sciatic radiculopathy - Sciatica Treatment by Physiotherapists
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Sciatica Treatment by Physiotherapists

Physiotherapy Treatment of Sciatica by Jonathan Blood Smyth Sciatica results from a structure impinging on a lumbar nerve root, causing compression and/or inflammation enough to cause neurological changes in the skin, reflexes and muscles served by the affected nerve. Not a common syndrome, it is estimated that 3-5% of the population suffer this kind of problem at some time. It affects men and women equally with men most susceptible in their forties and women in their fifties.?? Up to a quarter have symptoms which last more than six weeks and referral to physiotherapists for acute management is routine.


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Sciatica exercises come in many different forms, but the last thing you need when you're in pain is to have to learn a complicated exercise routine. But using exercise to alleviate sciatica doesn't have to be difficult. Getting relief can be as simple as doing just one exercise and doing it frequently until such time as the pain is gone or at least much improved.

For true sciatica, most people will find relief through the basic McKenzie extension exercise (named for physical thearapist Robin McKenzie). This exercise is performed by lying face down on a firm surface and then propping yourself up on your elbows, creating an increase in the curve of the lower back. Getting into this position may be painful at first, but within about 30 seconds, most people will notice a decrease in the severity or the range of the sciatica, or both. A positive sign is when the symptoms furthest from the spine decrease.

Exercise plays a leading role in treating sciatica. There are many sciatica exercises. These exercises are one the best ways of treating sciatica. They specifically target the muscles in lower back, thighs and abdomen area. Though doctors advise bed rest in case of acute sciatica pain, the muscles are still weak and this again brings back pain if physically demanding activities are performed.

Once you determine whether you have true sciatica or piriformis syndrome, or both, you can usually get considerable relief from just a single exercise for either condition (two exercises if you have both).

Sometimes even one form of exercise is good enough to get rid of the pain. However, finding that right exercise and doing it regularly to get rid of the pain depends on the exact cause of sciatica. Your sciatica may be due to herniated disc or it may be due to piriformis syndrome that occurs due to the contraction of piriformis muscle in the area around the hips. You can stretch these muscles slowly to reduce contraction, loosen the tight muscles and reduce pressure on sciatic nerve.

A thorough history performed by the physio will uncover any red flags, an indication of a possibly serious underlying medical condition responsible for the pain. Loss of weight or appetite, severe pain at night, a history of cancer, unwellness or fever, bowel or bladder control difficulties, young or older patients, all these things ring warning bells and the physio will refer the patient on to a medical specialist for evaluation. The location, nature and response to activities and postures of the pain will be noted by the physiotherapist.

Whether you need the McKenzie extension exercise, or the piriformis stretch, or both, the sciatica exercises work best when repeated frequently - up to several times per day while you are having signficant symptoms.

Sciatica usually comes on quickly after an aggravating activity or posture, along with some back pain but this can go off when the leg pain starts. Sciatica is worsened by sneezing, sitting and coughing and is better lying down or standing. The pain is in the buttock and either down the back of the leg or the side and down into the foot. In 5% of cases the affected nerves are the first, second or third lumbar, which give front of thigh pain not beyond the knee. The full picture may sometimes not be present, with individuals describing discrete areas of pain such as the foot only.

About the Author:

Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.

Types Of Sciatica Exercises Sciatica exercises are divided into three categories. Though their main purpose is to relieve pain, each category targets a specific aspect of reducing sciatic nerve pressure so that the pain can be reduced. The exercise which stretch the muscles are called stretching exercises. Exercises which stabilize and strengthen muscles are called stabilizing and strengthening exercises. The third category of exercises called general conditioning exercises. These exercises are stretching hamstrings, stretching of lower back, and making the core muscles strong. These exercises specifically target muscles in the torso, abdomen and back. An exercise regimen that combines the exercises from these three categories is very effective in reducing sciatica pain and in preventing it from recurring.

When the symptoms have subsided, it is extremely important to learn what sciatica exercises you can do to prevent the symptoms from returning in the future. Don't be fooled! Just because the symptoms go away, it doesn't mean that everything is back to normal. All too often, sciatica sufferers go from one episode of pain to the next, with episodes becoming more severe and more frequent over time, because they fail to manage the problem correctly so you can avoid the common problem of developing chronic pain and disability.

