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

Ever faced a nagging low back ache that just won't quit? You could be dealing with sciatica. Sciatica or sciatic nerve pain is not a diagnosis in itself, but is a symptom of a deeper problem. Conditions that trigger sciatica include degenerative discs, spinal stenosis, a herniated disc in the lumbar region or   spondylolisthesis. Whether your sciatica pain is persistent or sporadic, it can make routine tasks difficult to perform. The good news is that there are a number of remedies to ease this pain and improve the health of your spine.

1. Hot and cold therapy: Sciatic pain that extends down to the thighs can be relieved by alternating between a heat pack and an ice pack. Each pack can be applied for about 20 minutes at a stretch every two hours. However, this does not treat the sciatic nerve itself.

2. Pain medications and steroid injections: Over the counter pain medication like ibuprofen or muscle relaxants can help alleviate pain and reduce inflammation. In chronic cases, epidural steroid injections may also be prescribed to address the inflammation and pain. Pain relief provided by medication and steroid injections can last for a few days or a few months depending on the person.

3. Yoga: Sciatica patients looking for long term relief often turn towards alternative forms of treatment like yoga. Yoga helps strengthen muscles, increases flexibility and improves posture. This is more beneficial towards preventing sciatica problems from arising than treating ongoing sciatic pain. When practicing yoga with a sciatica problem, it is very important to understand your body's limitations and not over extend your back muscles.

4. Massage: A massage that treats sciatic pain is very different from the usual massage you may get at a spa. A massage to relieve sciatic pain involves putting pressure on the inflamed part of the back and the piriformis muscle. This is the muscle that sits over the sciatic nerve and triggers sciatic pain. In most cases, 3 to 4 massage sessions at intervals of 7 to 10 days can have effective results on sciatic pain.

5. Physical therapy: Sciatica patients often find the slightest movement extremely painful. While lying in a bad is tempting, it can actually worsen the pain. Exercise increases blood flow to the spine and helps flush out toxins. Going for a walk, light aerobics or swimming are ideal ways for a sciatica patient to exercise.

6. Chiropractic manipulation: This involves realigning the spinal column and is an effective way of treating underlying conditions that trigger sciatic pain. These spinal adjustments should only be performed by licensed chiropractors or osteopathic physicians.

Treatments for Sciatica Pain

Sciatica, which is pain along the huge sciatic nerve that runs through the lower back to the back of each leg, can bring about serious, weakening pain. The term sciatica depicts indications of leg pain along with potential shivering, weakness, or numbness that starts in the lower back and goes through the butt cheek and down the vast sciatic nerve in the back of every leg. However, here are some top ways to get pain relief from sciatica:

1. Chiropractic/manual control
Spinal adjustment and manual control performed by properly trained health experts, for example, chiropractors and osteopathic doctors, are centered around giving better spinal cord alignment. These are intended to address various basic conditions, which can bring about sciatic nerve pain.

2. Acupuncture
This practice is based on the goal of achieving or keeping up the strength through an open stream of energy by certain pathways in the body. Hair-thin needles (which are generally not felt) are embedded into the skin, close to the zone of pain.

3. Subjective behavior therapy
This treatment for taking control and evolving self-defeating behaviors can be useful in overseeing sciatica pain, especially in the short term. Sessions with an advisor might be face-to-face or on the web.

4. Massage treatment
Certain types of back rub treatments have proven to have various advantages for back pain, including expanded blood flow, muscle relaxing, and release of endorphins (the body's regular pain relievers).

5. Strengthening activities
Many activities can strengthen the spinal cord and the surrounding muscles, tendons, and ligaments. The greater part of these back exercises center around the lower back, as well as the (stomach) muscles and gluteus (butt cheek) and hip muscles.

6. Stretching
Stretching is usually prescribed to mitigate sciatic pain. Stretching for sciatica is intended to target muscles that cause pain when they are tight and unyielding. Hamstring stretch is very often an essential part of a sciatica exercise program. As part of everyday exercises, many people do not stretch these muscles, which extend out from the pelvis to the knee in the back of the thigh.

7. Low-impact aerobic activity
Some types of low-impact cardiovascular workout, for example, walking, swimming, or pool therapy, are generally parts of the recovery, as high-impact action increases the exchange of liquids and nutrients to make a better environment for healing.

8. Micro-disectomy
In situations where the sciatica pain is because of a lumbar disk herniation, a microdiscectomy is the most widely recognized surgical approach. It is an open surgery done using magnification techniques. In this surgery, just the bit of the herniated disk that is squeezing the nerve is evacuated. Whatever is left of the plate is left in place.

Top Eight Ways To Get Pain Relief From Sciatica!

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatica i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication. Ayurvedic herbs that improve the symptoms of Sciatica are:

1. Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.
2. Guggul is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.
3. Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 
4. Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 
5. Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.
6. Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.
7. Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica.

Ayurvedic Treatment of Sciatica

Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc.

When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed.

When should you consider undergoing surgery for sciatica?
Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following:

Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock
Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud.
When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy
When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough.
When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues
It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain.
In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc.
In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention.
Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.

Sciatica - When Do You Have To Go For Surgery?

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