Home Remedies vs. Interventional Procedures for Sciatica
Sciatica is an extremely painful condition that results when the sciatic nerve is injured or compressed by bone, spinal cartilage or other tissue. This condition can appear with burning, tingling, numbness or weakness in the leg or buttocks which may worsen while sitting. There are many treatment options for sciatica that range from simple home remedies like applying ice or heat up to aggressive medical options like surgery.
In most circumstances, sciatica requires only a minor amount of care because this condition will resolve on its own. Most people who encounter sciatica will experience symptoms up to 4 or 6 weeks. In many cases, self-care at home is sufficient to mitigate pain and other symptoms, but some sciatica patients may require more serious medical intervention.
What Causes Sciatica?
Before embarking on a course of treatment for your sciatica, it may be necessary to identify the cause of the condition. Essentially, sciatica occurs when the sciatic nerve, the longest nerve in the body which extends from the lower spine to the feet, becomes irritated. This irritation may be the result of
- Lumbar spinal stenosis—if the spinal canal in which the spinal nerve is located narrows, it can put pressure on the sciatic nerve and produce sciatica.
- Degenerative disc disease—in many older patients, the cartilaginous discs that cushion the spinal vertebrae may shrink or tear, allowing the bones to pinch the sciatic nerve.
- Piriformis syndrome—this is a rare neuromuscular condition in which the piriformis muscle which connects the lower spine to the thighbone involuntarily contracts and puts pressure on the sciatic nerve.
- Spondylolisthesis—if a small stress fracture occurs in a lower spinal vertebra, then a vertebra may become misaligned and impinge on the sciatic nerve.
It can be difficult to diagnose the exact cause of your sciatica, but your doctor should begin by performing a physical exam and taking your medical history. During the exam, your doctor may administer the straight leg raise test or slump test which will detect pain due to a compressed sciatic nerve. If there is still some uncertainty, your physician may perform an MRI or discogram to detect damaged spinal discs, spinal joint inflammation or tumors.
Self-care for Sciatica
Once you know what is causing your sciatica, you can start to take steps to speed your recovery. In general, your doctor should recommend treatments that you can perform at home first with more involved medical therapies available if necessary.
- Icing and heating—icing a painful area can numb the pain and reduce inflammation, while gentle heat promotes blood flow and healing. Only apply ice packs or heating pads for 15 or 20 minutes at a time (to avoid frostbite or overheating) and never fall asleep while applying.
- Exercise—you may want to lie in bed to avoid the pain, but studies show that extended bed rest may weaken your back and leg muscles which can aggravate symptoms. Instead, engage in gentle exercise like walking to strengthen and stretch back muscles.
- Adjust your posture—you may want to pay special attention to how your spine is positioned while at home or work. Monitor which positions cause more discomfort and adjust your position every 20 minutes or so.
- Topical pain medications—these non-prescription pain medications are applied to the skin of a problem area. Drugs like capsaicin, camphor, menthol or methyl salicylate provide fast, lasting pain relief with less risk of long-term side effects.
- NSAIDs—non-steroidal anti-inflammatory drugs like ibuprofen and aspirin offer pain relief and reduced swelling. You should discuss all of the medications you are taking with your physician prior to using them in case there are cross reactions with other drugs, supplements or dietary items.
- Braces—lumbar support braces can help some sciatica patients. These braces limit spinal movement and can stabilize the groin area which is often an area of radiating pain. Look for supports that are adjustable and made from breathable fabric.
Medical Therapies for Sciatica
If your condition persists for more than 6 weeks, your doctor may recommend that you try more aggressive therapies. These may include one or more of the following:
- Medications—there are many prescription drugs that may mitigate symptoms and expedite healing. Pain relievers like opioids and anti-inflammatories may offer some relief from pain or numbness. Patients with involuntary muscle contractions may respond to muscle relaxants. In some cases, antidepressants and anti-seizure drugs may also help.
- Physical therapy—a robust rehab program may help improve your posture and strengthen key back muscles. This will not only help support your spine and limit undue pressure on the sciatic nerve, but it will also help you limit your risk of re-injury in the future.
- Steroid injections—if inflammation is a component of your sciatica, then an injection of corticosteroids may bring relief. This anti-inflammatory compound will lower swelling around the sciatic nerve and may last several months.
- Surgery—in about 5 to 10 percent of sciatica patients all other medical therapies prove ineffective, so it becomes necessary to resort to surgical procedures. If you have lost control of your bowel functions, this indicates a serious neurological condition and your physician will immediately schedule a surgery to relieve pressure on the sciatic nerve. There are two primary surgical options:
- Discectomy—if there is a bone spur or bulging spinal disk compressing the sciatic nerve, during this procedure, the physician will cut and remove the impinging tissue. In some cases, it may be necessary to remove all of the spinal disk to remedy the issue. Although a discectomy requires general anesthesia, many patients are able to return home on the same day of the procedure.
- Laminectomy—during this procedure, part of the lamina, which is the ring of bone surrounding the spinal cord, is removed. This allows more room for the nerves and alleviates any nerve compression. You must undergo general anesthesia during the procedure which typically lasts about 2 hours. Most patients return home the same day of the procedure or the following day.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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