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Sciatica Treatment:
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Imaging Diagnostics tell a story
X-Rays or MRI’s or Cat Scans might reveal that the more serious Sciatica symptoms of radiculopathy, muscle weakness or leg numbness or calf pain, or foot pain are being caused by a herniated disc, or Spinal Stenosis, or Spondylolisthesis – Anterior Vertebra Displacement. The diagnostic imaging could also help to determine if Degenerative Disc Disease is present, which would help in the manner of a proactive and preventative Sciatica Treatment Plan. And yet, the results of the diagnostic imaging might be unremarkable, which could mean that the suspect cause of our sciatic pain might be Piriformis Syndrome, and that the Piriformis muscle is somehow the cause of our referred pain.Sciatica Treatment includes one or more of the following:
- NSAIDS – Non Steroidal Anti Inflammatory Drugs such as Ibuprofen, Naproxen, or Aspirin
- Opioids – Narcotic Medication such as Oxycontin, Oxycodone, Vicodin
- Gabapentin or Pregabalin-Prescribed for Neuropathic Pain
- Hydrotherapy- Water and/or Ice Therapy
- Heat Therapy-Used when inflammation is very low or non-existent
- Activity Behavior Modification
- TENS-Transcutaneous Electrical Nerve Stimulation
- Ultrasound
- Steroid Application
- Deactivation of Trigger Points
- Spinal Decompression
- Chiropractic Adjustments
- Topical Analgesics- The Tibial nerve component of the Sciatic Nerve also innervates Cutaneous structures, so this might provide some symptomatic pain relief
- Clinical Massage
- Sciatica Exercises
- Surgery in severe cases
Sciatica Exercise Part 1
Key Sciatica Treatment Motivators
Within the context of most sciatic problems, pain and muscle weakness are the strongest motivators of Sciatica treatment. This is where the pain scale of the sciatica pain assessment comes into play. If the pain is not too great, the doctor might prescribe some kind of NSAID. If the pain is more severe, the doctor may prescribe narcotic medication such as Oxycontin, or Oxycodone, or Vicodin to alleviate the pain.Sciatica Exercise Part 2
Medication Drawbacks
NSAIDS for Sciatica Treatment should be taken with care to avoid stomach upset and gastrointestinal distress such as IBS-Irritable Bowel Syndrome. They should be avoided altogether under circumstances such as stomach ulcers, and might only “take the edge off” if the sciatic pain is intense. Narcotic Medication affects the Nervous system, and is addictive. Some people experience constipation when using Opioids, so that is something else to consider.Nerve Pain Medication
Radiculopathy is radiating nerve pain from a nerve root, and a form of Neuropathy, which is Neuropathic Pain that affects the Peripheral Nervous system. Radiculitis is radicular pain, radiating nerve pain along the nerve’s sensory distribution (Dermatome) not necessarily from the nerve root. If your Sciatica Symptoms and/or Diagnostic Imaging results indicate the presence of radicular pain either from Radiculopathy or Radiculitis, your doctor might also prescribe Gabapentin or Pregabalin for Sciatica treatment, which are drugs that are used to treat Neuropathic Pain.What is Hydrotherapy?
Hydrotherapy is the use of water to decrease pain. That water can be lukewarm, or hot, or cold or ice.How should Heat be applied?
Heat should be used carefully, because if there is a high level of inflammation, heat will make the problem worse. Palpate the affected areas or tape a thermometer to the affected areas to try to get an idea if inflammation is present by the amount of heat in the area. If the likelihood of inflammation is low, Heat therapy with some type of heating pad can be applied to the affected areas to relax muscular hypertonicity. The application of Heat should never exceed 105 degrees Fahrenheit and there are contraindications to heat therapy that should be adhered to.How should Cold be applied?
The use of Blue Ice Packs should be avoided due to their ability to get extremely cold, and if not monitored properly, Frostbite becomes a real concern. Bags of frozen vegetables are just as effective, and the application of ice should be no more than 15 minutes alternating with 45 minutes breaks. An important thing to remember when applying Cold Therapy is that the area should feel numb for the treatment to work effectively.What is Vascular Flush?
The combination of Heat and Ice therapy, also known as Vascular Flush, is indicated to improve circulatory response in the affected areas, because sciatica can produce waste products in soft tissue like lactic acid that can contribute to pain, and tendons and ligaments have poor circulation compared to muscle tissue.How can Activity Modification help?