The great forces which we impose on the low back mean the lumbar intervertebral discs suffer structural changes and prolapses. Many activities involve a significant level of leverage, such as flexing over, performing movements in an upright position and lifting with the arms away from the body. This greatly magnifies the forces on the discs and due to their fluid mechanics they suffer 3-5 times the loads on the skeleton. This can cause the disc walls to degenerate, giving weak areas and predisposing to prolapse at some time.

The second test is to bend your leg to pull the knee toward your chest. Begin by first bringing the knee on the painful side toward the shoulder on the same side. Then release the leg slightly and pull the knee toward the opposite shoulder. If pulling the knee toward the opposite shoulder increases the pain significantly more than pulling it toward the same side shoulder, chance are you have piriformis syndrome. It should be noted that it is possible to have both true sciatica and piriformis syndrome at the same time.

An easy method to help you determine what the problem is can be done by doing a couple of tests while sitting in a firm chair. In the sitting position, try straightening your knee on the painful side, so that your leg is parallel to the floor. If this increases your symptoms, chances are you have true sciatica related to a disc problem.

The McKenzie technique works on pain centralisation, the tendency for pain to move towards the back from the legs, suggesting a disc problem, and many physios use this technique. Pain in the front of the thigh and over the knee can be referred from the hip joint, so the physiotherapist will assess the lower limb joints to check the diagnosis. A thorough examination informs the physiotherapist of the likely diagnosis and how they might treat the syndrome, or that the patient needs to be referred to a medical practitioner for a consultation and investigation.

Exercises are one of the most frequently used forms of sciatica treatment. They help a great deal in strengthening the muscles in the affected areas. However, it is very important to choose the correct type of sciatica exercises based on the underlying cause of sciatica in individual cases. It is always good to exercise with care and not to exercise when the pain is acute. Otherwise you will end up aggravating your pain.

For piriformis syndrome, you can do a simple stretch of the piriformis muscle. I recommend you do this by lying on your back, pulling your knee on the painful side toward the same side shoulder for a few seconds, then partially releasing the leg and then pulling your knee toward the opposite shoulder. Hold this stretch for about 10 seconds at a time, then carefully release your leg for a a few seconds before repeating the stretch.

About the Author:

Dr. George Best has been treating patients with sciatica and piriformis syndrome in his San Antonio, Texas practice since 1992. To access his free E-book and his free video course on understanding and treating sciatica, go to http://www.sciaticaselfcare.com.

In most circumstances conservative sciatica treatment is tried for three to six months. When conservative sciatica treatment fails to alleviate your pain more aggressive sciatica treatment options are usually attempted. Epidural Steroid Injections: An injection of a corticosteroid medication to the affected area may be helpful in some instances. If taken in doses that exceed your natural levels, inflammation is suppressed relieving painful symptoms caused by the pressure of the inflammation. Most effective when used in conjunction with a sciatica treatment rehabilitation program. Because of the serious side effects that corticosteroid injections can cause, the number of injections you can receive in a year is usually limited to no more then three. Surgery: Surgery is most often a last resort and left until the compressed nerve causes significant weakness, loss of bowel or bladder control, or if the pain itself is progressing and conventional sciatica treatment is not working. Most often surgery is preformed as a sciatica treatment to remove a portion of a herniated disk that is pressing on a nerve. The goal is to preserve as mush of the normal anatomy as possible, leaving as much of the disk intact as possible.

 
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Benefits Of Sciatica Exercises These specifically targeted exercise work because they work on the muscles that are crucial for supporting the back and reducing the pressure that affects sciatic nerve. These exercises lead to increased blood circulation. This results in healthy and supple spine and increased supply of oxygen and other vital nutrients to spine.

The physiotherapist begins with postural observation of the patient which can show an inability to stand up or a thoracic shift to one side. Spinal movements are performed and the pattern of movement limitation noted, with a full neurological examination of the lower limbs. The physio is looking for deficits in muscle power, reflexes or feeling which are related to the specific nerve root involved. The straight leg raise may be performed to check the stretch reaction of the spinal nerve.

As long as the symptoms are decreasing furthest from the spine, the exercise described is beneficial, even if the symptoms closer to the spine seem to increase at first (they'll usually improve with repetition of the exercise over time). I suggest you remain in this position for a couple of minutes and then take a break by either just lying flat, or by getting up and walking for at least a few minutes in between the exercise repetitions in order to avoid developing a lot of tightness in the low back muscles.

To figure out what exercise will be of most benefit, it is important to try to distinguish whether you have sciatica from a lumbar disc bulge /herniation, or whether you have a condition called "piriformis syndrome", which produces symptoms very similar to disc-related sciatica but is caused by contraction of the piriformis muscle in the buttock area.

