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MY SCIATICA HURTS!

Q: I’ve had sciatic pain down the back of my right leg for 2 weeks. What should I do?

I’m glad you asked!

I’ll respond based on my training and experience as a physical therapist and will talk you through a conservative approach to managing acute sciatica.

Here’s a link if you want to know more about me…
http://www.myblankhurts.com/aboutus-bios.php

What is sciatica anyway?

Sciatica is pain, tingling, or numbness caused by an irritation of the nerve roots of the sciatic nerve. The sciatic nerve is formed by the nerve roots exiting the spinal cord of the lower back. Branches of the sciatic nerve extend through the buttocks and down the back of each leg to the ankle and foot. The pain, tingling or numbness often extends from the low back, to the buttocks and the back of the upper and lower leg (though it’s possible for back pain to be absent). The lower down the leg the pain extends, the more significant the involvement typically. The pain can be one sided (unilateral) or two sided (bilateral), though most often it is unilateral.

What causes sciatica?

It’s most commonly caused by:
1. Herniated intervertebral disc / discs (herniated nucleus pulposus - HNP) - the center (nucleus) of the cushion (the disc) between the vertebra of your spine seeps out of it’s normal confines, causing the disc to bulge. If the bulge of the disc is significant enough, it pushes out into areas normally occupied by the nerves, thus irritating / compressing the sciatic nerve roots in the low back. This disorder is rarely associated with a single injury or incident; it is caused by the accumulated effects of months or even years of forward bending and lifting and / or sitting in a slumped, forward bent posture.
2. Spinal stenosis - bone abnormality that narrows the spinal space causing vulnerability to inflammation of the disc, which can create pressure on the nerve. Spinal stenosis occurs more commonly in older adults.
3. Piriformis syndrome - compression of the sciatic nerve as it passes through the piriformis muscle of the hip.

Other potential causes include facet joint osteoarthritis or other arthropathies (spinal joint diseases), spinal cord infection or tumor, or spondylolisthesis (spinal degeneration that leads to instability and resultant shifting of vertebrae on each other).

According to the AAFP (American Academy of Family Practice www.aafp.org), only 4% of back pain patients actually suffer from sciatica. Of those with sciatica, only 1% has bladder involvement and / or symptoms down both legs.

Who can help?

A first step in taking care of the pain is to obtain a proper diagnosis of the problem and its cause. Any of the following clinicians should be able to assist with a diagnosis and treatment recommendation:

Family practice doctor
Internist
Osteopath
Orthopedist
Chiropractor
Physical therapist

What is the evaluation like?

The clinician should do a physical examination and ask you a number of important questions regarding your pain and overall health which will help her determine the need for diagnostic tests such as x-rays, CT scan or MRI. Some clinicians advocate x-ray and / or MRI, while others, especially if you are otherwise healthy and with insignificant history, will recommend conservative treatment for 6 weeks, and then x-ray and MRI testing only if your pain doesn’t improve.

What will make it better?

Once any potential red flags from the evaluation are addressed and emergency medical causes are ruled out such as cauda equina syndrome, tumor or infection, and the most likely cause has been determined, conservative care is recommended for at least the first 6 weeks. Should symptoms not improve or should they worsen, you should be further evaluated for steroid injections or surgery.

What is conservative care?

1. Ice and / or heat
2. Acetaminophen (Tylenol) or NSAIDS (non-steroidals like Advil)
3. Normal activities of daily living as long as symptoms do not worsen
4. Prescribed exercise program incorporating flexion or extension and stabilizing (depending on the cause)
5. General fitness that incorporates aerobic and stretching exercises that do not worsen the pain
6. Ergonomics education (lifting and posture training) to minimize exacerbation
7. Spinal joint mobilization (physical therapists, osteopaths, chiropractors)
8. Spinal manipulation (perhaps osteopaths and chiropractors)
9. Return to work
10. Close clinical monitoring
11. Self-care education

I would start with a PT, and one that is an orthopedic certified specialist or has been practicing in orthopedics for 5+ years. These therapists see A LOT of sciatica. You can find a local PT that is a member of the American Physical Therapy Association by going to www.apta.org. On the home page you’ll find a “find a PT” button.

Potentially helpful products:

Lumbar roll – DEPENDING ON THE CAUSE of your sciatica, a lumbar roll can help to keep the spine in a more optimal position to relieve pressure on the nerve roots when sitting at your desk, in your car, and at home.
I found one here at Relax the Back for 17.95

And another here at The Price Saver for 12.95

Body pillow – A body pillow can help keep the pelvis and spine in its best position for relief during sleep. A physical therapist can help with the best position DEPENDING ON WHAT’S CAUSING your sciatica. I found some at Bed Bath and Beyond here
And at Relax the Back here

Treat Your Own Back by Robin McKenzie, PT – Robin McKenzie is a PT that developed a back exercise program that can be very successful for patients with sciatica, depending on the pathology. Her method can be especially effective for patients with herniated discs, but can cause more pain for patients with spinal stenosis. Many physical therapists are trained in the McKenzie method. This book is intended for self-care. I think it’s best used in conjunction with a physical therapist.

