herniated disc l5 s1 - Sciatica - the cause and the cure
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Sciatica - the cause and the cure

What it is Sciatica is the name people give to a pain in the buttock, leg or foot brought on as a direct result of some form of irritation to the sciatic nerve. The sciatic nerve is the longest nerve in the body. It runs all the way from the lower back splitting at the base of the spine and terminating in the foot.


Sciatic pain is usually nerve related and responds well to treatment with low doses of tricyclic anti-depressant drugs like amitriptyline, dothiepin, nortriptyline, lofepramine, desipramine, clomipramine or imipramine combined with acupuncture or the use of TENs machines. The low dosage of the tricyclic drug acts by closing "a pain gate" blocking the message to the brain.


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 Recent studies have shown that bed rest is not necessarily the best way to treat sciatica. It is better to remain active, starting off with some gentle stretching and exercise. Swimming is particularly useful, as it is not a weight bearing exercise. The good news is that herniated spinal discs usually do heal on their own, given time.

http://www.gardenstatepainrelief.com/1

1Jones MA, et al. Recurrent non-specific low-back pain in adolescents: the role of exercise. Ergonomics 50(10):1680-1688, 2007 2Cherniack M, et al. Clinical and psychological correlates of lumbar motion abnormalities in low back disorders. Spine J 1)4):290-298, 2001 3Plouvier S, et al. Biomechanical strains and low back disorders. Occup Environ Med 2007 (in press)

Find out what's causing your sciatic pain and learn exactly which exercises and stretches you should be doing by watching our Lose the Back Pain Video. Order your copy now online at http://www.losethebackpain.com

Learning about potential risk factors and taking appropriate action will help ensure a stronger, more flexible, and healthier lower back. By Dr. Ralph Santonastaso

Muscles get stronger when they're required to do work. Also exercise helps "train" the soft tissues around a joint - the ligaments and tendons - these supporting structures "learn" how to withstand mechanical stresses and loads without becoming injured. Basically, when you exercise - when you do any kind of exercise - your body gets "smarter" and you're less likely to get those annoying back problems.1

The term slipped disc makes it sound as if it can slip about inside. In truth the disc cant slip anywhere, it is firmly fixed at the top and at the bottom to the vertebrae above and below.

Risk factors for back pain may also be found in your personal and family medical history.2,3 During your initial visit your chiropractor will ask you about accidents and surgeries you've experienced, and discuss any important elements in your family history. For example, surgery to remove an inflamed gallbladder or appendix or to repair a hernia may result in weakened abdominal muscles. A motor vehicle accident or a fall from a height may have caused injuries that healed with soft tissue scarring.

Bill Morrison has his own website http://www.help4urback.com where he describes his own personal experiences coping with lower back pain and sciatica. He also includes personal recommendations for people who suffer from sciatica or lower back pain including what books to buy, TENs machines, and what web sites to check out.

There are many different treatments for sciatica and it is important to discuss these with your health practitioner. Accurate diagnosis to determine the exact cause of sciatic pain is also equally important. The most conclusive diagnosis is usually gained by a having an MRI scan. However having said that skilled medical practitioners, and I include Osteopaths and Chiropractors, are often able to determine the suspected cause by carrying out a physical examination

Did you go see your primary care physician and get diagnosis of Sciatica only to have them refer you to an orthopedic specialist and than get a diagnosis of Piriformis Syndrome... and than be told to see a Physical Therapist and the PT tells you a little heat, ultra sound, electrical stimulation and some therapeutic exercises and we will have you good as new???

In extreme cases spinal injections of corticosteroid into the epidural space (the area around the spinal nerves) or facet joint (between vertebrae) may be given. This is usually carried out by a specialist with follow up injections at a later date.

Sciatica or sciatic nerve pain is a term often used to describe all sorts of back pain. In fact, less than 5% of people who suffer from lower back pain will have sciatica.

Sciatica and Piriformis Syndrome are the same condition... it is just that the medical community is starting to call the condition by the muscle (Piriformis) that is involved and getting away from calling it by the name of the nerve that is involved (sciatic) nothing more than semantics.

