How Do You Treat Sciatic Nerve Pain

How Do You Treat Sciatic Nerve Pain

How Do You Treat Sciatic Nerve Pain

What Are Your Goals For This Surgery

How To Treat Sciatic Nerve Pain At Home – Stenosis

Making a decision about sciatica surgery when you are in a lot of pain can be tough. Be sure to discuss with your surgeon the post-surgery goals, especially those around pain and activity. Are you expecting to go back to work and the gym in a week? Are you hoping the pain will be gone entirely and for good?

Although most people experience up to 90 percent improvement in their pain levels after a sciatica surgery, no doctor can guarantee this. Numbness may still be present after the surgery, and there is always a chance of sciatica coming back at another vertebra.

Depending on the type of sciatica surgery, most people are walking the next day, and full recovery typically takes two to four weeks. Minimally invasive surgery usually means faster recovery, but if the surgery involves more than one vertebra or disc, your back may take longer to heal.

How Is Sciatica Diagnosed

First, your healthcare provider will review your medical history. Next, theyll ask about your symptoms.

During your physical exam, you will be asked to walk so your healthcare provider can see how your spine carries your weight. You may be asked to walk on your toes and heels to check the strength of your calf muscles. Your provider may also do a straight leg raise test. For this test, youll lie on your back with your legs straight. Your provider will slowly raise each leg and note the point at which your pain begins. This test helps pinpoint the affected nerves and determines if there is a problem with one of your disks. You will also be asked to do other stretches and motions to pinpoint pain and check muscle flexibility and strength.

Depending on what your healthcare provider discovers during your physical exam, imaging and other tests might be done. These may include:

• Spinal X-rays to look for spinal fractures, disk problems, infections, tumors and bone spurs.
• Magnetic resonance imaging or computed tomography scans to see detailed images of bone and soft tissues of the back. An MRI can show pressure on a nerve, disk herniation and any arthritic condition that might be pressing on a nerve. MRIs are usually ordered to confirm the diagnosis of sciatica.
• Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.
• Myelogram to determine if a vertebrae or disk is causing the pain.

How Long Does Sciatica Last

The duration of sciatica is critically dependent on its cause. A herniated disc, back sprain, shingles, and degenerative lumbar spine can all cause temporary forms of sciatica, lasting from days to weeks. Each can also cause chronic sciatica. Sometimes degeneration of the lumbar spine and discs can cause chronic sciatica that persists unless a surgical intervention is performed.

Medications For Relief Of Pain From Sciatica

There are different types of medications that can be used for sciatic pain, including oral medications.

• Over-the-counter pain relievers, such as aspirin, acetaminophen, NSAIDs (such as ibuprofen, ketoprofen, naproxen.
• Prescription drugs that can relax muscles to ease muscle spasms.
• Antidepressants for chronic low back pain
• Prescription medications for more severe pain

Note that don’t give a child aged 18 years old and younger because of the possibility of having Reye’s syndrome. A steroid medication, in some cases, is injected into around the spinal nerve. According to research, injections should moderate when irritation is caused by pressure from a herniated disc.

Sciatica usually occurs only on one side of the lower body. The pain usually extends from the lower back all the way through the thigh and the back of the legs. It may also extend to the foot or toes, depending on which sciatic nerve is affected.

Pain from sciatica can be severe and may lead to disability. Other people experience sciatica pain infrequently but can potentially get worse. In case you feel the following, seek medical attention right away.

• Fever and back pain
• Swelling and redness in your back or spine
• Pain that traverses down your legs
• Numbness or weakness in your upper thighs, pelvis, legs, or bottom
• Burning pain when peeing or blood in your pee
• Serious pain
• Loss of bowel or bladder control

When Your Sciatica Warrants a Visit to Your Doctor

 

Chiropractic Care For Sciatica

Sciatica Home Remedies And Self

Regardless of the cause, about 90% of people with sciatica will get better without surgerymost of them in just a few weeks. You can start treating your sciatica at home. In fact, home treatment may be all you need, especially if you know that your sciatica is caused by an injury or pregnancy.

Even if you don’t know what’s causing your sciatica, you can take steps to relieve your pain at home. Call your doctor if the pain isn’t manageable or under certain other circumstances.

