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

The sciatic nerve is the longest nerve in the human body. It runs from the lower back, through the buttocks, your hamstrings and into the lower leg. Sciatica means pain in the leg, numbness or any kind of weakness in the lower back. There can be many reasons for a leg pain such as an injury to the leg or it can be due to the main nerve which travels in the lower back. Many times, it is not diagnosed properly and hence it will take a lot of time to respond to the treatment or in some cases, it may not respond at all. 

Symptoms of Sciatica: 

You will experience pain in the lower back only on one side of the body. 
The pain continues from the lower back to the sciatic nerve. 
Rarely, you will see the pain on both sides of the body or buttocks. 
The pain is very sharp. 
In some cases, the patient may experience a needles or pins sensation in the leg and in some cases, it is weakness or numbness in the lower back. 
The pain gets so severe that you will not be able to walk or even stand. 
If you have lower back pain combined with leg pain, then lower back pain is not going to be as severe as the leg pain. With the help of the symptoms, your doctor will be able to diagnose sciatica but in order to know the exact cause and origin of this pain, you will have to undergo other tests and examinations. 
Physiotherapy for Sciatica: 
There are many surgical treatments available for sciatica, but it is always good to go for non-surgical treatments. So you can opt for physiotherapy. You will be able to see better and long lasting results with this treatment. As it involves a thorough assessment of it on which the treatment protocol is laid. 

Physiotherapy involves four phases: 

Pain relief 
Restoration of normal flexibility 
Restoration of full functionality 
Prevention of recurrence 
In sciatica, it is due to unbearable pain, you seek treatment. So that has to be treated initially. When you can see that the pain is under control, then the physiotherapist will start working on the range of motion for your joints. The muscle tension will be reduced and muscle strength will be improved. In the third stage, your physiotherapist will start working on restoring the normal function of your body, especially your legs and your lower back. In the last stage, the physiotherapist will help you with some exercises that will stop its recurrence. Usually, sciatica will return after some time but taking a little care at the early stage can prevent it.

Physiotherapy For Sciatica - Why Is It The Best Treatment Option?

Acupressure can prove to be extremely effective if you are looking for non-medicinal solutions to treat musculoskeletal problems, such as back pain, sports injuries, arthritis, etc. Acupressure is the application of putting firm pressure on the areas on the body which are swollen, agitated or tense by massaging the acupoints (specific points in the body). Acupressure believes that relieving these areas of pressure reduces the pain.

Here are some musculoskeletal problems that can be healed by acupressure:

    Arthritis: Those who seek acupressure as an alternative treatment for pain are mostly suffering from arthritis (a disease characterised by chronic joint inflammation and cartilage degeneration). Acupressure applies pressure on the inflamed joints.
    Back pain: Back pain is a common problem that can affect anyone irrespective of his or her age. Acupressure acts to relieve the points where the muscles are too tense and helps to tone or support the muscles which have become weak with disuse.
    Chronic pain: Unrelenting pain can stem from many causes. Acupressure focuses on the pain and the pain signals when treating chronic pain. The acupoint of the pain and the nerves are gently massaged to relieve the pain.
    Fibromyalgia: Traumatic injury to the soft tissue, emotional trauma or severe illness can cause fibromyalgia. It is non-inflammatory in nature and often leads to Chronic Fatigue Syndrome (a troublesome disorder with symptoms of deep fatigue, sleeping problems, pain, etc.). Acupressure can greatly improve the fatigue and sleeplessness that fibromyalgia causes.
    Tendonitis: The tendon connects the tissue to the bone, and tendonitis is the condition when the tendon is inflamed. Acupressure helps in reducing the inflammation and easing mobility restrictions.
    Sciatica: The sciatic nerve is the longest nerve in the body, stretching from the lower spine to the back of the foot. So when this nerve is agitated, pain radiates from the lower back to the foot. This condition is called sciatica. The acupoints in sciatica are the lower back and the hip. Acupressure effectively loosens the muscles in these regions and reduces inflammation.
    Sports injuries: Strains and sprains are common sports injuries, which mostly affect athletes. Acupressure has anti-inflammatory benefits that can help heal severely injured tendons, ligaments or muscle. Acupressure also plays a huge role in restoring and retraining the body, especially if you are an athlete and play high-demand sports.
    Carpel Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the pressure increases on the median nerve as it goes through the carpal tunnel, and this causes wrist pain. Acupressure involves the use of directed pressure to specific acupuncture points on the surface of the body.
    Insomnia: Insomnia is a sleep disorder. The Acupressure Points between your heel and anklebones (on both sides) have traditionally been used to relieve and prevent insomnia.
    Migraines: Acupuncture is used to effectively treat primary headaches, namely tension and migraine, which are the most common.

Acupressure: The Non Medicinal Solution to Musculoskeletal Problems

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!

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!

Sciatica is a neurological condition that mainly arises due to problems in the sciatic nerve. The sciatic nerve is believed to be the largest nerve originating from the spinal nerves L4 to S3. It extends downward from the lower spine into the back of each leg (thighs) right down to the foot. The sciatic nerve acts as a connecting link between the spinal cord and the foot and the leg muscles. People with sciatica often experience a tingling sensation along with a shooting pain radiates downwards from the lower back (mostly the lumbar region) to the back of one of the legs. Some may also experience the sciatic pain down both the legs (rare).

Types of Sciatic Pain:

Sciatica that affects a person can be of two types depending on the severity of the associated symptoms

Acute sciatic pain: In this case, a person experiences a sudden radiating pain which often heals by itself within a week or two. More than often, the pain is triggered by an injury to the spinal joints, nerves, or the disc.
Chronic sciatic pain: This is a more serious condition where the pain may linger for long, often more than three months. The chronic sciatic pain may affect a person with severe Arthritis and nerve injury and damage.
Symptoms associated with Sciatica:

One of the characteristic symptoms of Sciatica is a shooting pain that radiates from the lower back (often the lumbar) to the back of one (or both) of the legs.
In some, the sciatic pain may result in weakness and a tingling sensation down the affected leg.
A person with sciatica may find it difficult to move his/her foot and legs (restricts their movement).
Some people may experience a shooting pain even while they are in a sitting position. In some others, the pain may be at its worst when a person is in a standing position.
Sciatica can also trigger a hip pain.
What triggers sciatica and the associated symptoms?

The disc is a protective shield that prevents any damage or injury to the vertebrae. A degenerative disc problem can interfere with the normal functioning of the disc triggering sciatica.
Spondylolisthesis: In Spondylolisthesis, also known as a Slip Disc, a bone (mostly in the lumbar region) slips over the bone which is located just below it. People with prolonged and untreated spondylolisthesis are often known to suffer from sciatica.
The sciatic pain can also affect a woman during her pregnancy.
Lumbar spinal stenosis: This condition is is characterized by the spinal canal narrowing down in the lumbar region. Lumbar spinal stenosis exerts pressure on the sciatic nerve, giving rise to sciatica.
A muscular strain or spasm in the buttocks can also be a contributing factor.
Proper management and prevention for sciatica are possible. One should be alert and consult a doctor in case they experience the associated symptoms or any discomfort.

Sciatica Pain - What Can Trigger It?

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