Sometimes specialists that provide treatment for sciatica define sciatica as pain in the gluteal and lower area of the back. The pain travels into one or both legs, moving from the thigh into the calf, and then into the ankle and the foot. Other doctors sometimes define "genuine sciatica" as pain that radiates below the knee.
Causes of Sciatica
Sciatica is usually caused by compression of the sciatic nerve. Conditions that can cause irritation of the sciatic nerve include bulging or herniated discs, subluxations of the lumbar spine, tumors, and pregnancy. Non-spinal related conditions can also cause sciatic nerve compression and include constipation, diabetes, or the habit of sitting on a wallet that has been placed in the back pocket of a pair of trousers.
Piriformis syndrome is also a common cause of sciatica. In this syndrome, the piriformis muscle, which is located in the lower spine area and helps with the rotation of the hip, begins to cramp and spasm. Spasms and cramping in this muscle pinch the sciatic nerve, which runs underneath it. The piriformis muscle is prone to injury due to various causes like arthritis of the hip, falls or differences in leg length. When the sciatic nerve is pinched due to spasms of the piriformis muscle, it becomes inflamed and causes pain.
In addition to pain, compression of the sciatic nerve can also result in a sensory loss (the loss of feeling), insomnia, and, in severe cases, the paralysis of a group of muscles or a limb.
Treatment for sciatica depends on what is causing it.
Your physician will probably recommend medications as part of your treatment for sciatica. The severity of your symptoms will determine what your doctor prescribes. Treatment for sciatica sometimes includes:
- Epidural Injections: Steroids can help to relieve pain by decreasing inflammation. Epidural injections are administered close to the nerve roots. Sometimes these injections work to control pain for several months, but they don't work for all people.
- Over-the-counter non-steroidal anti-inflammatory drugs: These are also sometimes called NSAIDs. They help relieve swelling which will also help relieve pain. Not everyone can tolerate NSAIDs because they do have some side effects. Ask your doctor if you can take medications like ibuprofen or naproxen for treatment for sciatica.
- Prescription Medications: For treatment for sciatica, your doctor may prescribe a muscle relaxant to help relieve painful spasms. Antidepressants and medications sometimes used to treat other conditions such as epilepsy can sometimes help to relieve pain caused by nerve irritation.
Taking medications will not solve what is causing your pain because they are not curing your condition or addressing the root problem. When you're free from the pain you may be better able to participate in therapy or do the exercises your doctor has prescribed to treat the condition that has led to compression of the sciatic nerve.
Treatment for sciatica has historically been limited to bed rest. It was believed that rest would provide the best relief to aching joints and bones. But recent studies suggest that bed rest alone does not provide help for patients who have pain due to inflammation of the nerves.
Being active may provide more relief for people who suffer from pain in their back. This isn't to suggest that treatment for sciatica should include a prescription for running several miles every day. Staying active simply means being mobile for amounts of time that don't cause an increase in your pain. Some doctors may recommend walking or they may prescribe physical therapy.
Physical therapy is sometimes ordered as part of treatment for sciatica. It can help relieve pain and restore mobility through both active and passive treatments. Passive physical therapy treatments help your body to relax and prepare it for the active part of therapy which is a therapeutic exercise. Passive physical therapy for treatment for sciatica may include:
- Deep tissue massage: In this technique, the therapist uses friction and direct pressure to release tension in the soft tissues, such as muscles, tendons, and ligaments. This tension could be compressing your sciatic nerve or nerve roots. Reducing or eliminating muscular tension will help relieve your pain.
- Cold and hot therapies: Increased warmth brings more blood flow to an area of treatment for sciatica. Increased blood flow means more oxygen and nutrients are also delivered to the area. For instance, if your piriformis muscle is in spasms, a warm pack may help it relax by bringing more oxygen to the tissues. The application of cold slows circulation to an area which helps to bring down inflammation, pain, and spasms. Usually, therapists alternate applications of heat and cold.
- Transcutaneous electrical nerve stimulation: This treatment for sciatica is also known as TENS. A machine is used to stimulate the muscles with varying safe intensities of electrical current. This may increase the body's production of natural analgesics called endorphins, and it helps to decrease muscles spasms. Portable versions of a TENS machine can sometimes be used at home for treatment for sciatica.
- Ultrasound: In this treatment, ultrasound waves are sent into the tissues of the muscles, creating gentle heat. This increases circulation and stimulates healing, decreases spasms and reduces swelling, pain, and stiffness as a treatment for sciatica.
Following passive treatment, your physical therapist will teach you exercises in the active portion of the physical therapy. Each patient's physical therapy program is different and takes into account the patient's overall medical history and current condition. Your program may include strengthening exercises, aerobic conditioning, a range of motion and exercises to increase your flexibility.
Sometimes physical therapy also includes instructions on how to correct the posture and how to incorporate the principles of ergonomics into your daily life. This is done as part of treatment for sciatica in order to prevent further injuries or episodes of sciatic pain.
Treatment for sciatica sometimes includes alternative treatments such as acupressure, acupuncture, yoga and/or biofeedback. Some patients report being greatly helped by alternative treatments. You may want to consider:
Acupuncture: People who practice acupuncture believe the body contains an energy force referred to as Qi or Chi. They believe that when this force is blocked, physical illness develops. Acupressure and acupuncture work to restore the flow of Chi in the body. This is an Eastern approach to healing, which is different from the scientific concepts of Western cultures.