There are alternative forms of sciatica exercises too like Yoga. Yoga has many postures that can be used to provide relief from sciatica pain. All these yogic postures keep the muscles flexible and strengthen them which lead to faster healing.

In most people, self care measures is usually recommended a sciatica treatment as this usually responds well. Continuing with your usual activities but avoiding the original factor that aggravated your sciatica pain in the first place will help you to heal more quickly. Even though it seems like a few days of bed rest may provide some relief, any more then this is not a good idea. Inactivity will make your symptoms worse over time. In addition to self care sciatica treatment, try some of the following: Cold Packs: Cold packs help to reduce inflammation and relieve some of the discomfort. In a clean towel, wrap an ice pack or a bag of frozen peas and apply to the affected areas for fifteen to twenty minutes four times per day. Hot Packs: After 48 hours have passed, apply heat to the affected areas. Warm packs or a heating pad on the lowest setting should help to alleviate some of the pain. Try to alternate warm and cold packs if you continue to have pain. Stretching: When stretching initially after your sciatica flare up, stick to passive stretching and avoid jerking motions including bouncing or twisting. Over The Counter Medication: There are two categories of pain killers. The first one only relieves pain. The second type of pain killer relieves pain as well as treats inflammation. These are called Nonsteroidal anti-inflammatory drugs. Products such as aspirin, ibuprofen and acetaminophen products such as Tylenol can help to relieve sciatica pain. These can provide real pain relief but there is a limit to how much pain can be controlled. This is known as the ceiling effect - exceeding the recommended dosage wont provide better results. Worse though is that these NSAIDS are known to cause side effects in some people such as nausea, stomach bleeding or ulcers. Acetaminophen has been known to cause liver problems if taken in excess. If you use these medications on a regular basis talk to you health care professional so that you can be monitored for problems associated with prolonged usage. If you are exercising, stretching or following another sciatica treatment program you should periodically re-evaluate if you still require these NSAIDS for pain management. Prescription Drugs: A muscle relaxant along with anti-inflammatory medications may be prescribed by your health care professional. In some cases of chronic pain anticonvulsant and tricyclic antidepressant drugs may also be prescribed. By blocking the pain messages being sent to your brain or enhancing the bodies production of endorphins, pain symptoms can sometimes be handled this way. Your bodies natural painkillers are called endorphins. Physical Therapy: Physical therapy can play an important part in your recovery from a herniated disk. When your condition improves your physical therapist can work with you to help design a rehabilitation program that will help you prevent the same injury in the future. Regular Exercise: When you injure yourself you think that movement or exercise would be counterproductive and all you want to do is just lay down and rest until the pain goes away. The truth is that regular exercise is the best way to combat many ailments, including chronic discomfort. When you exercise your body releases endorphins. Endorphins are the chemical that prevent pain signals from reaching your brain and can also help to fight against anxiety and depression. Your pain may be more difficult to control if you suffer from either depression or anxiety.

There are exercises which target these areas to relieve pain. In case of substantial sciatica pain, doctors only recommend exercises that are mild in nature and do not cause discomfort. Lying prone, trying to touch the chest with both knees and pelvic tilt are the most common exercises that are suggested at this stage. You can lie on your stomach with a pillow for supporting you hips. Pelvic tilt requires that you lie down on your back, bend your knees to contract the abdominal muscles.

Physiotherapists use a variety of therapies to treat sciatica, with McKenzie technique being a mainstream technique for discogenic pains. Mobilisation and manipulation techniques, core stability work, myofascial release, specific exercises, manual techniques, soft tissue work and massage, analgesia, patient education, rest, the best position to relieve extreme sciatica pain and advice are all used as treatments. Most sufferers settle without investigation or surgery and a long term exercise programme is useful once the problem has settled.

Disc prolapse can result in the internal nuclear material being extruded past the outer disc wall, physically compressing the nerve root which runs nearby. The nuclear material is also chemically irritating to the nerve structure and these irritants make the nerve and nearby structures swell, partly blocking the local circulation and the nerve's message transmission. Disc prolapse is typically the cause of proper sciatica but the size of the prolapse is not closely related to the amount of pain the person suffers.


Always consult your doctor before you start on any form of exercise.

About the Author:

For more info on sciatica treatment head to: http://www.sciaticatreatment.org today!


 
 
     
 
 





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