Herniated Disc and Sciatica Facts

Introduction

Herniated discs are probably the most common diagnosis for severe back pain and sciatica (leg pain). Discs are large cushions that lie between the individual vertebrae of our spinal columns.

The disc is composed of layers of ligaments (annulus fibrosis) arranged in a criss-crossing matrix that hold in a gel-like substance (nucleus pulposus), giving the disc its "shock-absorbing" ability. Sometimes the gel swells (which is called a disc protrusion or bulge).




A more problematic situation occurs if the gel pushes through its ligamentous wall (which is a disc prolapse or extrusion). Both situations can led to pressure or irritation of the vulnerable spinal nerve roots. This can lead to sciatica - an abnormal sensation felt anywhere from the buttocks to the feet.

For more that 70 years, orthopedists have believed that most lower back pain and sciatica were caused by herniated discs. The "dynasty of the disc" led to the typical medical advice of bed rest and medication. Gordon Waddell, a renowned British orthopedic surgeon, wrote in the journal Spine, "There is remarkably little scientific or clinical evidence to support the value of bed rest for low back pain or even sciatica." Bed rest is now known to cause prolonged pain, muscle weakness, joint stiffness, and depression.

If bed rest failed, surgery was the usual next step. Unfortunately, due to poor patient selection, many unnecessary surgeries were performed. Waddell said, "surgical successes unfortunately only apply to approximately one percent of patients with low back pain." According to Alf Nachemson, M.D., editor of the journal Spine, bulging discs are found and taken as an excuse to do a lot of surgery and percutaneous discectomy. Discs are made to bulge; that is a normal finding."

Edward Carragee, M.D. the Dean of Neurosurgery at Stanford University reported that disc bulges are present even in 20 year olds, BUT by age 30 there are more episodes of back pain in individuals whose spines had no abnormalities when they were 20 than in those with the bulges! He has also written in the journal Spine that the long-term results of surgery vs. conservative care for pinched nerves is no different.

Back and even leg pain can arise from the muscles, joints, or ligamentous structures of the spine. Whatever the cause, evidence is growing showing that rehabilitation not surgery is the treatment of choice for most lower back disorders.

When should I see a doctor?

Anytime a person has pain radiating down their leg they should see a doctor to find out the reason why. This is not something urgent unless there is buckling of one or both legs, incapacitating pain, progressive pain or numbness, loss of bowel or bladder control, or numbness around the genitalia or anus.

Pain Control/First-Aid

Goal: reduce pain, swelling and inflammation

• physical therapy (e.g. ice, electrical muscle stimulation)

• manual therapy (e.g. massage, traction) and manipulation

• anti-inflammatory/pain medication if necessary

What can I do for myself?

An important study from a leading orthopedic center in San Francisco demonstrated that more than 90 percent of patients with disc herniations responded to non-surgical treatment. Most of these patients had already been referred by neurologists for immediate surgery. Their treatment included simple pain control methods in combination with rehabilitation. According to Nachemson, "All the structures in the back fare better with early, controlled motion....if something is injured and you start to slowly move it under controlled conditions, then the structure heals quicker and better."

It is important to spare your spine if you have a pinched nerve. Slumping or bending forward from the waist are key sources of irritation of the disc. Prolonged sitting is another problem. Try not to sit for more than 20 minutes at a time without getting up and limbering your back. Because the disc is mostly water it swells at night when you are recumbent. Thus, the morning time is a critical time to keep your spine from bending forward while you brush your teeth, dry your feet and change.

Besides taking over-the-counter pain relievers of anti-inflammatories iceing your back at home is a key treatment. This can be performed for 20 minute intervals a few times a day.

Ways to increase your activity.

Walking is a safe exercise for pinched nerves due to herniated discs. If bending forward increases your leg symptoms, but bending backwards ONLY hurts in your back you may want to perform press-up and standing back extension exercises a few times a day. 10-12 slow repetitions are generally recommended. It is best to see a qualified health care provider to determine what exercise is best for you.


Rehabilitation

Goal: stabilize back through better flexibility, strength, and endurance

• education about lifting, sitting, etc.

• exercises to increase back and cardiovascular fitness

• encouragement to achieve and maintain a healthy back

Sources from : Clinicalrehabspecialists.com

Low Back Pain During and After Pregnancy Facts

Introduction
Low back pain (LBP) is a common problem during pregnancy and even more so afterwards. The pain can vary from a mild discomfort to severe and disabling. Serious causes of back pain are rare and easy for your doctor or chiropractor to diagnose. Most back pain is mechanical in nature and greatly subsides in just a few weeks.

When should I see a doctor?
LBP often gets better on there own as nature takes its course. Many women do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Back pain can occasionally be associated with pain extending down into the leg. This condition sometimes known as “sciatica” and you should see a doctor to diagnose it.

Health care providers are useful for making sure you don’t have serious disease and offering reassurance. Also they can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life or the pregnancy. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities. Often the rehabilitation specialist will work hand in hand with your physician when appropriate.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

There are several preventive measures one can take to help reduce the likelihood of developing low back pain or as self-care for back pain.

• Staying active: By staying active often times you can reduce minor episodes of low back pain from becoming more serious. The old notion of staying in bed until the pain is gone is no longer the best advice. The sooner you get moving again, the quicker you’ll progress through the pain episode and move on with your life.

• Lifting: If you have to pick up something try to bend at the knees, keeping your low back curved forward, not slumped. This is called the “hip hinge” and forces you to use your buttock and thigh muscles to take pressure off your back.

