Questions To Answer Before Considering Sciatica Surgery
Sciatica is the type of pain that originates in your lower back and typically radiates down one or both of your legs. It results from the inflammation of the sciatic nerve in your lower back. The medical term for sciatica is lumbar radiculopathy: pinching of a nerve as it exits the spine.
Surgery is one of the treatment options for sciatica, but its not for everyone. Below are some important questions to consider before making your decision, addressed by orthopaedic surgeon Brian Neuman.
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When Is Sciatica Surgery Recommended As A Treatment
Surgery for sciatica is rarely recommended as a first treatment step. Thats because a combination of nonsurgical treatments can often be effective at healing pain. Theres no guarantee that nerve pain will go away or stay away after surgery. Surgery may provide more sciatic pain relief initially, but long-term pain relief is likely the same as nonsurgical treatments.
Surgery may make sense for you if the cause of your sciatica wont go away on its own. For example, you have a bony growth pressing down on your sciatic nerve. Doctors generally wont consider surgery unless youve had sciatic pain for at least six weeks. But back surgery may be recommended immediately if you have any of the following:
- Caudia equina syndrome an emergency situation where all the nerves in the lower back are suddenly and severely compressed, resulting in loss of motor and sensory function in the lower body
- Tumors that are pressing on the nerves in the lower back
- Sciatica in both legs
- An infection in the pelvis that cant be treated with medication
Which Treatments Have You Already Tried
There are several ways to manage sciatica without surgery, depending on the cause. They may include pain relief medications, steroid injections, physical therapy, aquatic therapy, meditation and nerve blocks, among others. What works for one person may not be as effective for someone else.
There are several types of doctors who treat sciatica pain. If you feel like you have exhausted your options with your primary care physician, consider making an appointment with a rehabilitation physician or a pain medicine specialist before calling a surgeon. Because every person experiences pain differently, it often takes working with the right specialist to find the combination of treatments that works for you.
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How Can I Tell The Difference Between Both
Back pain is often complicated by pain in the leg from one of the nerves being pinched in the back but supplying the leg. If there is discomfort in the lower back, central or unilateral, and this is accompanied by leg symptoms, such as pain in the leg, numbness, pins and needles or weakness, then the origin of the symptoms is likely the lower back. The cause is most likely degenerative or wear and tear change in the tissues, usually the vertebral disc.To test this at home you could lie on your back and ask a friend to raise the painful leg in the air to 90 degrees. This will likely cause leg pain if the cause is in the lower back. Alternatively, stand and try to bend forwards to touch the floor to test the symptom.
What Sciatica Pain Feels Like
Firsthow do you first realize you may have sciatica? What does sciatica pain feel like, and why is it happening to you?
Because the symptoms of sciatica usually appear in the buttocks and leg , many people mistakenly believe theyve sustained a leg injury. Actually, sciatica pain is a lower back issue. It originates in the largest nerve in the human body, the sciatic nerve. Also called the ischiadic nerve, the sciatic nerve begins in the lower back and runs behind the thigh to the knee, where it splits into the tibial and common peroneal nerves that continue down into the feet.
So when you feel a shooting pain or tingling, burning sensation somewhere in your leg, the actual source of these symptoms is some part of the sciatic nerve in the lower back or buttocks being pinched, damaged, or inflamed. For example, a vertebral disc may slide out of alignment, putting pressure on the nerve. Likewise, a back muscle may be swollen or inflamed from overexertion or injury, which can crowd the area around the spine and apply pressure.
The causes of sciatica pain can vary. Sports or accidents may contribute, as can degenerative spinal conditions. Pregnancy is also a very common cause.
Before treating your pain, your doctor will need to examine you and to determine the reason youre experiencing symptoms. Often, treating the underlying cause takes the pressure off the nerve and makes the symptoms disappear.
What are these symptoms, exactly?
- Pain anywhere along the leg
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What Are The Best Treatments For Sciatica
There are numerous ways to go about treating sciatica, depending on what specifically is causing the syndrome.
If the issue is the result of a herniated disc in the back, you may decide to go for the surgical option. Surgeons can cut out a portion of the disc, relieving the pressure on the nerve.
Other patients may decide to simply treat the symptoms with medication. There are a variety of medicinal options that can dull the pain or discomfort caused by nerve pain.
However, both surgery and medication pose serious risks to patients. Many people with sciatica are desperate to find a more risk-free solution to their nerve issues, and they may take drastic measures that can cause worse problems for them.
But there is good news! Exercise is one of the best, most research-backed solutions for sciatica symptoms. Lets take a look at some of the best stretches and movements that can help you overcome sciatica today!
