Sciatica Therapy & Treatment Coventry, Warwickshire

The sciatic nerve is the longest nerve in your body. It runs from your pelvis, through your hip area and buttocks and down each leg. The sciatic nerve branches into smaller nerves as it travels down the legs providing feeling to your thighs, legs, and feet as well as controlling many of the muscles in your lower legs. The term sciatica refers to pain that radiates along the path of this nerve.

What causes Sciatica?

Sciatica is actually a sign that you have an underlying problem putting pressure on a nerve in your lower back. The most common cause of this nerve compression is a bulging or herniated lumbar disc. Piriformis syndrome is another common cause of sciatica. The piriformis is a muscle that lies directly over the sciatic nerve. If this muscle becomes tight or if you have a spasm in this muscle, it puts pressure directly on the sciatic nerve. Occasionally, sciatic pain in men is caused by sitting on a wallet.

How do I know if I have sciatica?

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze.

How is Sciatica Treated?

The vast majority of the time, sciatic pain can be relieved through a combination of stretches, deep tissue massage of the piriformis muscle and chiropractic care. Occasionally, in cases where chronic spasm of the low back or piriformis muscles is causing the sciatic pain, it may be necessary to do a procedure called a trigger point injection, where a medical pain specialist injects a small amount of anesthetic directly into a spasmed muscle to break the spasm cycle. (See our Cold Laser Therapy Section under Inflammatory conditions.)

Complementary and alternative medicine

Complementary and alternative medicine (CAM) refers to medical and health care systems, practices, and treatments that aren't currently part of conventional medicine, i.e. the care you receive in your primary care doctor's surgery. Many of these therapies and treatments are being studied intensely, and some have proved to help alleviate back pain.

• Chiropractic. Chiropractic is a system of treatments which is based on the philosophy that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain.
  
  Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm.
  
  Some studies done on spinal manipulation have found it to be as effective and safe as standard treatments, especially for initial pain relief, though the optimal number of treatments depends on individual case
  
  Recent research has shown that 75% to 80% percent of patients suffering with chronic sciatica benefit from chiropractic treatment
  
  
• Massage. To conduct an objective clinical trial in massage can be difficult due to variances in practitioners and in massage types however, studies that have been conducted suggest that massage may ease low back pain symptoms by reducing muscle spasm.

Risk factors

The greatest risk factors for sciatica include:

• Age.Age related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're in your late 20s, and most people who develop herniated disks are in their early 30s and 40s and Previous injuries from sport and work related, activity are also common factors.
  
  
• Occupation.jobs that requires you to twist your back, and carry heavy loads, driving a motor vehicle for extended periods makes you more prone to develop sciatica.
• Prolongedsitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than people with active lifestyle.
  
  
• Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

When to seek medical advice

Seek immediate medical treatment if:

• You experience sudden, severe pain in your low back or ether or both legs and numbness or muscle weakness in ether or both of the legs
• The pain follows a injury, from a traffic or work related accident
• You have trouble controlling your bowels or bladder.Seek medical advice urgently.

Screening and diagnosis of sciatica

To help diagnose sciatica and pinpoint which nerves, if any, are affected, your chiropractor will ask about your medical history and perform a thorough physical exam, paying special attention to your spine and legs.

You're also likely to have some basic tests that check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during this examination.

If your pain lasts longer than four weeks or is very severe, or you have another serious condition such as cancer, you may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes for your symptoms.

These tests include:

• Spinal X-ray. Because ordinary X-rays can't detect herniated disk problems or nerve damage, they're not usually helpful for pinpointing the cause of sciatica. A spinal X-ray can show most cancers affecting the bony structures of the spine, narrowed disks and spondylolisthesis, however, and can help rule out other causes of nerve root impingement.
• Magnetic resonance imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments as well as the presence of tumors. MRI is noninvasive and has no harmful side effects.
  
  During the test, you lie on a movable table inside the MRI machine, which is essentially a large magnet. If you have a hard time lying still for the required period of time or you're anxious about the enclosed space, you may be given a sedative. Some MRI units may be wider, shorter or open on all sides, which may be more comfortable for you, although the quality of images taken with these systems may vary.
• Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body. When 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.

Complications of sciatica

Although people recover from sciatica, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur,

They included

• Loss of feeling, may affected one or both or legs.
• Loss of movement may affected one or both legs
• Loss of bowel or bladder function

Different Treatment of Sciatica Include.

Physical therapy. For a herniated d isk, physical therapy can play a role in your recovery. Once acute pain is reduced and range of movement improves a physical therapist or Chiropractor can design a rehabilitation program to help prevent further injuries.