In severe cases the leg may feel weak and the strength may be reduced. Often, disc bulges cause no back pain at all; the symptoms are felt only in the legs.

If you're reading this article, it's a good bet that you have a radiating pain running down the back of your leg that just won't go away. If what I'm about to tell you sounds familiar, don't worry, help is on the way.

Why are so many people given the diagnosis of sciatica? Very often, as soon as anyone has any lower back or leg symptoms they are told that have sciatica. However, there are other things that can cause leg pain; a strained facet joint for example can cause pain in the buttock and thigh. But if the sciatic nerve is not irritated then it is not sciatica.

As you can see, there is a trend here... in nearly every case, muscle imbalances are the primary cause of the pressure being placed on the sciatic nerve.

So how do you get rid of your pain? Will learning one new stretch be enough? It very well may be. However depending on the severity of your condition you may need to change your activities of daily living to include new stretches, new exercises that include the use of the hip rotators like roller-blading, basketball, tennis, etc, and even better, specific corrective exercise specific to your situation... like those covered in our video. As always, learn as much as you can about your condition, so that you can ask the tough questions to your healthcare providers and get the best care possible.

Recovery Tip: In severe cases, the sciatic pain can run from the top of the hip to the bottom of the foot. It is very important to recognize that changes and shifting of pain is often times a sign of improvement. Further more as a way of gauging recovery, take note of how far down the leg the pain goes. If the pain goes to the foot one day and then only makes it to the calf and then to the knee and then it can only make it to the hamstring that is a sign of improvement. You should feel good about those noticeable improvements and this should give you encouragement to keep working toward a full remission of pain.

Stretching and exercising are a must if you really want to progress along the road to rehabilitation and if you are in extreme pain this is probably the last thing you will contemplate doing.

The cause The most common cause of sciatica is a prolapsed (slipped) disc, pinched nerves or some form of arthritis. It usually starts with back pain which sometimes improves only to be followed by hamstring or calf pain. It may also include numbness in the toes depending on which branch of the sciatic nerve is irritated.

The disc can and does cause problems however. Sometimes the central area of the disc bulges, usually backwards and sideways. This can cause an irritation of the nerve root as it leaves the spine. Occasionally the bulge is severe enough to actually squash or trap the nerve but this is fairly rare.

An important thing to know is that many people have disc bulges and have no symptoms at all. There are some other conditions that can cause sciatic nerve pain but they are much less common. These include degenerative disc disease, severe osteoarthritis, spinal stenosis or spondylolisthesis. Fractures, tumours and infection can also cause sciatica.

There is a fairly new procedure called IDET which stands for Iintro Discal Electrothermy). When a disc is herniated the water content of the inflamed disc causes it to bulge and press against the nerve. IDET dries up the disc very quickly, in less than 20 minutes, a process which might take weeks or months if left to dry up naturally

To understand this you need to have a bit of an idea about human spine anatomy. The spine is made up of large bones called vertebra. These bones are separated from one another by spinal discs. Each vertebra overlaps the next at the back to form a joint called a facet joint.

Are there risk factors for back pain? And, if there are, what can I do to keep myself healthy and well? Your chiropractor can help answer these questions and more.

3. Pressure caused by Isthmic spondylolisthesis which is simply when a vertebrae slips or moves... this can sometimes pinch the sciatic nerve but often times people who have this condition don't have any pain, symptoms, or even know they have it!

If your pain is not relieved by analgesics or NSAIDs, your doctor might prescribe narcotic analgesics (such as codeine) for a short time. Side effects of these include nausea, constipation, dizziness and drowsiness, and continued use may result in dependency.

4. Pressure caused by a herniated or bulging disc. A herniation is when a disc protrudes out from between the vertebrae and this can either be caused by an event like a car accident, or, by months or years of uneven pressure due to muscle imbalances. It is also important to note that many people with herniated discs don't even experience pain or symptoms, and many don't know they have the condition.

Other treatments to manage sciatica include traction; manipulation by a skilled osteopath, physio therapist or chiropractor; Chemonucleolysis (injection of a special enzyme into the disk).

When you have an injury to a muscle, both strength and flexibility are compromised, and if your recovery ends before strength and flexibility return, you will never be 100% and will likely struggle with the problem forever.

