Do’s and Don’ts in Sciatica
Sciatica or lumbar radiculopathy is a collection of symptoms caused by compression or irritation of the nerve roots that form the Sciatic nerve. The Sciatic Nerve is formed by the nerve roots L4, L5, S1, S2, and S3 in the lower spine. The sciatic nerve is the largest nerve in the body and supplies the muscles and skin in the lower extremities.
The symptoms of Sciatica include a shooting, burning, or sharp pain in the buttocks, back of thighs/legs which may go down the foot and toes. The pain may be accompanied by feeling pins and needles in the legs. In severe compression, there may be a weakness in the legs and patients may complain of numbness.
Sciatica is most often caused by a prolapsed/slipped intervertebral disc. The prolapse of the soft tissue in between the vertebrae occurs commonly due to degenerative changes with age but may occur as a response to trauma/injury. The slipped disc may press upon the nerve roots and cause Sciatica. The symptoms usually get worse with bending forward, coughing, sneezing.
Sciatica may also result from an accidental fall or trauma. Spinal canal stenosis may produce symptoms of Sciatica due to narrowing of the canal where the nerve roots lie. The Sciatica symptoms as a result of spinal canal stenosis get worse with bending backward and may get relieved on bending forward.
Spondylolisthesis occurs due to the displacement of the vertebrae over one another. The displacement may make the neural foramen and the central canal narrow causing Sciatica symptoms. The slippage may also cause prolapse of the intervertebral disc.
Sciatica is largely diagnosed with a clinical examination by the physician. Most cases of Sciatica get better in a few weeks with conservative management. Some common do’s and don’ts for Sciatica are as follows.
- It is highly advised to stay active and continue your day to day activities. Staying inactive and bed rest may actually worsen the symptoms and delay the recovery. Only avoid activities that worsen the pain.
- Over the counter medications such as Tylenol and Ibuprofen may help provide pain relief and reduce inflammation. The medications should be discussed with your physician to see if there are any contraindications in your case.
- While laying down, keeping a cushion under the knee may help alleviate Sciatica symptoms to get a sound sleep. The slight bending of knees relieved the tension on the Sciatic nerve, thus reducing the irritation of the nerve. Similarly, when laying on your side, keeping a cushion between your knees helps with the pain.
- Heat therapy in the form of heating pads and warm bottles may be used. The heat helps to increase the blood flow and relax the muscles. The increased blood flow leads to a quicker recovery. However, heat should not be used in acute cases of Sciatica. The heating pad should not be used while sleeping and cotton or covering should be used with a warm bottle to prevent potential skin burns.
- Cold therapy is highly effective in acute cases of Sciatica. The cold therapy may be given using ice packs and should not be used for more than the recommended time to prevent cold burns. Cold therapy numbs the nerves carrying pain signals and reduces swelling around the irritated nerves.
- Light exercises to increase flexibility and improve the strength of muscles in the back and abdomen are advised. Regular exercise may lead to quicker recovery and prevent future episodes of Sciatica.
- Keeping a correct posture while sitting or standing is important to prevent excess stress on the spine. The lower spine bears the majority of the body weight from the upper body and excessive stress from improper position may lead to disc bulge or herniations.
- While lifting any object off the ground, it is advised to bend at your knees while keeping your back straight. Grab the object and stand up by straightening your knees.
- Complete bed rest is contraindicated even if normal activities cause slight mild pain. Similarly it is not advised to sit or lie down for long periods. Staying active leads to a faster recovery.
- It is advised to quit smoking as smoking delays recovery and may potentially lead to additional disc herniations.
- It is advised not to do any exercise or activity that worsens the pain. Continue the exercises that you are comfortable with and avoid using improper techniques.
Sciatica is mostly treated with conservative management. Corticosteroid injections in the form of epidural or transforaminal nerve root injections may be indicated in patients who did not benefit from conservative treatment. Surgery is indicated in patients with motor/sensory weakness and any signs of cauda equina syndrome.
Cauda equina syndrome can present as worsening numbness and weakness in the legs. The patients may complain of numbness in the saddle area. Patients often complain of inability to feel the toilet paper. Some patients may experience bladder or bowel incontinence. Cauda equina syndrome is treated with immediate surgical lumbar decompression.
Surgical treatment for sciatica involves lumbar decompression surgery and may involve lumbar fusion depending upon the cause of sciatica. Lumbar decompression surgery involves a lumbar laminectomy. Prolapsed intervertebral disc may be treated with microdiscectomy or endoscopic disc removal surgery.
My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.
I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.
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