Why You Should Avoid Back Surgery

One of the primary reasons why back surgery should be avoided is the risk. All surgeries carry the risk of infection, excessive bleeding, and nerve injury. Not to mention many people dont like being put under general anesthesia or that they may have to use potentially addictive pills to manage the pain after surgery.29 2020 .

When Further Sciatica Treatment Is Required

Any further treatments required are based on the nature and severity of the underlying problem. If there is something that can be addressed by a surgeon, we will refer you to a specialist.

Some additional interventions can be performed at The Pain Center. For example, we sometimes see patients who have already had a discectomy, laminectomy, or fusion. If a patient does not respond to minimally invasive treatments, we consider aggressive interventions such as spinal cord stimulation.

Where Is The Sciatic Nerve Located

Yes, its true Sciatica is a pain in the butt! Literally. However, the sciatic nerves are not confined to the gluteus maximus, the bodys largest nerves; sciatic nerves extend from the low back to your toes. The nerves exit the spine between two vertebrae in the lower back, travel behind the hip joint on both sides, down the buttock, and back each leg into the foot. One of the most important things about Sciatica is first identifying you have it and then determining what is causing it, in order to treat it effectively. If you dont seek help for sciatic problems, over time, the condition may only continue to get worse and cause lasting damage to the lower back and hips.

Dr. Elijah Chiang PT, DPT from Foothills Sports Medicine Physical Therapy , shows us his top 4 exercises to relieve sciatic nerve pain.

Are Restless Leg Syndrome Multiple Sclerosis Carpal Tunnel Syndrome Plantar Fasciitis Shingles Or Bursitis Related To Sciatica

How to Treat Sciatic Pain

While all these conditions affect either the spinal cord, nerves, muscles, ligaments or joints and all can cause pain, none are directly related to sciatica. The main causes of these conditions are different. Sciatica only involves the sciatic nerve. That being said, the most similar condition would be carpal tunnel syndrome, which also involves a compression of a nerve.

A final word about sciatica. . . .

Most cases of sciatica do not require surgery. Time and self-care treatment are usually all thats needed. However, if simple self-care treatments do not relieve your pain, see your healthcare provider. Your healthcare provider can confirm the cause of your pain, suggest other treatment options and/or refer you to other spine health specialists if needed.

Last reviewed by a Cleveland Clinic medical professional on 03/25/2020.

References

Do The Benefits Outweigh The Risks

Like most surgeries that require general anesthesia, sciatica surgery comes with the risk of blood clots and heart attack. Infection is also a risk with most surgeries. And since this particular operation involves tissues around a nerve, nerve injury is a possibility.

In addition to the general surgery risks, there may be risk factors specific to your background, lifestyle or state of health. Doctors call them comorbidities. They may increase your risk during the surgery or affect how successful the surgery is in relieving your sciatica pain. Studies have shown that factors such as smoking, high blood pressure, diabetes and duration of the sciatica pain before surgery may affect the outcome of the procedure.

If you are seriously considering sciatica surgery, it’s important to partner with a surgeon who would look beyond your physical symptoms and help assess many other factors that may influence your decision.

Physical Therapy And Stretching

Depending on whats causing your sciatica, movement might be the best answer. Dr. Shah can help you determine the proper types of stretches and exercises that will take the pressure off your sciatic nerve. While physical therapy can help reduce inflammation, consult Dr. Shah before embarking on an exercise routine, as some activities can aggravate your condition.

Bed Rest May Not Be Helpful For Sciatica

Traditional advice for treating sciatica recommended complete bed rest. However, recent Australian studies have concluded that lying in bed may offer only minimal improvement, or may even exacerbate the condition.Unless specifically advised by your doctor, remaining active may be the preferred option. Gentle exercises can help. Swimming is particularly useful, as it is not a weight bearing exercise so flexibility and strength can be improved without unduly stressing your back. Herniated spinal discs usually heal themselves with time.

What Is The Prognosis

In general the clinical course of acute sciatica is favourable and most pain and related disability resolves within two weeks. For example, in a randomised trial that compared non-steroidal anti-inflammatory drugs with placebo for acute sciatica in primary care 60% of the patients recovered within three months and 70% within 12 months. About 50% of patients with acute sciatica included in placebo groups in randomised trials of non-surgical interventions reported improvement within 10 days and about 75% reported improvement after four weeks. In most patients therefore the prognosis is good, but at the same time a substantial proportion continues to have pain for one year or longer.

