You might have experienced pain which runs down one or both legs from the lower back. The complaints may sometimes be accompanied by weakness, numbness, tingling in the leg or stiffness of calf muscles. Your doctor might have told you that you have Sciatica. He might have explained you the situation and various treatment options from medications to surgery. For Sciatica there are certain treatment options that your doctor might not have mentioned you. Those non-conventional options may prove highly beneficial in long term management of Sciatica.
Here we will discuss what Sciatica is and what treatment options are available to you to manage this painful condition. As every case is different, the remedy too will differ. The process of finding relief from low back pain and leg pain associated with sciatica can often require some trial and error. Some patients may find certain treatments more effective than others. Certain decisions are to be made by patient only, doctor may only guide. So awareness of every possible treatment option is vital in order to take correct decision in the treatment of Sciatica. This post serves exactly the same purpose.
What is Sciatica?
Sciatica is the pain radiating along the sciatic nerve, which runs down one or both legs from the lower back. It also causes weakness, numbness, tingling in the leg or stiffness of calf muscles. You may not be able to walk resulting in limping when sufferings are severe. Pain may become worse by prolonged sitting, squatting, standing up, coughing, sneezing, twisting, lifting or straining. Symptoms of Sciatica largely depend on where the nerve is pinched. You may not have pain starting from exactly where the herniation is. For example if you have L4/L5 disc herniation you may experience pain from L5/S1 region.
As many as 4 out of every 10 people will get Sciatica, or irritation of the sciatic nerve, at some point in their life. The sciatic nerve starts in the lower back at lumbar segment L3. This nerve comes from either side of the lower spine and travels through the pelvis and buttocks. Then the nerve passes along the back of each upper leg before it divides at the knee into branches that go to the feet.
What causes Sciatica?
Anything that puts pressure on or irritates this nerve can cause pain that shoots down the back of one buttock or thigh. Pain in lower back running down one or both legs, weakness, numbness, tingling in the leg or stiffness of calf muscles is usually caused when sciatic nerve is compressed by a herniated disk or bone spur in the spine. Injury to Sciatic nerve may also cause sciatica. Sciatica is a symptom of another medical problem, not a medical condition on its own.
Diagnosis of Sciatica is done by physical examination like Straight Leg Raise (SLR) test, imaging tests like X-ray and MRI.
How can I treat Sciatica pain and Sciatica itself?
For treatment of Sciatica you have two main options: Nonsurgical treatment and Surgical treatment.
Nonsurgical treatment consists of medications and exercises / physiotherapy. Surgical treatment consists of surgeries like Microdiscectomy or Fusion Surgery or Lumbar Laminectomy (Open Decompression) to release the compression on Sciatic Nerve manually. Let’s see in detail what non-surgical and surgical treatment options are available for Sciatica.
Nonsurgical treatment for Sciatica
Home remedies or Self-help measures:
There are a number of things you can do yourself to help reduce troublesome Sciatica symptoms. For acute sciatic nerve compression pain, heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes on painful areas, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn. It can help to reduce the pain.
Exercise for Sciatica and Physiotherapy (Physical Therapy):
If you have Sciatica, it’s important for you to remain as physically active as possible. Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back. While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful. If you have had to take time off work due to Sciatica, you should aim to return to work as soon as possible.Physical therapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any Sciatica treatment plan. When patients engage in a regular program of gentle exercises, they can recover more quickly from Sciatica pain and are less likely to have future episodes of pain.
Many exercises can help strengthen the spinal column and the supporting muscles, ligaments and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttocks) and hip muscles. Taken together, these strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.
Stretching is usually recommended to alleviate sciatic pain. Stretches for Sciatica are designed to target muscles that cause pain when they are tight and inflexible.
Hamstring stretching is almost always an important part of a Sciatica exercise program.
Low impact aerobic exercise
Some form of low impact cardiovascular exercise, such as walking, swimming or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.
Aerobic conditioning also has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.
Physiotherapy may help in many cases. A physiotherapist can teach you a range of exercises that strengthen the muscles that support your back and improve the flexibility of your spine. They can also teach you how to improve your posture and reduce any future strain on your back.
In conventional medicine, a number of over-the-counter or prescription painkilling medications are used that may help in reducing or relieving Sciatica pain. These include:
- Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen Naproxen, or COX-2 Inhibitors
- Muscle relaxants to ease muscle spasms
- Oral steroids can reduce the inflammation that is usually part of the cause of the pain
- Opioid medication, such as codeine or, in severe cases, morphine
- Tricyclic Antidepressants (TCAs), such as Amitriptyline – these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
- Anticonvulsants, such as Gabapentin – these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve painThese medications are not suitable for everyone, particularly when used in the long term, so it’s important to consider all available options. Some of these medications can also cause significant side effects in some people. Pain killers may help in acute pain for short term relief, however are not of any use for long term relief.
