Sciatica

Sciatica

Sciatica refers to pain in a very large nerve which is called the sciatic nerve.  This nerve is not a fine filament or thread.  It can be as thick as 2 fingers in places.  It is made up of contributing nerve roots from several low back levels.  It can be squeezed by structures in the low back that compromise its ability to move blood and nutrients within its numerous nerve cells.

Herniated Disc, Bulging Disc

If one or more discs have a significant alteration in shape, the sciatic nerve may be pinched causing pain.  If a relatively young person, say into their mid 30’s, herniates the “cottage cheese ” like inner part of the disc out into the space of the spinal canal, a nerve root can get squeezed and irritated by the different pH of the disc’s central material.

If one or more discs have a significant alteration in shape, the sciatic nerve may be pinched causing pain.  If a relatively young person, say into their mid 30’s, herniates the “cottage cheese ” like inner part of the disc out into the space of the spinal canal, a nerve root can get squeezed and irritated by the different pH of the disc’s central material.

Depending on where and how much herniated disc is in the space of the spinal canal can make the difference between surgical and non-surgical recovery options.

Facet joints

Other structures in the low back can change shape over time.  The small joints on the vertebrae that help control and guide movement are called facet joints.  Over time and with accumulated injuries, poor  posture, diseases, and aging, the bones thicken and grow cauliflower like extra bumps and shapes.  This bone overgrowth can significantly contribute to restricting the space for the nerve roots nearby.

Another cause of sciatica is a slippage of one vertebra forward or backwards over its neighbor.  This will cause narrowing of the space for nerves that are joining up into the sciatic nerve. This is a called a spondylolithesis.

Nerve pain is particularily painful.  It can be sharp, burning, shooting, electric like, or tingling. Sometimes its there no matter what position you’re in and sometimes its only when you arch back or bend forward.

Treatment

Physical Therapy treatment is directed at relieving pressure on the nerve, decreasing swelling in the area, teaching recovery positions that allow circulation to improve and pressure within the discs to lessen.  The areas around the painful area will usually be stiff.  Restoration of motion even if its small movements, will help improve the pain.

If posture was a cause of the problem, it needs to be addressed so there can be better long term recovery. Just telling yourself to sit up isn’t effective.  The unconscious parts of your brain shape your sitting and standing patterns.  Its hard to make much lasting change by conscious control only.  There is a lot of subtle stretching and motion restoration that needs to occur to help a person significantly improve posture. Usually you will need direct hands on help for this.

Medication can help with sciatica. Over the counter anti-inflammatant medicines can be carefully used. Sometimes having an anti-inflammation medicine put right into the spinal canal where it can directly help calm the nerves is highly beneficial.  This is called a spinal epidural. Some pain management doctors specialize in this.

If non surgical measures don’t provide a good enough or long enough period of relief, surgery may provide better comfort.  Most people try a long stretch of conservative treatment before deciding they are ready for surgery.