Let me give you some examples of what I mean: 1. If you sit on the edge of your chair with you legs separated and your feet pointing outward you are keeping your Piriformis muscle in a shortened position and that's how it gets tight and with extended sitting in that position, it gets weak form lack of use. Hence the imbalance.

 
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The discs which cushion the vertebrae in the lower back become progressively thinner and harder as we get older. This stresses the lower back and often causes a variety of lower back pain disorders, including sciatica.

Since getting mobile and becoming flexible is extremely important you might require some pain management to help you get going. For mild cases of sciatica your doctor may start off by recommending non prescription medications like aspirin, ibuprofen, or naproxen, known as non steroidal anti-inflammatory drugs, or NSAIDs. A downside of these drugs is that they may cause stomach upsets or bleeding.

There are many easy-to-do exercises for your abdominal muscles. The key is to actually do them - and do them after you're finished doing the rest of whatever exercises you've scheduled for that day. How often? Three times a week is plenty. Abdominal routines are quick - no more than 10 minutes. And, remember to use your abdominal muscles throughout the day. Imagine your abdominals are being pulled in and lifted up. This is not a "tightening" - your thought should be "activate". Your body will know what to do, once you've started adding consistent abdominal training to your exercise routine.

In the legs there are two main, large nerves, the femoral nerve at the front and the sciatic nerve at the back. The sciatic nerve passes down through the buttock area into the back of the thigh and leg.

To learn more about muscle imbalances and how they affect your body, please read our article "Aches, Pains, and Injuries" which you can find on our website here: http://www.losethebackpain.com/achesandpainsarticle.html

The spine is made up of a series of connected bones called "vertebrae." Spondylolisthesis or isthmic spondylolisthesis occurs when a cracked vertebra slips over the vertebra below it. Poor posture and curvature of the back or weak abdominal muscles can contribute to this slippage, which can press on the nerve. The presence of this spondylolysis usually does not represent a dangerous condition in the adult and most treatments concentrate on pain relief and increasing the patient's ability to function.

If you are not sure which one of the four is causing your sciatic pain, I recommend you start with the basics. Most cases of sciatic pain are caused by muscle imbalances so if you begin to work on correcting any muscle imbalances you have, you should start to see improvement right away.

Sciatica is caused by a sciatic nerve irritation. This is most commonly caused by a disc bulge in the lower back. What is the sciatic nerve?

2. Another example is runners and bikers who actually work very hard tend to get sciatica because they fail to keep a strength vs. stretch balance in their workouts. Hence the imbalance creates a greater pull toward external rotation and the result is a tight Piriformis and an irritated sciatic nerve creating pain.

The best way to tell if it is sciatica is to undergo a series of test that your physiotherapist or doctor can perform. These simple clinical tests will be enough to identify if the problem is an irritated sciatic nerve. Paula Fitzpatrick is a British trained physiotherapist specialising in the treatment of back pain. Visit The Lower Back Pain Toolkit for up to date, reliable information about the causes and treatment of lower back pain. Learn more about sciatica and sciatic nerve pain.

First, let me tell you why today's traditional treatment methods just flat out miss the boat. The medical community is so conditioned and focused on treating only the symptoms and trying to get in as many patients a day as possible, that many people are misdiagnosed and/or mistreated.

2. Pressure caused by spinal stenosis, which is a decrease in the space between the vertebrae. This is primarily caused by uneven pressure and compression due to muscle imbalances.

One primary risk factor relates to exercise. Everyone has heard, "if you don't use it, you lose it". If you're not exercising regularly, your back muscles are deconditioned and much more susceptible to injury - the strains and sprains we're accustomed to calling "back pain".

As a last resort you may consider surgery to remove fragments of the prolapsed disc are then removed. As I mentioned earlier it is important to stay active and continue with an exercise and stretching program. Especially do exercises to develop your back and stomach muscles. This will help stabilize your spine and support your body.

At each vertebra the spinal cord braches out to form a nerve root, these nerve roots leave the spine via a gap between each vertebra and then bundle together to form much larger nerves.