Homeopathy is the least known and least used treatment option. However it is probably the simplest, most effective and most economical among all treatments discussed here. Homeopathy treatment is completely non-invasive and safe and don’t have side effects of any kind even when taken over a long period.. It doesn’t consist of steroids. It doesn’t consist of pain killers either. As this treatment targets “Sciatica” rather than “Sciatica Pain”, the pain subsides when the body starts to adopt itself to the condition in a very natural way. Treatment relieves inflammation in the area around the nerves of your spine, which helps release the pressure on your sciatic nerve and reduce your pain. Homeopathy has been helpful in giving not only short term relief from Sciatica pain but also long term benefits for the condition itself. Homeopathy treatments are in the form of chewable sweet pills which are very easy and simple to take. If your doctor is not trained in homeopathy, he may not be able to suggest you or guide you regarding benefits of homeopathy in Sciatica. Homeopathy treatment is highly recommended for those who have already tried exercises, pain medications, corticosteroid injections without relief. Homeopathy is best option for those who are not medically fit or not willing for the surgery. Surgery can be avoided in many cases with homeopathy treatment of 6 months or so. This may be the best non invasive / non surgical cure for Sciatica. Homeopathy treatment can be received by visiting any qualified, trained, registered and experienced homeopathy doctor nearby you. Also you can order your Sciatica homeopathy treatment to be delivered by submitting required information online.
Chiropractic / manual manipulation:
Spinal adjustments and manual manipulation performed by appropriately trained health professionals, such as chiropractors and osteopathic physicians, are focused on providing better spinal column alignment, which in turn should help to address a number of underlying conditions that can cause sciatic nerve pain. It has shown to provide effective Sciatica pain relief for many patients.
Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers).
Spinal / epidural steroid Injections:
If other methods of pain relief have not worked, your doctor may advice you for a spinal corticosteroid and/or local anaesthetic injection to help decrease the inflammation that may be causing the pain. An epidural injection is different from oral medications because it is injected directly into the inflamed and painful area around sciatic nerve which may help release the pressure on your sciatic nerve and temporarily reduce your pain. While the effects of Corticosteroids injections tend to be temporary and the effects usually wear off in a few months (providing pain relief for as little as one week up to a year), and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently. However, it can provide some relief to allow a patient to progress with a conditioning and exercise program and/or homeopathy.
For most, readily available nonsurgical remedies along with homeopathy will go a long way to relieving their pain and the condition itself. For others, when the pain does not get better with above non-surgical remedies, possibly surgery may offer the pain relief.
Surgical treatment for Sciatica
Surgery is rarely necessary to treat Sciatica, although it may be considered if the condition has an identifiable cause, such as a herniated or “slipped” disc and the symptoms have not responded to other forms of treatment (especially homeopathy and physiotherapy), or the symptoms are getting progressively worse. Surgery can be considered when the condition is limiting the patient’s ability to participate in everyday activities. In most cases, Sciatica surgery is elective, meaning that it is the patient’s decision whether or not to have surgery. The patient’s decision to have surgery is based primarily on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. The patient’s general health may also be a consideration in whether or not to have surgery.
The type of surgery recommended will depend on the cause of your Sciatica. Some surgical options include:
- Microdiscectomy – Done in cases where the Sciatica pain is due to a lumbar disc herniation. In this surgery the part of the herniated disc pressing on your nerve is removed – the rest of the disc is left intact. This is the most common type of surgery required.
- Fusion Surgery – it may be possible to fuse a vertebra that has slipped out of place by using a metal or plastic cage between the vertebra, supported with metal rods and screws
- Lumbar Laminectomy – Decompression laminectomy is a procedure often used to treat cases where the Sciatica pain is due to lumbar spinal stenosis, where a section of vertebrae called the lamina, that is pinching the nerve root, is removed.
Patients may have a positive result from surgery but, as with all surgical procedures, spinal surgery carries some risks. Potential complications range from the relatively minor, such as an infection at the operation site, to the more serious, such as permanent damage to the spinal nerves.
Before choosing spinal surgery, your orthopaedic surgeon will discuss the relative risks and benefits with you.
Before going for surgery it is highly recommended that you try all non-surgical options first, especially homeopathy. Because spine surgeries are delicate and don’t always give expected output even when done at highly skilled hands. Some patients may prefer to try as many different non-surgical Sciatica treatments and remain with non-surgical care for as long as possible, and often they will figure out how to successfully manage their condition and keep painful symptoms at bay.
The important point is that it is almost always the patient’s decision whether or not to have the surgery, and the surgeon’s role should be to help inform that patient of his or her options to help the patient make the best choice.
Dr. Nitin Dhole
Sushanti Homeopathy Clinic
Ground Floor, Guru-Gajanan Apartment,
Gajanan Colony, Behind Reliance Mart, Garkheda,
Aurangabad (Maharashtra) India. 431009