Helpful Videos:

Here’s a link to an intro to McKenzie exercises on You Tube

Dr. Aaron Filler MD, PhD
Dr. Filler has an MD from the University of Chicago, a PhD from Harvard University, and is also a Fellow of the Royal College of Surgeons in England. He is an expert in spine and nerve pain based in Santa Monica, CA. www.nervemed.com

These two videos are produced by Dr. Filler for commercial and educational purposes. He has plenty of plugs for his practice, his technologies and techniques, but at the same time, he is an expert in his field and in these videos he provides a good deal of insight about back pain, sciatica, its causes, and options. He calls Piriformis Syndrome one of the most under diagnosed causes of sciatica, and the reason for many unsuccessful back surgeries.

Piriformis Syndrome Video

Do You Really Need Back Surgery Video

Other helpful sites:

Medline Plus – from the National Library of Medicine and National Institutes of Health
http://www.nlm.nih.gov/medlineplus/

You can learn more about sciatica at My Blank Hurts! by clicking here

Good luck, and good health!

Meredith Soelberg, MPT, MBA

COMPLIMENTS FOR COMPLEMENTARY MEDICINE

What do you know about complementary medicine? And how can it help me with my pain?

GREAT QUESTION. Thanks for asking. I had the pleasure of meeting with Nina Yannoukos, BSH, Lead Practitioner / Homeopath at Pharmaca Integrative Pharmacy in the Pacific Palisades, CA, and Partner at Restoration Health who shared her expertise in complementary medicine and related pain management products with me. Here’s what I learned from Nina, and I’ve included links to additional information for your review if you feel like digging more deeply.

Complementary medicine is a ‘complement’ to conventional medicine with which westerners are most familiar. Complementary medicine is not the same as alternative medicine. According to The National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes on Health (NIH), complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy, a therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being to help reduce a patient’s discomfort following surgery.

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer rather than surgery, radiation, or chemotherapy that may be recommended by a conventional doctor.

For tons of details on complementary and alternative medicine (CAM), go to the National Center for Complementary and Alternative Medicine (NCCAM).

Nina Yannoukos, BSH, of Pharmaca Integrative Pharmacy and Restoration Health gave me a tutorial on complementary medicine and its component parts, which include homeopathics, supplements (vitamins, minerals, amino acids, etc.) and herbs (Western and Chinese). And, more specifically, she introduced me to different homeopathics, supplements and herbs that her patients have found helpful for different types of pain.

Definitions:

Homeopathics – small diluted remedies in various potencies to stimulate the body’s immune system.

Herbals – plant-based remedies in crude form

Supplements – products that contain substances like vitamins, minerals, foods, botanicals, amino acids and are intended to supplement the usual intake of these substances.

For more on homeopathy, go to NCAAM’s section on homeopathy here.

Here are Nina’s recommendations and comments:

Herbals:

Zyflamend by New Chapter (www.newchapter.com)

Nina shared this product with me when I asked her to introduce me to some products that may not be especially well known, but are effective and that she thinks more people should be aware of. “It’s not well-known, but it’s extremely effective for joint and muscle pain due to inflammation. It’s a miracle herbal remedy of our time.”

Back and Neck Rescue by Peaceful Mountain

This is a topical product. There are numerous products in the Rescue Line by this company. In Nina’s experience, she has found Back and Neck Rescue to be particularly helpful for customers.

Infla-profen by GAIA Herbs

This is a new product, and Nina says it is especially helpful for back and joint pain.

St. John’s Wart Oil by GAIA Herbs

This is a topical product specifically for nerve pain.

GI Encap by Thorne Research

According to Nina, this product helps with Irritable Bowel Syndrome (IBS) pain and ulcer pain.

Digestive Enzymes and Herbs by Pioneer

Nina feels this product helps with overall gastrointestinal health and comfort.

Supplements:

Glucosamine + Chondroitin + MSM with Magnesium and Vitamin C by Jarrow Formulas

According to Nina, this supplement can help with overall joint health and joint pain.

In doing some additional research, I found controversy among experts about the effects of glucosamine + chondroitin for the prevention of osteoporosis and joint pain. Here are two articles with different conclusions about these supplements and their effectiveness:

http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/glucosamine.html

http://arthritis.webmd.com/tc/glucosamine-and-chondroitin-topic-overview

Ionic Fizz Magnesium Plus by Pure Essence Labs

According to Nina, magnesium is an important mineral that is very helpful for pain. She feels that this particular product is unusual because the magnesium is in powder form and therefore is absorbed by the body better.

Here’s an article (I found) on the risks of insufficient magnesium intake including heart disease, diabetes, muscle cramping, myalgias (including fibromyalgia) and back pain, as well as a 10 point summary on ways that magnesium can help you, and how much is recommended:

http://www.usaweekend.com/02_issues/020901/020901eatsmart.html

Homeopathics:

Traumeel by Heel, Inc.

According to Nina, this homeopathic remedy is not especially well known. It can relieve muscle, joint, and nerve pain.

In a recent study published in Complement Ther Med Journal, traumeel was found to be as effective as conventional medicines in the management of mild to moderate injuries (sprains, strains, contusions of ankles, knees and hands). Traumeel was safe in use and judged by physicians to be better tolerated than conventional medicines. Click here for the study.

So… all this should give you something to chew on… If you’re interested in complementary medicine to help with painful conditions, I think a good place to start is at the National Center for Complementary and Alternative Medicine (NCCAM) associated with the National Institutes of Health (NIH). Get informed.

Look for the MyBlankHurts! Alternative Medicine Practitioner Finder coming soon.

Good luck, and good health!

Meredith Soelberg, MPT, MBA