that misdiagnosis would be rare, and perhaps it is becoming rarer. But, even with all of the fancy new equipment, misdiagnoses still occurs.

 

Conclusion

Synovitis Hip

 

 

Runners have a likelihood of running straight into the pains of sciatica because of irritation to the nerve via muscles in direct contact with it, or traumatic injury. Running, however, can be a preventative measure and a form of conditioning the body. One method to avoid sciatica is to regularly exercise. If this pain that pertains to symptoms regarding sciatica and does not resolve or worsens after 6 weeks of treatment, it is recommended to see a medical professional for diagnosis and care. Overall, the best treatments for this condition involve seeing a physical therapist and psychiatrist that specializes in physical medicines.

In general, it is likely that the cause of sciatica is not a serious issue that would require surgery, such as a herniated, ruptured, or bulging spinal disc. Please note that taking over the counter medication is not a solution and should only be used in situations where they are direly necessitated, as many will actually slow the healing processes.

Co-written by Eddy Mihai

Curated by Diana Rangaves, PharmD, RPh


Sources


Reading this article is not a substitution to seeing a licensed physician for medical diagnoses, especially in trauma situations. Research for this article has been done with reputable sources that have been linked below for the convenience, trust, and cross evaluation of readers. The majority of sources were written by medical professionals or consist of published studies in medical journals, and peer reviewed studies. 

Sources

  1. unknown, Sciatica Pain Relief Options, WebMD, Apr 07, 2017
  2. Koes B.W.| Van Tulder M.W. | Peul W.C. , Diagnosis and Treatment of Sciatica, NIH, Apr 07, 2017
  3. Md Shahidur Rahman | Mohd Taslim Uddin | Md Ahsanulla , Management of Sciatica: Conservative Versus Surgical, JBCPS, Apr 07, 2017
  4. 4. Wilco C. Peul M.D. | Hans C. Van Houwelingen Ph. D. | Wilbert B. Van Den Hout Ph. D | Ronald Brand, Ph.D. | Just A.H. Eekhof M.D. Ph.D. | Joseph T.J. Tans M.D. Ph.D. | Ralph T.WM. Thomeer M.D. Ph.D. | Bart W. Koes Ph.D. | , Surgery Verses Prolonged Conservative Treatment for Sciatica, New England Journal of Medicine, Apr 07, 2017
  5. Zongshi Qin | Xiaoxu Liu | Qin Yao | Yanbing Zhai | Zhishun Liu , Acupuncture for treating sciatica: a systematic review protocol, BMJ, Apr 07, 2017
  6. unknown, OrthoInfo: Sciatica , American Academy of Orthopaedic Surgeons , Oct 18, 2017
  7. Anderson, K.N., Anderson, L.E. & Glanze, W.D, Mosby-Year Book, Inc. , Oct 18, 2017
  8. Barrett. J. , The Gale Encyclopaedia of Medicine, Oct 18, 2017
  9. unknown, Sciatica , Mayo Clinic, Oct 18, 2017
  10. unknown, The Quit Book: Beating the Smoking Addiction, Quitline, Oct 18, 2017
  11. Taunton, J.; Ryan, M.; Clement, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A , A retrospective case-control analysis of 2002 running injuries, British Journal of Sports Medicine , Oct 18, 2017
  12. unknown, Smoking and Cancer: A Cancer Society Fact Sheet, Cancer Society, Oct 18, 2017
  13. 14. Macintyre, J.; Taunton, J. E.; Clement, D.; Lloyd-Smith, D.; McKenzie, D.; Morrell, R., , Clinical Journal of Sports Medicine , Oct 18, 1991
  14. Petering, R. C.; Webb, C., , Treatment options for low back pain in athletes, . Sports Health: A Multidisciplinary Approach , Oct 18, 2017
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