Incorrect lifting position with slouch Correct lifting position with hip hinge



• Sleeping: Try supporting under your knees with a pillow when sleeping on your back or between the knees when lying on your side.

• Specific stabilizing exercises: Often a rehabilitation specialist can prescribe specific exercises for back pain to help strengthen and stabilize muscles. As no two patients are alike, your rehabilitation specialist can help find what exercises are appropriate for you.



Ways to increase your activity.
Sometimes it may seem quite daunting to deal with activities which increase your LBP. Often times its frustrating because the activities you were first able to perform without pain are now giving you discomfort. Find out how long you can perform a specific activity without “flaring-up” your condition or making you worse off than when you started. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point.

Having a little discomfort is normal, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. Monitor the sciatic leg pain and tell your health care provider if it is either not improving or getting worse. It’s normal to have good days and bad days. Don’t be afraid to ask others for assistance. Your body has changed and it’s natural for symptoms to occur, but they should pass with time.


Here are some other examples of ways to modify your activity:

Staying active and doing your normal activities is one of the most important things you can do for yourself. You may have to modify the way you perform certain activities to keep from aggravating your back. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Your rehabilitation specialist can help you with modifying activities which are giving you difficulty. Massage, manipulation and other modalities may help relieve the pain, but they are best used to getting you re-activated and moving on with your life. Sometimes ice or heat packs may give some relief. Some women find relief with braces or belts that support the increasing abdominal weight. Medication (even over-the-counter) is to be used only with approval by your physician. Ask your rehabilitation specialist about specific problems you may be experiencing.


Rehabilitation
When self-care and activity modification does not give you sufficient relief, see a rehabilitation specialist for help. These doctors and therapists are specially trained to bridge the gap between what you are capable of doing and what you want to do. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts, fears and concerns to your healthcare provider. Often specific procedures following the pregnancy such as “Caesarian births” or the use of an epidural may dictate a specific kind of exercise or therapy. Pain and “flare-ups” may happen from time to time. This is normal and you will learn “first-aid” approaches for this. However, the more important goal is to re-condition your abdominal and back muscles so you are more stable during your chosen activities.

By staying active, modifying activities, and getting information from your healthcare provider, one can greatly reduce the occurrence or duration of LBP episodes.

Sources from "clinicalrehabspecialists.com"

Chiropractic Treatment of Sciatica

Chiropractic Treatment of Sciatica

Chiropractic Treatment of Sciatica

-Susan Spinasanta

Doctors of Chiropracticmedicine regularly treat sciatica. Sciatica is characterized by pain that originates in the low back or buttock that travels into one or both legs. Sciatic nerve pain varies in intensity and frequency; minimal, moderate, severe and occasional, intermittent, frequent or constant.

Pain is described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks. Other symptoms associated with sciatica include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder - however, sciatica is really a symptom of a disorder.

Caused by Nerve Compression
Sciatica is generally caused by sciatic nerve compression. Disorders known to cause sciatic nerve pain include lumbar spine subluxations (misaligned vertebral body/ies), herniated or bulging discs (slipped discs), pregnancy and childbirth, tumors, and non-spinal disorders such as diabetes, constipation, or sitting on one's back pocket wallet.

One common cause of sciatica is Piriformis Syndrome.

Piriformis syndrome is named after the piriformis muscle. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis, or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby pinching the sciatic nerve and causing inflammation and pain.

Sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.

Proper Diagnosis Since there are many disorders that cause sciatica, the chiropractor's first step is to determine what is causing the patient's sciatica. Forming a diagnosis involves a thoughtful review the patient's medical history, and a physical and neurological examination. Diagnostic testing includes an x-ray, MRI, CT scan and/or electrodiagnostic tests (nerve conduction velocity, electromyography). These examinations and tests help to detect possible contraindications to spinal adjustments and other chiropractic therapies.

Treatment Approach The purpose of chiropractic treatment is to help the body's potential to heal itself. It is based on the scientific principle that restricted spinal movement leads to pain and reduced function and performance. Chiropractic care is non-invasive (non-surgical) and drug-free. The type of chiropractic therapy provided depends on the cause of the patient's sciatica. A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments - sometimes called manipulation.

1. Ice/Cold therapy reduces inflammation and helps to control sciatic pain.

2. Ultrasound is gentle heat created by sound waves that penetrates deep into tissues. Ultrasound increases circulation and helps to reduce muscle spasms, cramping, swelling, stiffness, and pain.

3. TENS unit (transcutaneous electrical nerve stimulation) is a sma

ll box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms. Larger versions of the home-use TENS units are used by chiropractors, physical therapists and other rehab professionals.

4. Adjustments (Spinal Manipulation) At the core of chiropractic care are spinal adjustments. Manipulation frees restricted movement of the spine and helps to restore misaligned vertebral bodies to their proper position in the spinal column. Spinal adjustment helps to reduce nerve irritability responsible for causing inflammation, muscle spasm, pain, and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is proven to be safe and effective.

In college and during their training, students of chiropractic learn many different adjustment techniques enabling them to treat several types of subluxations and disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision. Spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.

To prepare a patient for adjustment, the chiropractor may instruct the patient to sit up or lie down. It is not uncommon for the chiropractor to use a totally different adjustment technique during the patient's subsequent visit. Treatment tables differ too. Some are stationary, flat padded tables and others are elaborate with electrically or manually operated head and foot rests.

Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If the Doctor of Chiropractic determines the patient's disorder requires treatment by another type of doctor, then the patient is referred to another specialty. In some cases, the referring chiropractor may continue to treat the patient and co-manage the patient's care with the specialist.