These are just two examples of how muscle imbalances can affect the Piriformis muscle and cause Sciatic pain. You may not be a runner or cyclist but I'll bet you have muscle imbalances that are causing your sciatic pain!

Sciatica is usually caused by a prolapsed or 'slipped' disc bulging and pressing on to a nerve. It doesn't usually cause permanent nerve damage since the spinal cord is not present in the lower part of the spine and a prolapsed or herniated disc in this area does not pose a risk of paralysis.

A related risk factor is weak abdominal muscles. When you were a kid, at some point one of your gym teachers probably told you to "suck in your stomach". Actually, it turns out that was pretty good advice. Your abdominal muscles support the muscles of your lower back. If your abdominals are weak or if you're not using them - letting them hang out and droop instead of keeping them activated - your body weight has to be held up by the muscles of your lower back. They're not designed to do that - they're designed to move your spine around. And eventually, these lower back muscles will give way under the excess strain. The result is a very painful lower back injury.

Running down through the middle of the spine is a channel called the spinal canal, its here that the spinal cord sits. The spinal cord is the main structure that passes messages from our brains to our bodies.

Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve. The piriformis muscle is a small muscle behind the gluteus maximus. Piriformis syndrome is most common among women, runners and walkers.

The Cure Some cases of sciatica which result from inflammation get better with time and heal themselves perhaps within six weeks to three months.

When the nerve is irritated by the disc bulge it can become inflamed. Remember what it feels like to hit your finger with a hammer or catch it in a door for a moment. Following the nasty sharp pain you are left with a dull ache. The finger may become red and swollen; there may be some heat or warmth there. After a while, those symptoms settle and everything gets back to normal. Its very similar with the sciatic nerve. It becomes very sore and can give you a lot of pain, even though it is not actually trapped or squashed.

It is also important to maintain a reasonable body weight, ensure you have a good posture, sleep on a mattress that is neither too soft nor too hard, be careful when bending or lifting heavy weights.

There are several self assessments you can perform to help identify which specific muscle imbalances you have and these are covered in our Lose the Back Pain Video along with step-by-step instructions on what to do to eliminate your imbalances and pain. You can learn more by visiting http://www.losethebackpain.com

However, from a technical stand point the process really describes the development of the muscle imbalance in your hip. The Piriformis muscle is responsible for external rotation (moving your leg so your feet point outward). So over time that muscle gets tight from the positions you put your self in and weakens from lack of use.

In most cases, people go to physical therapy or minimize their physical activity to break the pain - spasm cycle and in most cases your symptoms subside. However...the event will also set you up for a life time of sciatic pain if the Piriformis muscle does not recover 100% in both strength and flexibility.

Article courtesy of http://www.losethebackpain.com. Get the facts on sciatic nerve pain that your not getting from your doctor... free access to back pain articles, information, and research.

Spinal stenosis is the name given to the narrowing of the nerve channel (vertebral canal) of the spine. This narrowing causes compression of either the spinal cord within the vertebral canal, or the nerve roots that exit the spinal cord. People with spinal stenosis experience sciatic pain symptoms in the legs and feet. It usually results from degenerative arthritis causing a narrowing of the spaces in the vertebral canal. Manual workers are more prone to developing symptoms of spinal stenosis but it seldom affects people under 30 years of age - unless it is due to traumatic injury to the vertebrae.

Sciatic pain comes about either due to a traumatic event, muscle imbalances, or a combination of both. The event scenario is most likely the catalyst for sudden onset of sciatic pain. So what happens... when there is undue stress on the Piriformis muscle that stress causes it to go into spasm and then you have pain due to the Piriformis muscle putting pressure on the sciatic nerve.

This information in this article should not be used to diagnose, treat, or prevent any disease. You should always consult with your health care professional especially relating to the suitability of supplements or drugs and on all health matters that may require diagnosis or medical attention. If you suffer from progressive weakness in the leg or bladder or bowel incontinence this constitutes a medical emergency and you should seek immediate medical attention - you may have cauda equina syndrome a serious condition due to compression of the nerve roots in the lower end of the spinal canal.





Julian P. Porter

 
 
     
 
 





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