How Is Sciatica Treated

The goal of treatment is to decrease your pain and increase your mobility. Depending on the cause, many cases of sciatica go away over time with some simple self-care treatments.

Self-care treatments include:

• Appling ice and/or hot packs: First, use ice packs to reduce pain and swelling. Apply ice packs or bag of frozen vegetables wrapped in a towel to the affected area. Apply for 20 minutes, several times a day. Switch to a hot pack or a heating pad after the first several days. Apply for 20 minutes at a time. If youre still in pain, switch between hot and cold packs whichever best relieves your discomfort.
• Taking over-the-counter medicines: Take medicines to reduce pain, inflammation and swelling. The many common over-the-counter medicines in this category, called non-steroidal anti-inflammatory drugs , include aspirin, ibuprofen and naproxen . Be watchful if you choose to take aspirin. Aspirin can cause ulcers and bleeding in some people. If youre unable to take NSAIDS, acetaminophen may be taken instead.
• Performing gentle stretches: Learn proper stretches from an instructor with experience with low back pain. Work up to other general strengthening, core muscle strengthening and aerobic exercises.

Secret #3: Chiropractic Care

What is the best treatment for sciatica? In a nutshell, comprehensive chiropractic care.

Chiropractors are specialists in all things to do with the musculoskeletal system of the body, so it makes sense that they would know the best ways to treat the root cause of your pain! Whether it is from a bulging disc or a lumbar subluxation, your chiropractor can diagnose and treat your problem, virtually eliminating sciatica pain for most people.

One study comparing chiropractic manipulations to simulated manipulations found chiropractic manipulation to be effective for sciatica pain relief. These manipulations, also known as spinal adjustments, can help align the spine and relieve pressure on the disc that is pressing on the sciatic nerve in the lumbar spine. 

Here at Better Health Chiropractic & Physical Rehab, we have successfully treated over 6,000 sciatica cases in Juneau since 1998 using a proven combination of non-invasive treatments. Patients suffering from sciatica’s big pain in the behind can call any of our three clinics before 4 pm and get in to be seen that same day.

You should know that not only do we offer secrets 1, 2, and 3, but our chiropractors can also offer advice about secrets 6, 7, and 8 all in one location!

How to get rid of sciatica pain forever? Of course, this wont be possible if you suffer from certain health problems, but for most people, regular visits to your chiropractor will keep sciatica pain from ever rearing its ugly head again!

Which Treatments Have You Already Tried

There are several ways to manage sciatica without surgery, depending on the cause. They may include pain relief medications, steroid injections, physical therapy, aquatic therapy, meditation and nerve blocks, among others. What works for one person may not be as effective for someone else.

There are several types of doctors who treat sciatica pain. If you feel like you have exhausted your options with your primary care physician, consider making an appointment with a rehabilitation physician or a pain medicine specialist before calling a surgeon. Because every person experiences pain differently, it often takes working with the right specialist to find the combination of treatments that works for you.

Selective Nerve Root Blocks

How to Treat a Pinched Sciatic Nerve

This type of injection is administered near the spinal nerve as it exits the intervertebral foramen . The medication reduces inflammation and numbs the pain transmitted by the nerve. Selective nerve root blocks may be given on one or more nerve roots from L4 to S3 to control sciatica pain.

For most therapeutic injections, results vary widely. Some people may experience immediate and sustained pain relief, some may have pain relief for only a few weeks or months, and some may experience no pain relief at all.

The above list of potential treatments is by no means exhaustive. For anyone experiencing sciatica pain, it is advisable to consult a qualified medical professional for treatment. As a general rule, if nonsurgical methods fail to provide relief after 6 to 8 weeks of treatment or if neurologic deficits increase, surgery may be considered.

See When Sciatica Pain Is a Medical Emergency

How Can I Tell If Pain In My Hip Is A Hip Issue Or Sciatica

Hip problems, such as arthritis in the hip, usually cause groin pain, pain when you put weight on your leg, or when the leg is moved around.