Activity behavior modification will help by avoiding the activities that exacerbate and aggravate Sciatica. By altering some of our activities, we hope to reduce the nerve inflammation, which hopefully in turn will reduce the nerve impingement.TENS-Transcutaneous Electrical Nerve Stimulation
TENS-Transcutaneous Electrical Nerve Stimulation for Neuropathic Pain is the application of an electrical current to the nerves of a chronic pain location in order to activate nervous system opiod receptors, reduce pain receptor (Nociceptor) activity, and increase GABA (neurotransmitter) release, thereby causing a reduction in Pain. The stimulation of nerves causes a continual cyclic contraction and relaxation of the associated musculature.TENS should not be applied:
- where the jugular vein or Carotid Artery is located
- to the Carotid Sinus area
- to the front of the neck
- to any undiagnosed pain symptoms
- to any internal parts of the body
- to the eyes
- to Genitalia
- to any wound
- to any infected area
- to any area affected with Tuberculosis
- to tissue that increases pain rather than decreasing pain
- in any situation that increases pain
- so that the current flows thru the head
- if the person has heart disease
- if the person has a history of blood clots
- if the person is pregnant
- if the person has a pacemaker
- if the person has skin problems
- if the person has seizures
Ultrasound for Sciatica Treatment
Ultrasound is the therapeutic application of inaudible high frequency sound waves to human tissue. The application of high frequency sound causes tissue molecules to vibrate off of each other at high speeds. This process causes an increase in temperature and inflammatory response resulting in tissue repair. Ultrasound must be used with care to avoid causing excessive inflammation and/or burning internal tissue.Ultrasound should not be applied for the same conditions as TENS above, and also:
- on areas that have a plastic or metal implant due to the risk of burns
- if the person is taking blood thinning medication
- if excessive inflammation is suspected
- if the person has Cancer
Be careful with Steroids!
The application of Steroids is a controversial form of treatment. The goal of steroid application is inflammation reduction. The steroid can be injected or delivered transdermally (thru the skin) via Ultrasound (Phonophoresis), or electrical current (Iontophoresis). Although it can have outstanding results in some situations, if used excessively, it has been linked to Avascular Necrosis-reduced bone circulation resulting in death of bone tissue.Lumbar Epidural Steroid Injection
What are Trigger Points?
It is possible that Sciatica could create Trigger Points, which are extremely irritable knots in taut bands of muscle and connective tissue that transmit referred pain into different parts of the body. They could be an additional source of leg pain or referred pain into the glutes. Trigger points in the glutes have been known to transmit referred pain into the back, which can cause lower back pain. Deactivation of trigger points will provide for the relaxation of hypertonic muscles in the lower back, glutes, legs and feet.When should Spinal Decompression be used?
If you have Spinal Stenosis, or a herniated disc or a ruptured disc, Spinal Decompression might be recommended by your doctor in the hopes of providing you with some degree of sciatic nerve pain relief, by decompressing the structures of your spinal column. This could be accomplished with a special Spinal decompression machine, or possibly with a device similar to an inversion table.Choose your Chiropractor Carefully
A seasoned Chiropractor whom has conducted a Sciatica Pain Assessment would be able to perform the appropriate Chiropractic Adjustments of the lumbar spine which could also provide you with some degree of sciatic pain relief for a variety of Sciatica symptoms such as Spondylolisthesis – Anterior Vertebra Displacement, or if your spine is misaligned or fixated.How can a Topical Analgesic help me?
The Tibial nerve component of the Sciatic Nerve also innervates Cutaneous structures, in particular, the skin on the back of the leg, so the use of a Topical Analgesic might provide some kind of symptomatic pain relief, but maybe not exactly Sciatic Pain Relief. There are a number of topical analgesics on the market that help to provide some degree of pain relief. Most of them do not work very well, but there is one in particular that does a magnificent job of not only reducing pain, but inflammation as well for short periods of time up to two hours, but it is accomplished none the less.Clinical Massage helps tremendously, but choose your therapist carefully
Clinical Massage is a big help to Sciatica sufferers, especially if Piriformis Syndrome is present. The skilled Clinical Massage Therapist is a professional whom should have conducted the Sciatica Pain Assessment, and would thereby know what to do to provide you with the maximum possible amount of Sciatic nerve pain relief within their scope of practice.Your Therapist should test for certain aspects of your Sciatic Nerve Pain
If you have a leg length difference, or hip rotation or elevation, or a leg length difference or decreased internal femur rotation or a hypertonic Piriformis Muscle, or Trigger Points, the therapist should not only be able to define those conditions, but be able treat them as well.Multidimensional clinical massage skills are required for Sciatica Treatment
The Clinical Massage Therapist that is seasoned and highly skilled in Medical Massage Therapy for sciatica treatment would also know how to deactivate trigger points, reduce inflammation, apply Hydrotherapy, apply Sciatica exercises and supply you with Sciatica Exercises for Sciatica Home Treatment as part of a comprehensive Sciatica Treatment Plan. Ensure that you are instructed on Sciatica Exercises that help to stretch the Piriformis Muscle as well as the Glutes and Hamstrings.What happens when all else fails?
Surgery should be the last resort for Sciatica treatment, because there are no guarantees of what the outcome will be. Depending on the Surgeon’s diagnosis, skill, and abilities, this could entail one of the following:- Laminectomy-Lamina Bone Removal
- IDET-Intradiscal Electrothermoplasty-Sealing of disc wall fissures to reduce disc bulge
- Nucleoplasty-Reduction of pressure inside the disc
- Discectomy-Disc Removal
- PDN-Prosthetic Disc Nucleus
- Disc Replacement Surgery
- Foraminotomy-Surgical enlargement of the nerve passageway
My advice to you for Sciatica treatment is to start conservatively, because some forms of treatment are more radical than others, and some forms of treatments could create additional problems. Use conservative common sense. If something causes increased pain, avoid it.
Sciatica Pain Assessment Where is my Sciatic Nerve Pain coming from?
Return to Sciatica from Sciatica Treatment Irritation-Impingement-Compression-Entrapment of the Sciatic Nerve
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