This article continues the subject that I started in my previous article “When Not to Stretch.”Taking into account the complexity of the subject, I would like to give you some ideas about the common afflictions and the various ways in which treatment can be approached. Some symptoms can be managed by you at home with at least some relief, while others necessitate a professional intervention so the condition does not get worse.
Sciatica is a symptom rather than a condition. It’s a pain in the buttock or in the back of the thigh, lower leg and even foot. Sciatica can be caused by several conditions, the most common being a herniated disk in the lumbar (lower back) region of the spine.The name refers to the fact that the pain is caused by the injury to the sciatic nerve.This nerve starts out in the lower part of the lumbar spine and sacrum and goes all the way down the back of the thigh and lower leg.The problem with sciatica is that the nerve can be damaged or compressed anywhere along its course.Aside from a herniated disk pressing on the nerve root, some other conditions that can cause sciatica are listed below.
Spinal stenosis
Spinal stenosis is a condition that causes narrowing of the space that houses our spinal cord.There are various subclasses of stenosis, and treatment may be different depending what caused the narrowing.
Piriformis syndrome
The piriformis is a muscle deep inside the buttock which usually overlies the sciatic nerve; in about 15 percent of people the sciatic nerve actually goes through the piriformis instead of under it. In either case, inflammation or spasm of the piriformis can cause sciatica. Sacro-iliac joint inflammation
The Sacro-iliac joint is the space joint between the sacrum and the upper part of the pelvis. It can become inflamed for various reasons such as trauma, fall, sprain during sports activities, uneven leg length, limping after injury to the other leg, etc.When the joint becomes inflamed, the muscles surrounding it may go into spasm and develop trigger points, which may irritate the sciatic nerve and cause sciatica-like symptoms.
Degenerative disk disease
This condition is caused by the degeneration of the intervertebral disks. This usually is age-related and happens to a greater or lesser degree in most people. This condition leads to the lessening of the space between the vertebrae and an increased chance of compression of the spinal nerve roots.
Trauma
Traumas, such as falls, hits and sprains, can cause inflammation around the nerve root or a segment of the nerve itself and create symptoms of sciatica.
Tumors
A tumor growing near the nerve root might press on it and create the symptoms of sciatica. There are different treatments for each different condition. You will not be able to get rid of the symptoms if you don’t take care of the underlying condition.And the treatment for spinal stenosis might be very different from the treatment for a herniated disk.
Usually, there is at least something you can do at home to lessen the pain and discomfort. Ice and initial rest can go a long way in preventing the worsening of the symptoms. However, most professionals agree that early movement and walking is very beneficial and will minimize the debilitating effects of the injury. The key is to note which positions and activities worsen the leg pain as opposed to back pain and then to avoid these positions and activities.
Pain that does not change at all with change of position may signify that something is seriously wrong internally, such as a tumor or a problem with the internal organs. If change of position lessens the pain or, better yet, moves it from the leg to the lower back, this position should be used extensively because it apparently minimizes the nerve root compression.
If the nerve is compressed long enough by a fragment of a herniated disk, a condition known as an adherent nerve root may develop.This usually starts as sciatica.The symptoms improve slightly with time and then become unchanging. Needless to say, the longer the duration of the symptoms, the more difficult it is to treat.
So what can you do if you develop symptoms of sciatica? Try to lie on the affected side with the knees and hips flexed in the fetal position. If this abolishes the pain or moves it to the small of your back you are on the right track. Keep using this position when the symptoms worsen.Another position to try is lying on your stomach. However, people with spinal stenosis might find that this worsens their symptoms. Usually, spinal stenosis symptoms will get better with sitting and worse with standing and walking.
After you find a position that decreases the leg pain, put ice on the lower back.You can apply ice for about 20 min- utes every couple of hours. If you feel spasms in your back muscles, massaging them with an over-thecounter pain relieving cream or Biofreeze may help as well.
If your symptoms don’t improve within a couple of days or come and go, don’t postpone a visit to your physical therapist. Early diagnosis and intervention will prevent the injury from reaching a chronic state.
There are very specific ways to deal with various conditions that cause sciatica.The good news is that with proper and timely intervention you can dramatically improve the symptoms and fully recover in a short period of time.
Michael Sheynin, physical therapist, is co-owner of Free Motion Rehabilitation Center, 528 New Friendship Road, Howell. For more information, call 732-901-8844.