During an acupuncture treatment for sciatica, very thin sterile needles are inserted into precise points of the body. These points are referred to as meridians. Each meridian is also a channel, acupuncture point or an acupoint. Meridians are very close to the surface of the skin, so the needles are not inserted deeply into the tissues of the body and nothing is injected into the skin. The meridians correspond to the different systems of the body, such as the lymphatic, musculoskeletal, nervous or cardiovascular system. The acupuncturist may twirl or gently heat some of the needles.
Most people say that acupuncture as a treatment for sciatica is not painful. Even people who are opposed to needles find it to be relaxing. If you decide to try acupuncture, be sure to look for a practitioner who is licensed. Make sure they use sterile equipment.
Acupressure: Like acupuncture, acupressure is a sciatic treatment used to unblock the flow of Chi, but it does not use needles. It is non-invasive and is gentle. The acupressure therapist uses his or her fingers, thumbs and elbows to exert a precise amount of force on specific points of the body. This therapy includes applying consistent pressure to a point, then rubbing the area briskly to stimulate it. The points used are the same ones used in acupuncture.
Biofeedback: Biofeedback is a form of mind-body treatment for sciatica in which a patient is instructed in how to control their reaction to stress or pain. It is not always successful because it many times requires extensive participation by the patient. It uses special instruments to measure and then provide feedback to the patient about his or her reactions to specific stimuli, such as muscle tension or stress. By using relaxation techniques, such as visualization, physical and mental exercises, or deep breathing, the patient learns how to control their reaction to stimuli. For example, muscle tension related to sciatica may be dealt with by learning to control it through various biofeedback techniques.
Yoga: Some yoga poses and stretches may be used in treatment for sciatica if the cause is piriformis syndrome. The piriformis muscle is in the low back and helps in the rotation of the hip. Gentle stretches of this muscle sometimes help to relieve pain. Other yoga stretches can make sciatica more severe, such as twisting and bending forward. Any exercises in which the back of the legs is stretched will irritate the sciatic nerve. Any stretching needs to be done very gently and carefully.
If you're interested in treatment for sciatica that involves alternative therapy, talk to your doctor. Not all treatments are right for every patient. Your physician is the best person to ask if some form of alternative therapy might be the answer for you.
Doctors of Chiropractic often provide treatment for sciatica. The purpose of a chiropractic treatment is to help the body heal itself. It is based on the principle that restricted movement in the spine leads to pain and decreased performance and function. Chiropractic medicine is non-invasive and is free of medications.
The type of care a chiropractor provides will depend on what is causing the patient's pain. During their training, chiropractors learn different techniques for performing adjustments that enable them to treat various types of disorders. These techniques vary from quick thrusts to those in which gentle pressure is applied. The art of chiropractic medicine takes a great deal of precision and skill to master. The manipulation of the spine is the treatment that makes chiropractic different from other areas of medicine.
A patient's sciatica may be caused by conditions which a chiropractor cannot treat. If this is the case, the chiropractor will refer the patient to a different doctor for further treatment for sciatica.
Surgical Treatment for Sciatica
The majority of patients respond to treatment for sciatica which is non-surgical, such as medication or physical therapy, and surgery is rarely necessary. There are some situations in which an operation is needed. These may include:
- Sciatica with bladder or bowel dysfunction. This may occur with compression of the spinal cord.
- Sciatica with spinal stenosis
- Sciatica with neurological dysfunction, such as severe weakness in the leg
- Sciatica with severe symptoms despite conservative treatments
Your surgeon will recommend the type of surgery that is best for you, based on the condition that is causing your sciatica. Be sure to ask any questions so you clearly understand the procedure. The final decision to have surgery is yours to make. You may want to get a second opinion before deciding to have surgery as a treatment for sciatica. Two surgeries that are commonly performed as treatments for sciatica are:
- Discectomy: In this treatment for sciatica, surgery is performed that removes part or all of a disc that is herniated and is pressing on the sciatic nerve. A microdiscectomy is a minimally invasive procedure in which a very small incision is made and the surgeon uses small instruments and microscopic magnification. Patients usually recover from minimally invasive surgery more quickly.
- Laminectomy or Laminotomy: The lamina is the arch-type bony projection of the vertebra that protects the spinal cord. A laminotomy procedure removes a portion of the lamina; a laminectomy removes the entire lamina. These procedures are done as a treatment for sciatica to make more room in the spinal canal and remove pressure from the sciatic nerve.
Recovery from Surgery
Following surgery, you will be given instructions on what activities you can safely perform. Your body will need time to heal so you will probably need to restrict some of your usual activities. You will need to avoid bending and twisting, heavy lifting and contact sports until your surgeon releases you. If you have any problems with increased pain, a fever or signs of an infection, call your doctor right away.
Will Spine Surgery Relieve Sciatica?
The goal of surgery as a treatment for sciatica is to attempt to remove whatever is compressing the sciatic nerve, so it is hoped that relief of your symptoms will be accomplished. By removing a bone spur or a ruptured or herniated disc, for example, your sciatica should be relieved.