Sciatica refers to the pain one experiences due to the irritation or compression of nerve roots contributing to formation of Sciatic nerve. The sciatic nerve is the longest and widest nerve in the body, running from the lower back, down to the back of each leg. The pain can occur in the lower back and spread to the hips, buttocks and leg. Sciatica generally affects one side of the body. There are numerous causes of irritation of the sciatic nerve and sciatica.
 
Some of them are:
 
1. Spinal Stenosis
The narrowing of the spinal canal caused by natural wear and tear of the vertebrae (individual bones in the spine protecting underlying nerves) of the spine is known as spinal stenosis. The narrowing may put pressure on the roots of the sciatic nerve, causing pain.
 
2. Herniated Disc
A disc is made up of cartilage and acts as a cushion between vertebrae, allowing flexibility of the spine. A herniated or slipped disc occurs when a disc is temporarily pushed out of place, putting pressure on the sciatic nerve.
 
3. Spondylolisthesis
It is a condition where one of the lower vertebrae slips forward over another. This also causes a collapse of the disc space between both, causing the nerve to get pinched. This may cause sciatica.
 
4. Piriformis Syndrome
Piriformis is a muscle found deep inside the buttocks, which connects the lower spine to the upper thighbone, running directly over the sciatic nerve. Spasming of this muscle can pressurize the sciatic nerve, triggering symptoms of sciatica.

5. Sacroilitis
Sacroillac joints are the place where the lower spine meets the pelvis and inflammation of one or both of these joints causes sacroilitis. This can give rise to symptoms of sciatica as it causes pain in the lower back, buttocks and legs.
 
6. Spinal tumors
Very rarely, tumors growing inside or along the spine may put pressure on the sciatic nerve.
 
7. Infection or injury
Muscle inflammation, infections, fractures or any other spinal injury may lead to irritation or compression of the sciatic nerve.
 
8. Pregnancy
Pregnant women may suffer from sciatica due to weight gain, expansion of the uterus or increased fluid retention or other changes occurring in the body, which put pressure on the sciatic nerve.
 
9. Other causes
Osteoarthritis and fractures caused by osteoporosis may also affect the sciatic nerve, producing symptoms of sciatica.

Top 9 Causes Of Sciatica Nerve Pain - You Need To Know About

Sciatica is a very common neuropathic pain that is caused by damage to the sciatic nerve, a large nerve that runs from the lower back region down the end of each leg. It is the largest single nerve in the body.
This condition affects around 4 out of 10 people at some point of their lives. The nature of the pain varies from a mild ache to a sharp stinging sensation and may cause feelings of numbness and extreme weakness.

Causes of sciatica
The causes for the onset of sciatica are numerous. Some of them are as follows:
-slipped lumbar disc
-muscle inflammation
-internal bleeding
-pregnancy
-obesity
-awkward sleeping position
-uncomfortable footwear
-spinal injury

How can physical therapy help?
There are many ways of treating sciatica, such as medication, acupuncture and surgery, which can provide relief. The most common and easy treatment method however is physical therapy. A progressive and controlled exercise routine that is specifically tailored to the nature of the condition in consultation with a physical therapist acts as an effective remedy in treating the problem. It alleviates pain and also eliminates the chances of relapse.

Physical therapy exercises used to treat sciatica are of many types. They are a combination of core strengthening, muscular stretching and aerobic conditioning routines, which aim at correcting the root of the problem.

The different types of exercises employed to treat sciatica include the following:
Strengthening exercises
These aim at strengthening the spinal column and the pelvic region, which includes the hips and buttocks. They help in making the muscles and ligaments in this region more robust and allow for improved flexibility and support. Lunges and squats are some of the examples.

Stretching exercises
These provide pain relief through improved agility and flexibility. The most important aspect of these routines is stretching and exercising the hamstring. Hamstring, stretches, calf stretches and tricep stretches are a part of stretching exercises.

Aerobic conditioning
These are cardiovascular exercises of low intensity, which provide pain relief through the release of endorphins and the facilitation of fluid and nutrient exchange. Examples of these are swimming and brisk walking.

Reduce Sciatica Pain With Physical Therapy

The hand is one of the most commonly used parts of our body and is susceptible to damage, wear and tear as well as injury. Pain in the hand can be attributed to numerous causes, including damage and other conditions that can affect the joints, cartilage, nerves and other parts of the hand.

