The lumbar nerve roots emerge from the spine and at this point they are vulnerable to impingement from a disc prolapse, causing inflammation and/or compression of the nerve and the symptoms of sciatica. Sciatic leg pain is not common, affecting 3 to 5% of adults and both sexes equally. Men are more likely to get it in their 40s and women in their 50s, with pain symptoms lasting over six weeks in up to a quarter of cases. Physiotherapists are routinely asked to supervise the management of sciatica. A "slipped disc" is the result of the outer wall of the disc (the annulus) developing a split through which the central material (nucleus) partly herniates. The prolapse can directly compress the passing nerve root, damaging the nerve through pressure and from the irritant chemicals in the nuclear material. This can alter and obstruct the nerve's normal electrical activity and block the circulation which leads to swelling. While true sciatica is typically caused by disc prolapse the size of the prolapse does not relate the level of suffering experienced. The great forces which we impose on the low back mean the lumbar intervertebral discs suffer structural changes and prolapses. Many activities involve a significant level of leverage, such as flexing over, performing movements in an upright position and lifting with the arms away from the body. This greatly magnifies the forces on the discs and due to their fluid mechanics they suffer 3-5 times the loads on the skeleton. This can cause the disc walls to degenerate, giving weak areas and predisposing to prolapse at some time. Patients report that the onset of sciatica is rapid and accompanied by back pain, although pre-existing back pain may ease when the leg pain starts. Worse with coughing, sneezing and sitting down, the pain is better standing up or lying flat. Typical pain distribution is through the buttock then down the back of the leg to the ankle and foot or down the side instead. Sciatica does occur in disc levels L1 to L3 but only in for five percent of cases, the pain being in the front of the thigh and not in the lower leg. Some patients present with individual areas of pain rather than the whole picture. The physiotherapist will take the patient's history with particular attention to "red flags" which are indicators of a serious medical reason for the back pain and the patient will not be appropriate for physio. Weight loss, fever, night sweats, age (under 20 or over 55), problems with bladder and bowel control, serious past medical history and night pain will be noted. Any uncertainty means referral to a doctor for investigation. The physio will note any postural abnormalities and the nature, position and activity response of the pain symptoms. A patient with lumbar radiculopathy may exhibit abnormal posture, sometimes bent forward and unable to bend backwards, with a one-sided trunk shift. Physiotherapists check the ability to perform spinal movements, any pattern of limitation or tendency for the pain to centralise on repeated movements. Physios will test the reflexes, sensibility and muscle power to perform the neurological examination. This and the straight leg raising test allow the physio to check which of the spinal nerves is likely to be the culprit. Discogenic pain may change with repeated movements, spreading more towards the leg or in towards the back, the latter being called centralisation. Physiotherapists use this phenomenon to diagnose and treat disc related back pain and examine the joints of the lower limb as thigh and knee pain can be referred from an osteoarthritic hip joint. A full history and examination both eliminates patients who need medical referral for investigation and allow the physio to form a treatment strategy. Physiotherapy sciatica treatments include many therapies: manipulation, mobilisation technique, lumbar stability, myo-fascial release, McKenzie method (especially useful in disc prolapse), stabilising exercise, massage and soft tissue techniques, pain killers, education of the patient, advice on the best position to relieve extreme sciatica pain and rest. Sciatica settles as the pressure and inflammation ease but physiotherapists would recommend an ongoing exercise programme to maintain back fitness over the long term.
Sciatica has long been a difficult and unrelenting symptom to treat. Many treatments have failed to produce long term results, until now. A new treatments provides relief in the majority of cases without the risk on invasive procedures. The complaint of Sciatica is often used inappropriately to define any pain down the leg, the true description, however is irritation to the sciatica nerve which is comprised of several nerves as they leave the lower back and join together to travel down the leg. The most common cause of true sciatica is either a bulging or herniated disc in the lumbar spine. The discs are soft structures in between each bone int he spine that acts as a shock absorber. When you look at the consistency of a disc it is made up of 2 distinct layers. The outer portion is the consistency of cartilage and the inner portion is much softer and almost jelly like. The combination of these structures provides good cushioning and flexibility to the disc. The problem arises when the outer portion weakens and allows the softer inner portion to begin to migrate outward creating a bulge or herniation. This then compromises the exiting nerve and creates the symptoms often associated with sciatica such as pain, numbness and weakness. The most common treatments for sciatica include medication, injections and potentially surgery.While medications like muscle relaxers and NSAIDS can provide temporary relief they don't actually fix the problem. When the problem becomes more then just inflammation and is the result of actual nerve compression from the disc these medications rarely help. Treatments like injections may also be effective at temporarily decreases the swelling of the nerve, but again once the medication wears off the pain will return. These approaches also carry with them significant risk of side effects. One of the most common treatments from the above list are spinal injections or epidurals. This treatment may offer a short term solution to a debilitation problem, however it offers very little in the way of a long term benefit. The injections work by combating inflammation and reducing swelling of the affected nerve, however side effects may be associated with this treatment. These may include a spinal headache, a spike in blood sugar for diabetics and the potential of a rebound effect where the pain returns with greater intensity. The relief these injections bring may be worth the risk but a long term solution needs to be combined for the treatment to be truly effective. In extreme cases of unrelenting sciatica surgery may be recommended and in a small number of cases may be an appropriate treatment. However, the overall success rate for disc related surgery is poor at only about 50% and in many cases the problem may worsen after surgery resulting in a condition called failed back surgery syndrome. This complication may arise from post surgical scarring, spinal instability, and increased stress on adjacent discs. It is very common to require another surgery in later years. Fortunately a new treatment exists that is highly effective and doesn't bring with it the risk of side effects associated with other treatments. Spinal Decompression is a new, advanced form of spinal traction with a patented computer monitoring device. This device allow a gently and logarithmic pull of the spine safely bypassing the guarding reflex muscle contraction associated with traditional traction. Bypassing this muscle response allows a therapeutic negative pressure to develop inside the disc space drawing in nutrition and fluid to help the disc heal, but also reducing herniated or bulging material and relieving the sciatica nerve. The treatment is safe and gentle and brings with it a very high success rate in the high 80 percentile and because it physically treats the cause of sciatica the problem is not likely to return. While spinal decompression may not be right for everyone suffering from sciatica, research shows it to be a very promising and long term option for many. Because it offers a true healing environment for the disc and nerves the problem is not just masked or covered up, but a true healing of the structures takes place. The treatment is safe and represents a real promise for sciatica sufferers everywhere.
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Jonathan Blood Smyth has sinced written about articles on various topics from . Jonathan Blood Smyth is a Superintendent at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking a. Jonathan Blood Smyth's top article . to your Favourites.
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