No Magic Bullet For Sciatic Pain
When injured, compressed or irritated, a sciatic nerve causes significant discomfort, including shooting pain in typically one side of your bottom, unabating painful tingling, or numbness and weakness down the back of one or both legs. As many as 40% of adults experience sciatica in the course of a lifetime, experts have estimated. Unfortunately, without proper treatment, the condition can become chronic.
If youve experienced sciatic pain, youve probably spent hours searching the internet for ways to make it stop, only to encounter conflicting advice. Thats because sciatica is a symptom of numerous conditions that respond to different treatments. The most common causes originate from either nerve compression coming from the lumbar spine, or nerve impingement due to muscle tension in the buttocks, trapping the sciatic nerve.
With sciaticas varying causes, there isnt a single magic bullet for relief. However, the right corrective exercises, done regularly, can be effective in not only relieving sciatica but also preventing it. Read on for techniques to try to help you determine the cause of your pain and the best ways to alleviate it.
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Taming The Pain Of Sciatica: For Most People Time Heals And Less Is More
- By Steven J. Atlas, MD, MPH, Contributor
Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.
Fast Facts On Sciatica:
The main symptom is a shooting pain anywhere along the sciatic nerve from the lower back, through the buttock, and down the back of either leg.
Other common symptoms of sciatica include:
- numbness in the leg along the nerve
- tingling sensation in the feet and toes
This pain can range in severity and may be aggravated by sitting for long periods.
We will look at treatments for acute and chronic sciatica individually:
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Commonly Overlooked Sciatica Remedies
The constant soreness or intermittent discomfort of sciatica can range from a warm, wet feeling in your thigh to shooting and searing pain along your leg. The symptoms may strike anytime, so it is a smart idea to have a treatment plan in place.
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What Is The Efficacy Of Conservative Treatments For Sciatica
Conservative treatment for sciatica is primarily aimed at pain reduction, either by analgesics or by reducing pressure on the nerve root. A recent systematic review found that conservative treatments do not clearly improve the natural course of sciatica in most patients or reduce symptoms.14 Adequately informing patients about the causes and expected prognosis may be an important part of the management strategy. However, educating patients about sciatica has not been specifically investigated in randomised controlled trials.
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Origin: Hips And Buttocks
Weve already covered how tight hips lead to low back compensation, resulting in back pain. Tight hips can also cause sciatica due to tense muscles in the middle of the buttocks your piriformis muscles putting pressure on the sciatic nerve. This condition is known as piriformis syndrome. If piriformis syndrome is the cause of your sciatic symptoms, releasing tension in your hips will take pressure off the nerve to relieve your symptoms.
The seated hip-opening twist in this video is designed to stretch your piriformis. Try this exercise slowly and carefully, paying attention to your form as you rotate. The twist needs to initiate from your midback. Do not force it, as compensating from your low back could exacerbate any lumbar disc issues. Stop if your pain worsens.
If you feel your sciatic symptoms abate while practicing this exercise, do two to three rounds once or twice a day for a few days to see how you progress. You should also try the hip-opening reclined and seated figure-four exercises included in the full video at the top of this article.
Manual soft tissue techniques, such as massage and foam rolling, can also provide some symptom relief, but the only way to prevent sciatica is by proactively using corrective exercise to strengthen, mobilize and realign the areas of your body that were causing the issue in the first place.
Avoid Twisting Your Spine
You dont need to avoid isolated twisting motions but when you combine twisting motions with other movements like forward or side bending, this can aggravate the joints and muscles in your lower back, Dr. Singh says. A good example of what NOT to do is shovel snow or lift objects the wrong way, she says.
What to do instead: Learn the right way to lift objects. Make sure to do core strengthening exercises and stretch beforehand to improve your flexibility, range of motion, and prevent injury.
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How To Tell If Sciatica Is Triggering The Pain In Your Back
If you have pain that runs from your lower back through your buttock, down your leg and into your ankle or foot, it could be sciatica. Sciatica is a medical condition caused when your sciatic nerve gets irritated.
With sciatica, the pain is typically constant, but it can be aggravated by movement or activity, said R. John Hurlbert, MD, a neurosurgeon at Banner – University Medicine North in Tucson, AZ. Its common to have numbness and tingling that accompanies the pain.
Immediate Relief For Sciatica Pain
There is no one definitive answer to this question. However, some possible methods of immediate relief for sciatica pain include: ice/cold therapy, heat therapy, gentle stretching exercises, and over-the-counter pain medication.
The lower back, buttocks, and/or lower legs can experience intense pain with sciatica. This condition can cause pain so severe that it interferes with daily activities in addition to radiate pain down the back of the leg. Heat and ice therapy are commonly used to relieve sciatica in many cases. Inflammation is reduced by ice, while blood flow to the painful area is accelerated by heat. Heat and ice may also be beneficial in relieving painful muscle spasms associated with sciatica. When you have sciatica, you should try to sleep on the side of the pain area that is the most severe. When you put a pillow between your knees, you can make side sleeping easier. You can also alleviate pressure on your pelvic floor if your hips are properly aligned.