Causes

De Quervain's tendinitis: This is also known as de Quervain's tendinosis. It causes pain on the thumb side of the wrist. The pain may grow slowly or suddenly. It can also spread to every part of the thumb and up the lower arm. On the off chance that you have de Quervain's tendinitis, you may experience pain while performing the following actions:

- Clenching The fist

- Handling on or holding objects

- Turning the wrist

Treatment for this includes the following:

- Wearing a prop to rest the thumb and wrist

- Calming drugs

- Cortisone infusions

Carpal tunnel disorder: This is common amongst the well-known nerve issues. It can cause pain in the following parts of the hand:

- Palm and a few fingers

- Wrist

- Lower arm


The treatment methods includes the following:

- Resting the hand and wrist

- Painkillers

- Wrist support

- Steroid infusions

- Active recuperation

- Breaks

Fracture: It's a crack or break in a bone that can cause immense pain in the hand. Other than this, the hand may also experience the following:

- Stiffness

- Swelling

- Loss of proper motion and movement

The kind of treatment depends on the kind of fracture. Braces are usually used for small fractures. Sticks, wires, or plates might be used to treat severe fractures. Likewise, surgery may also be recommended to set the broken bone properly.

Arthritis: This is a disease causing joint inflammation and stiffness of the joints. It causes the joints to lose the ligament that permits them to move easily against each other. This tears the ligament, giving rise to crippling pain and swelling.

In the hand, the regions where this regularly happens are as follows:

- Base of the thumb

- Center joint of one or more fingers

- End joint, which is nearest to the fingertip

The treatment depends on the seriousness of the injury and the following may be used:

- Painkillers

- Props for the fingers or wrist

- Heat

- Non-intrusive treatment

Trigger finger: Also known as stenosing tenosynovitis, this defect causes the fingers or the thumb to bend. It can be difficult, particularly when bowing or fixing the influenced finger or thumb.

Knobs may form on the influenced ligaments. Also, the sheath itself may thicken. In the long run, the ligament may get to be adhered when you attempt to fix a twisted finger or thumb.

Resting now and again while wearing a support may help resolve the issue. Over-the-counter torment pharmaceuticals can facilitate the agony. Corticosteroid infusions can mitigate side effects. Surgery might be recommended for extreme cases.

Causes of Common Hand Pain and How to Find Relief

Cubital Tunnel Syndrome is also known as Ulnar Neuropathy, a nerve compression syndrome where the Ulnar nerve, also known as the funny bone nerve, gets compressed due to heightened pressure or stretching. It can lead to numbness or a tingling sensation in little and ring fingers, sometimes pain in forearm and an overall weakness in the hand. Ulnar nerve is one of the three main nerves in the arm. It runs in a groove on the inner side of the elbow. Since it travels through a narrow space and has very little protective tissue, the nerve is quite vulnerable to compression.

Symptoms
The symptoms of this condition may range from mild to severe. Some of the mild symptoms include:

Numbness in little and ring finger as the fingers fall asleep
A tingling sensation, usually like the pinch of pins and needles in ring and little finger
Pain in forearm
Weakness in the hand
Some of the severe symptoms include:
Reduction in overall hand grip
A claw like deformity in hand
Wasting of muscles of the hand
Bending elbow over a long period of time like while using cell phone or during sleep can cause ulnar nerve compression. Resting the elbow for a long period over a hard surface can also cause an irritation of the nerve, leading to such symptoms. In some cases, the nerve snaps back and forth over a bony bump, resulting in an irritated nerve. People who undertake intense physical activity, especially using their arms, are more likely to develop this problem. Eg. baseball pitchers. Apart from this, people who have suffered from a dislocated elbow or have arthritis are also at risk.

Generally, doctors diagnose this condition through the symptoms. However, nerve tests are also conducted to check the level of nerve compression. Electromyography is a procedure in which electrodes are placed on the skin and muscles to measure muscle health. Determining muscle health and level of compression helps decide the mode of treatment. Generally, the symptoms of cubital tunnel syndrome are managed through a conservative treatment. However, in cases of severe compression, surgery can be considered as an option to relieve pressure, moving nerve to the front of the elbow or removing a part of the bone.

For mild cases, a towel or a protective cover for elbow is recommended. The towel should be wrapped around the elbow loosely. An elbow splint can be worn at night to protect the elbow from being bent for long time.

How can a physical therapist help?
A physiotherapist has an essential role to play in treatment of this syndrome. A therapist can help the patient to learn ways of avoiding pressure to the nerve. After surgery, with restrictions of movement, a therapist can help achieve smooth recovery and movement of the elbow. Your physical therapist will determine the activities that bring on your symptoms. The recommendations at this point will be to avoid those activities for a time. Remember, the nerve is irritated and at times swollen. If the irritation and swelling are reduced, the symptoms should resolve.

Cubital Tunnel Syndrome  - How Physiotherapy Can Help You?

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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