Rehabilitation includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Physical therapy, exercises should be Started as early as possible.

Prescription drugs. Doctors may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Antidepressants and anticonvulsant drugs can be used in easing chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, the body's natural painkillers.

More invasive treatment

Epidural steroid injections. In some cases, doctors may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands, Corticosteroids suppress inflammation around the irritated nerve thus giving pain relieve.

Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited usually no more than four per joint.

Surgery. This is usually occurs when the compressed nerve causes significant weakness, bowel or bladder incontinence, (when this occurs seek medical advice urgently) or you have pain that gets progressively worse or does not improve.

Surgical options include lumbar laminectomy and microdiskectomy. In lumbar laminectomy with diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy).

Success rates of standard diskectomy and microdiskectomy are about equal, but you may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks as surgery is not always successful. (Always get a second opinion).

Prevention

Exercise regularly. This is the most important thing you can do for your overall health as well as for your back. Pay attention to your core muscles the muscles in your abdomen and lower back that are essential for proper posture and alignment. For cardiovascular benefits, try using a exercise bike or treadmill. Swimming is also recommended.

Maintain proper posture when you sit. A good chair should comfortably support your hips, and the seat should not press on the back of your thighs or knees. If the chair does not support the natural curve in your lower spine, place a rolled towel or pillow behind your back.

When working at a computer, adjust your chair so that your feet are flat on the floor and your arms rest on your desk or the chair's arms, with your elbows bent at a right angle. Take frequent breaks every 20 minutes, even if it's just to walk around your office a little stretching will also help.

Driving, before setting off adjust your seat to keep your knees and hips level, and move the seat forward to avoid overreaching for the pedals.

Using body mechanics. Being aware of how you stand and lift heavy objects and even how you sleep can go a long way toward keeping your back healthy. That's because poor posture stresses your back, leading to fatigue and stress on joints and nerves. Always hold reading material at eye level instead of bending forward, and if you’re standing for long periods rest one foot on a raised object about the height of a foot stool.

Before you lift something heavy, decide where you'll place it and how you'll get it from A to B. Bend at your knees, not your back, so that your legs do the lifting. Carry objects close to your body at about waist level. If possible, set the object down on a surface between shoulder and knee height to avoid lifting objects over your head or bending over too far. Don't twist at your waist. Instead turn by pivoting your feet.

Be careful moving heavy things when you become tired, Tiredness can cause you to move more awkwardly than normal. Heavy loads are the greatest risk to your spine, so know your limitations. Don't attempt to lift something that is beyond your normal ability.

Try the following measures:

• Cold packs. Initially, using cold packs may be able to reduce inflammation and relieve discomfort. Wrap an ice pack in a thin towel and apply to the painful areas for 15 to 20 minutes at least 7 times a daily.
  
  
• Stretching. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid or sudden movements and twisting during the stretch and try to hold the stretch as long as possible. Around 40 seconds per stretch if possible.
  
  
• Medications. Pain killers (analgesics) fall into two categories those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and acetaminophen (Tylenol,) will be helpful for sciatica.
  
  Although they provide real relief, both types of medication have a limit to how much pain they can reduce. If you have moderate to severe pain, exceeding the recommended dosage will not provide any additional benefits. In addition NSAIDs can cause side effects such as nausea, stomach bleeding or ulcers, and acetaminophen can cause liver problems.
  
  If you’re using these medications, you should talk to your GP so that you can be monitored for any arising problems. Periodically reassess whether you still need drug treatment or not. Exercise, stretching, massage and other none drug treatments can often provide the same benefits without side effects.
  
  
• Regular exercise. It may seem counterintuitive to exercise when you're in pain, but regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts your body to release endorphins chemicals that prevent pain signals from reaching your brain. Exercise in moderation.
  
  In the early stages of sciatica, swimming or other low-impact exercise such as an exercising bicycle will help you stay active without worsening your symptoms. Later, as you improve and the pain becomes less combining aerobic activity with strength training and core stability exercises that improve the strength of your back muscles can help limit the effects of degenerative changes in your spine.
  
  Start out slowly and progress to at least 45 minutes ever day. To prevent further injury, learn proper lifting techniques.

At Central Chiropractic we aim to be available when you need help most.

When possible we will prioritise emergencies. For more information, please call us today to arrange an appointment.

Maria Kibkalo DC.MSc (Chiro) CCEP & Associates BCA & GCC registered.

BUPA, AXA, PPP & all major health insurers.

All physiotherapists chartered and registered with the health professionals council.

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