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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.


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.


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 Another cause can be spondylolisthesis, or more commonly known as slipped discs. It may also cause sciatica when a vertebral disc moves out of place and applies direct pressure to the spinal nerve adjacent to it, usually occuring on the lumbar or the lower portion of the spine. Blunt force trauma to the lower back region may cause severe damage to the spine and may cause sciatica as well. Accidents or external forces that may cause bone fractures like vehicular accidents, horse riding accidents, sports injuries may all lead to sciatica as bone fragments may occasionally be the cause of the nerve compression. The piriformis syndrome occurs when the piriformis muscle spasms and compresses the sciatic nerve. In this case, the sciatic nerve running beneath the piriformis muscle may sometimes get irritated by movement of the said muscle.

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.

A large amount of confusion and misunderstanding exists concerning the conditions sciatica and piriformis syndrome. There are some who insist that the two conditions are actually the same thing, but even though they can have symptoms that are very much alike, the underlying causes differ.

Sciatica refers to irritation of the sciatic (often mis-spelled as syatic or psyatic) nerve, that arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation, or "true" sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region. Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve comression and inflammation, may extend down the entire leg to the ankle and foot.

Two simple maneuvers will distinguish sciatica from piriformis syndrome in the majority of cases (when the problem is one versus the other and not both conditions at the same time). First, in a seated position, if one straightens the leg on the painful side (so that the leg is parallel to the floor), and the sciatica symptoms increase, this is usually a sign of true sciatic nerve irritation.

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.

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

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.

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.

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.

Piriformis syndrome, also known as "pseudo-sciatica" (meaning "false sciatica"), is actually referral pain and other symptoms (tingling, numbness, etc.) caused by tightness and knots of contraction in the piriformis muscle, which runs from the upper femur bone to the edge of the sacrum, the triangular pelvic bone that is below the lumbar spine. The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica.

So if you have been experiencing sharp, burning pain on your lower extremities, it is best that you consult a medical practitioner at once. You might be experiencing sciatica. But like they say, prevention is better than cure. Let's not abuse our bodies. RESOURCE BOX: Choose Variety of High Quality Medicines at Online Medicines Enjoyed Reading this article? More here: Pharmacy Articles

Other medications like Corticosteroids taken orally or by injection are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids also have side effects and the pros and cons of taking them should be fully discussed with your doctor.

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.

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.

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.

As mentioned earlier, the symptoms of true sciatica are very similar to piriformis syndrome. Both cause pain, tingling, burning, "electrical shock" sensations, and/or numbness down the leg, often all the way to the foot. In addition, both sciatica and piriformis syndrome tend to be at least partially related to biomechanical functional problems in the joints of the back and pelvis and they may even be present simultaneously in the same person, so it an be difficult to tell them apart.

It is important to distinguish between sciatica and piriformis syndrome, because the treatment for the conditions varies, and getting the diagnosis right typically leads to more effective treatment.

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

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!

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

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

About the Author:

Dr. George Best is in private practice in San Antonio, Texas. For more information, check out Dr. Best's free e-book and online video course to assist in understanding and treating sciatica and piriformis syndrome, including in-depth instruction on sciatica exercises at http://www.SciaticaSelfCare.com .

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.

But since the most effective treatment for the two conditions varies signficantly, it is important to determine the correct diagnosis if at all possible. In most cases there is an easy way to distinguish between sciatica and piriformis syndrome.

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.

If this is the path you have been down and you're tired of all the worthless treatments that just don't work, you must read this article! I guarantee you, it will likely be far different than what you have read or heard anywhere else!

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.

 
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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

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.

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.

Lastly, spinal tumors are anomalous growths on the spine that can either be benign or malignant. Rare as sciatica cases being caused by spinal tumors may be, once a tumor develops in the lumbar region, it may cause nerve compression that may trigger sciatica.

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.

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.

In some cases, piriformis syndrome may cause true sciatic nerve irritation, as the sciatic nerve may run underneath or even through the middle of the piriformis, so contraction of the piriformis may produce sufficient compression of the sciatic nerve to produce actual nerve symptoms. This is one of the main sources of confusion when it comes to distinguishing true sciatica from piriformis syndrome.

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.

1. Pressure caused by shortening and tightening of the piriformis muscle. This is almost always due to months or years of muscle imbalances in the hip rotator muscles.

Sciatic pain is simply caused by pressure being placed on the sciatic nerve and there are primarily four things that can create this... you may have one or more of the following:

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.

The most common causes of sciatica are: a herniated disc, lumbar spinal stenosis, spondylolisthesis, trauma, piriformis syndrome, and spinal tumors. When one suffers from a herniated disc, there is an inflammation or bulging of the spinal disc causing it to protrude out of the annulus. The annulus is the space between the spine where the spinal discs are located. Disc herniation could exert pressure on the nearby nerve root causing a direct compression on sensitive nerve tissues such as the sciatic nerve. Lumbar spinal stenosis is almost the same as disc herniation in the sense that spinal nerves are pinched. In this case, though, the spinal canal shrinks, squeezing and applying too much pressure on the spinal nerve inside. The spinal nerve branches out of the spinal canal to the entire body through openings called as neural foramina. Once these passages are congested or narrowed, it causes nerve compression. If the blockage happens on these passageways, they're considered foraminal stenosis. If it occurs on the opening where the sciatic nerve passes, it may 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

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.

There are a lot of treatments recommended for sciatica, some non-invasive and some involving surgery. In cases of bone fragments, spinal tumor, and severe cases of slipped or herniated disc causing the sciatica, of course surgery would be required as treatment. But for some minor instances, chiropractic treatment and acupuncture is enough to relieve the pain. Chiropractic therapy may range from ice/cold therapy, ultrasound, transcutaneous electrical nerve stimulation (TENS), to spine adjustment or manipulation. These entail for the lumber area to be exposed to cold or heat to reduce inflammation and muscle spasms.

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.

The second maneuver is done in two parts. First, from the sitting position one bends the leg and pulls the knee on the painful side towards the same-side shoulder. In all but the most severe cases, there is usually no major increase in pain in this position. The second part of the maneuver is to pull the knee toward the opposite side shoulder. An increase in the sciatica-like symptoms is a strong indication of piriformis syndrome.

One last point, sciaitic pain is not caused by a lack of prescription medications so don't think that taking some anti-inflammatories or muscle relaxants will fix it... it won't! Also, many people are able to eliminate sciatic pain within days just by performing a few exercises and stretches... but not general exercise... the exact corrective exercises and stretches they need to do.

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???

Acupuncture is a form of alternative medicine that originated from China. Fine needles are inserted into your skin in strategic points in the body to release negative energy and restore health and well-being, and treat pain and illnesses. It has been proven effective by medical practitioners. It is highly recommended as a treatment for generic lumbar pain, even for mild sciatica, as it supposedly releases tension from the spastic muscles and relieves the pressure from the compressed nerve.

Have you ever felt a chronic, burning pain that spreads from your lower hip running down to your foot? Is it just as painful sitting down or standing up? You might be suffering from sciatica.

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.

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.

The other way sciatic pain creeps into your life is due to your lifestyle and habits, and that is what we like to call the process. The process can be described as a prolonged onset of symptoms based on your everyday activities...

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.

About the author:
Article by Jesse Cannone of http://www.losethebackpain.
com. Jesse is a certified personal fitness trainer and
post-rehab specialist and he has helped hundreds of individuals
to eliminate their back pain. Visit his site now and be sure to
sign up for his free email course on eliminating back pain.


 
 
     
 
 





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