There are many different treatments for sciatica, some are more general in nature, and some are more specific to a particular cause of sciatica. The best treatment will depend on the cause of your sciatica.
When considering treatments for sciatica it helps to understand your diagnosis and what is causing your sciatica.
The more you understand about the cause of your pain the easier it will be to understand the possible treatments for sciatica.
Sciatica itself is not actually a disease, it is a symptom. It is a sign that there is something wrong somewhere along the course of the sciatic nerve.
"irritation or pressure on the sciatic nerve"
The sciatic nerve is the largest nerve in the body. It is formed by several nerve roots as after they exit the lumbar spine, and it runs from the posterior pelvis through the buttock and down into the thigh. In the lower thigh the sciatic nerve divides into the smaller nerves that innervate the lower leg and foot.
In most cases sciatica is caused by irritation or pressure on the sciatic nerve somewhere along its course. The pain of sciatica is often described as, a very severe ache, deep in the buttock or thigh.
"Cauda equina syndrome is a medical emergency..."
Sciatica may be a associated with low back pain, and it may radiate into the lower leg and foot. In severe cases, there may be lower extremity weakness and/or problems with the bowels or bladder, which are symptoms ofcauda equina syndrome.
Cauda equina syndrome is a medical emergency that requires immediate attention by your doctor to prevent permanent impairment. Any time you are having back pain or sciatica, and you begin developing weakness in one or both of your legs or you begin having problems controlling your bowels or bladder it is important to see your doctor immediately. If you cannot contact your doctor you should go to the emergency room.
The most common causes of sciatica would include lumbar spinal stenosis, herniated or bulging discs, and piriformis syndrome. Each of these conditions can cause pressure on the sciatic nerve in a different way and for a different reason, but they all can cause the pain of sciatica.
Each of these different conditions will require different treatments for sciatica because they are in different places and they are caused by different things.
"begin with the most conservative and least invasive treatments"
Most doctors will begin with the most conservative and least invasive treatments for sciatica, if these do not improve your symptoms, you may consider proceeding to the more invasive treatments.
Depending on your particular situation, there is a chance that all types of sciatica from all different causes may improve with simple activity modification and good back mechanics.
"consider how each of these may be affecting your back"
You need to think about your job and the things you do at work, your chores around the house, your hobbies and how you spend your time on weekends. You need to consider how each of these may be affecting your back.
If any of these activities make your back hurt, or make your sciatica worse, then you need to stop doing them. Another option would be to change the way that you do them. Sometimes, just using good back mechanics, is enough to make a difference. It will allow you to do the things that need to be done, without making your symptoms worse.
"you are protecting the little joints and not straining the ligaments"
Good back mechanics means not bending your lumbar spine forward. If you always keep a little arch in your low back, you are protecting the little joints and not straining the ligaments. When your spine flexes forward it puts extra load and strain on the facet joints and ligaments of your lumbar spine.
If you must bend over, bend at your hips and not with your back. Bend like a golfer, and raise one leg up behind you. Squat or kneel when you must get down on the floor, and always keep that little curve in your back.
"consider treatments for sciatica that are more specific to the cause of your sciatica"
You can discuss anti-inflammatories with your doctor. If your symptoms are not too severe, anti-inflammatory drugs may take away the swelling that is causing your sciatica.
These medications can also affect your blood pressure, they may bother your stomach, and they may interact with other medications you may be taking, so you need to discuss these with your doctor before beginning any new medication.
If these general treatments for sciatica do not relieve your symptoms, you may want to consider treatments for sciatica that are more specific to the cause of your sciatica.
However, you should continue to avoid activities that make your sciatica worse, and continue to practice good back mechanics. These will always contribute to relief of your symptoms.
If you have lumbar spinal stenosis you could consider:
Traction or inversion therapy as a treatment for sciatica can separate the vertebrae and relieve symptoms by making more room for the nerves.
Epidural steroid injections will reduce inflammation and swelling. These can be very effective when your sciatica is caused by arthritis in your back.
Surgery to relieve your pain. When less invasive treatments have failed to improve your symptoms you may need surgery to relieve your pain. A lumbar laminectomy may be needed to remove the bone and other tissues that are squeezing the nerves.
If you have a bulging or herniated disc you could consider:
Hyperextension exercises can be used to reduce a bulging or herniated disc. Arching your back can create negative pressure within certain parts of the disc. This can move a bulge or small herniation away from the nerves.
To perform these exercises begin by lying on your stomach on the floor or an exercise mat.
Now use your arms to raise your shoulders and arch your back while keeping your pelvis flat on the mat.
Hold for a count of 5, and repeat 5 times.
Hyperextension exercises can be done several times per day but be careful, it is easy to overdo and cause increased back pain. So start gently and progress slowly.
Lumbar traction, or inversion therapy, can stretch the lumbar spine removing the bulge or reducing the herniation of a disc relieving pressure on the nerves.
A tapering dose of oral steroids, such as prednisone, can be used to reduce swelling. These may be used when pressure on nerve is caused by an accident or injury to the lumbar spine.
Epidural steroid injections can be used to place medication precisely into the area of swelling. These can effectively relieve swelling and inflammation which may be pressing on a nerve.
A herniated disc may be treated surgically with a discectomy to remove disc fragments that may be pressing on nerve. Bulging discs are seldom treated with surgery, but should be amenable to other treatments.
If you have piriformis sciatica you could consider:
Several weeks of rest, and avoiding athletic activities that aggravate your symptoms.
When your symptoms have subsided you could begin a gentle conditioning program to strengthen and stretch your piriformis muscle.
Some doctors will do steroid injections along the piriformis muscle to relieve swelling and take pressure off of the sciatic nerve.
In severe cases when piriformis sciatica cannot be relieved by more conservative treatments for sciatica, surgical release of the piriformis muscle has been effective at relieving pressure on the sciatic nerve.
"what you do and how you do it"
There are many possible treatments for sciatica to consider. It is always best to start with the most conservative and least invasive treatments, and progress from there.
If your symptoms are not too severe, you could try being careful about what you do and how you do it, and start a program of stretches for sciatica to see if anything makes a difference.
"be involved in the decisions regarding your care"
If your symptoms are more severe, or they prevent you from performing your normal activities, you need to get in and see a doctor. He can examine you, and order the appropriate tests to evaluate your condition. After determining a diagnosis, you can decide which treatments for sciatica to pursue.
Understanding your diagnosis and the different treatment options will allow you to be involved in the decisions regarding your care.
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