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Avoid Lifting Heavy Weights Before Warming Up
Certain exercises with heavy resistance can aggravate your sciatica unless you have sufficiently warmed up your muscles first, says Adeepa Singh, MD, attending physician in the Department of Physical Medicine & Rehabilitation at Montefiore Health System in New York City. Weighted deadlifts, weighted squats, and Olympic lifts can increase loading and strain on your lumbar spine, she explains. If you do train with weights, be sure to stretch beforehand to warm up your muscles.
What to do instead: Stretching and strengthening that start with gentle range of motion exercises, says Dr. Singh. These alleviate inflammation of your back muscles and help improve your mobility to prevent further injury, she says.
Use caution and warm up extensively before heavy deadlifts or other exercises that work the posterior chain.
Find Relief And Stay Active With These Simple Stretches And Strength Moves
For up to 40 percent of Americans, at one time or another, sciatica pain becomes a literal pain in the butt due to the sciatic nerve. Check the best acupuncture points for sciatica pain relief here
A blanket term for any radiating pain that originates from the sciatic nervethe longest nerve in the body, running from the low back through the buttocks and down the legssciatica symptoms occur when the nerve becomes pinched or aggravated.
Two of the most common causes of sciatic nerve pain include herniated discs and narrowing of the lumbar spine , explains Brian Jones, D.P.T., a physical therapist at the Hospital for Special Surgery in New York City.
A tight piriformis muscle or hamstring muscle that squeezes the sciatic nerve just a little too tight is another top culprit. If youre not familiar with the piriformis, its a small muscle thats tucked away behind the gluteus maximus.
Inactivity or lengthy bouts of sitting, along with obesity and type 2 diabetes, can also contribute to issues anywhere along the sciatic nerve.
Whatever the root cause, if youve been diagnosed with sciatica, you know the pain very well: Sometimes, its dull and achy. Other times, its sharp enough to take your breath away or for your leg to give out.
So it might have you thinking that an exercise program is a no-go for you. Think again. We have exercises that will help.
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Causes Of Pinched Nerve In Buttocks
In most cases, nerve pain in the buttocks and legs is caused by a condition known as sciatica, where the sciatic nerve that is near your spinal canal becomes pinched. In addition to the pain you are feeling, numbness, tingling, and weakness are also signs that sciatica is the cause of your pain. Sciatica itself is usually caused by a herniated disc or slipped disc.
Discs are rubber-like pads that sit between your vertebrae, which are the individual bones that make up your spine. When one of these discs pushes through its covering, this is known as a herniated disc, which can put pressure on nearby nerves, including the sciatic nerve. When the disc that becomes herniated is low in the spine, this can lead to the buttocks and leg pain you are experiencing. While discs can become herniated due to an injury, they are also more likely as you age and the discs begin to break down. A chiropractor in Atlanta can perform imaging to determine the health of your spinal discs.
When sciatica is not the cause of your buttocks nerve pain, there are a number of other conditions that may be at fault. Spinal stenosis, in which the spinal canal gradually narrows, is one possibility. Piriformis syndrome, Spondylolisthesis, and Deep gluteal syndrome are all other possibilities.
Sciatic Nerve Glide Exercise
This seated exercise can alleviate sciatica symptoms. You can use this exercise to help your sciatic nerve relax and desensitize.
Follow these steps to complete this exercise:
- Keep your other foot flat on the floor as you sit upright in a chair.
- Bring your toes towards you while slowly bending your ankle.
- Keep bending your ankle backward and forward, pointing your toes away from yourself and then towards your body.
- When the first stretch is tolerated, you can also do the nerve glide while bending your head forward and bringing your chin towards your chest.
- Repeat the exercise 15 to 20 times with one leg, and then with the other.
- Make sure to do three rounds a day for each leg.
Its worth noting that while home remedies like stretches for sciatica pain can help reduce sciatic nerve pain, but they dont fix the underlying cause. A thorough chiropractic review pinpoints the cause of the discomfort, offers medication to alleviate sciatica symptoms, and creates a personalized treatment plan to ensure you stay pain-free for the long haul.
Sciatic nerve pain can be so excruciating and debilitating that you dont even want to get off the couch. Reclining pigeon pose is a common yoga pose that works to open the hips. Sit on the floor with your legs stretched out straight in front of you, standing hamstring stretch. Standing hamstring stretch is a great way to stretch the hamstring muscles. Sciatica pain is triggered when vertebrae in the spine compress.
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