If your pain starts in the back and moves or radiates towards the hip or down the leg and you have numbness, tingling or weakness in the leg, sciatica is the most likely cause.

Randomised Controlled Trials Not Yet Included In Systematic Reviews

Two additional randomised controlled trials have been published comparing disc surgery with conservative treatment. One trial compared microdiscectomy with conservative treatment in patients who had had sciatica for six to 12 weeks. Overall, no significant differences were found for leg pain, back pain, and subjective disability over two years of follow-up. Leg pain, however, seemed to initially improve more rapidly in patients in the discectomy group. The large spine patient outcomes research trial and related observational cohort study was carried out in the United States. Patients with sciatica for at least six weeks and confirmed disc herniation were invited to participate in either a randomised trial or an observational cohort study. Patients in the trial were randomised to disc surgery or to conservative care. Patients in the cohort study received disc surgery or conservative care based on their preference. In the randomised trial both treatment groups improved substantially over two years for all primary and secondary outcome measures. Small differences were found in favour of the surgery group, but these were not statistically significant for the primary outcome measures. Only 50% of the patients randomised to surgery received surgery within three months of inclusion compared with 30% randomised to conservative care. After two years of follow-up 45% of patients in the conservative care group underwent surgery compared with 60% in the surgery group.

Should I Go To An Orthopedic Doctor For Back Pain

• What can an orthopedic doctor do for a pinched nerve?

• But if the pain is severe, ongoing, or accompanied by other symptoms such as numbness or tingling in your arms or legs, it may be time to see a back doctor. Start with someone who specializes in nonsurgical treatment for back pain. This can include a physiatrist, chiropractor, or orthopaedic physician assistant.

  Sciatic Notch And Piriformis Muscle Syndrome

  

  When talking about sciatic nerve, it is apt to mention the sciatic notch and piriformis muscle too. There are, in fact, two sciatic notch, greater sciatic notch and lesser sciatic notch. The greater sciatic notch is the large, deep notch situated on the posterior margin of the ischium which forms the lower and back part of the hip bone. This greater sciatic notch gives passage to the piriformis muscle and many other vessels, nerves and muscles on their course from the pelvis to the gluteal region. Of these, piriformis muscle is of great importance when trying to understand sciatic nerve pain.

  The piriformis muscle is situated deep in the hip and it runs in close proximity to the sciatic nerve. When this piriformis muscle gets tight or swollen, it leads to irritation of the sciatic nerve, which in turn leads to a pain resembling to sciatica pain, tingling and numbness. This is sometimes called Piriformis Syndrome. To relieve such sciatica-like pain, piriformis muscle stretches need to be done. We will discuss such Piriformis stretches when we learn about sciatic nerve stretches to relieve sciatic nerve pain.

  Now that we know what sciatic nerve is, lets know more about sciatica and its causes, symptoms and remedies.

  Treating Sciatic Nerve Pain At Home

  Thankfully, many cases of sciatica can be resolved with conservative treatments. Over-the-counter medications, including ibuprofen and other anti-inflammatories, can decrease inflammation and improve pain. Both heat and cold therapy can help, as well; ice can be used to reduce swelling and minimize pain, and heat is useful for stimulating blood flow and relaxing stiff muscles.

  Some patients want to just lie in bed when the pain is too bad, but we dont recommend that. Taking it easy for a few days is fine, but prolonged bed rest can make the problem worse. Instead, if the sciatic pain is really interfering with the patients ability to move around, its time to make an appointment with a doctor.

  Bring A Friend To Your Sciatica Appointment

  If your sciatic pain is severe, it may be difficult to concentrate. Bringing a friend or family member to your appointment to take notes can allow you to focus on the conversation with your doctor without having to worry about forgetting something later.

  A friend can also help you prioritize your discussion topics and ensure you dont forget to talk with your doctor about an important matter.

  See Preparing to See A Doctor for Back and Neck Pain

  How Do I Relieve Sciatic Nerve Pain

  Sciatic nerves go back to your lower legs. If you press something like a slipped disk or a bone spike on them, you get sciatica. You may have a burning sensation, numbness , weakness, or pain. Some people say it feels like pins and needles, while others say its more like having an electrical shock or being stabbed with a knife. No matter how much you feel, there are many ways to get relief.

  Below are the tips that you may not have heard before, all of which may contribute to the reduction of sciatic pain:

• Release the natural pain killers with a massage.

• Massages can help you feel relaxed, release endorphins , improve blood circulation, and soothe sore spinal muscles.

  • Deep tissue massage can help restore the range of motion of the spine and improve its flexibility.
  • Manual therapy, a special form of medical massage, can help knead knots, trigger points, or muscle tension.

  There are many forms of massage that can be beneficial, such as myofascial release and Shiatsu . These massages may be more effective in alleviating sciatica pain from poor posture, muscle strain, or tired muscles in the lower spine.

• Keep Moving.

• If your pain isnt too severe, its a good idea to stretch, go for short walks, and do any other physical activity you feel like doing. Its especially important to try to stretch your lower back, because thats where you can pinch your sciatic nerve.

• Reduce inflammation by nutrition.
• Heat Things Up or Cool Them Down.
• Walk in a swimming pool.
• Over-the-Counter Meds.

• How Is Sciatica Affecting Your Quality Of Life

  How To Treat Sciatic Nerve Pain Naturally

  Sciatica pain may extend all the way from the lower back, through the back of your thigh, to your foot. The pain can come and go, sometimes lingering for days and even weeks. This may cause anything from mild discomfort to making the simplest tasks intolerable. Sitting could be painful with sciatica and driving even more so. Not to mention playing sports and being active.

  As you contemplate surgery for sciatica, consider how much the pain affects your quality of life. If your work, hobbies, social life or relationships suffer from your being in constant pain, it may be time to think about surgery.

  Although sciatica starts as nerve inflammation, it may eventually progress to nerve damage. If the sciatic nerve is damaged, it could result in numbness, tingling and, in more severe cases, weakness in the knees or legs. The longer it is left untreated, the longer it will take for numbness and weakness to go away, and they may become permanent.

  Who Is The Best Doctor For Spine Surgery

  Many years ago, neurosurgeons were primarily responsible for spine surgery, but in the past 20 to 25 years spine surgery has evolved so that both neurosurgeons and orthopedic surgeons specialize in spine surgery, and for most of the typical spine operations both types of surgeons are equally well qualified.

  How Do You Treat Sciatica At Home

  Many people struggling with the pain of sciatica get relief with basic home remedies. One of the most effective ways to treat back pain is with a daily stretching routine. Yourpain doctor can provide details on the types of stretches that work best for the specific pain you are experiencing.

  Though exercise is often helpful in reducing inflammation, there are situations in which you might be better off with bed rest. If so, try three days off of your feet to give your irritated nerves a chance to heal. Hot and cold packs have been proven effective for getting back pain under control. Begin with cold packs several times a day for three days, then switch to hot packs for maximum relief.

  Some people find success with a variety of alternative therapies. For example, in certain circumstances, yoga, acupuncture, and massage can ease your pain. Throughout your at-home treatment attempts, you can try over-the-counter pain relievers. Acetaminophen, aspirin, naproxen, and ibuprofen are often helpful. However, none of these medications are intended for long-term use, so be sure to speak with your pain doctor if you need them for more than a few days.

  Write Down Your Symptom History To Save Time During The Appointment

  Your doctor is going to ask you several questions about your symptom history, so writing it down in advance will save time during your appointment and ensure you dont leave out any important information. When you have a well-maintained pain diary, you will likely provide more precise and complete information, and avoid missing important symptoms or factors that can be crucial in your diagnosis.

  Symptom-related questions your doctor is likely to ask you:

  • How would you describe your symptomsis the pain throbbing, searing, electric-like, or dull and localized?
  • Do your symptoms extend below the knee?
  • How long have you had these symptoms?
  • Are they getting worse or staying the same?
  • What causes a flareup in your symptoms
  • Do you have neurological symptoms, such as difficulty in lifting your foot , numbness, or weakness?
  • Does a specific position offer temporary relief or aggravate the pain further? For example, does bending forward make your symptoms better or worse ?

  Maintaining a pain diary can be helpful when you have sciatica. The diary doesnt have to be an actual bookuse the notes app on your phone so that you can have the information accessible at all times. Make a note every time you experience a symptom of sciaticawrite down the type, severity, and duration of the symptom.

  
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