Dr. Jitender Singh

Exercises for Sciatic pain from Piriformis Syndrome
Sciatica is a symptom. It consists of leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible.

The pain might be worse when you sit, sneeze, or cough. Sciatica can occur suddenly or it can develop gradually.

Symptoms:

• Pain in the rear or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.

For some people, the pain from sciatica can be severe and debilitating might include the inability to bend your knee or move your foot and toes.. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.

Causes of Sciatic Pain:

• Slipped Disc: In majority of cases sciatica is caused by a herniated or "slipped" disc. This is when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.
• Spondylolisthesis (a condition in which one vertebra slips forward over another one)
• Other causes include spinal stenosis (narrowing of the nerve passages in the spine), a spinal injury or infection, or a growth within the spine (such as a tumor).
• Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
• Piriformis Syndrome: It is referred as neuritis of branches of the sciatic nerve caused by pressure of an injured or irritated piriformis muscle. Symptoms associated with piriformis syndrome typically consist of buttock pain that radiates into the hip, posterior aspect of the thigh, and the proximal portion of the lower leg.
• Piriformis syndrome typically does not result in neurological deficits such as decreased deep tendon reflexes and myotomal weakness.

Diagnosis:
Sciatica is diagnosed with a medical history and physical exam. Sometimes X-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.

• X-ray- to look for fractures in the spine
• Magnetic resonance imaging (MRI) or computed tomography (CT) scan - to create images of the structures of the back
• Nerve conduction velocity studies/electromyography - to examine how well electrical impulses travel through the sciatic nerve
• Myelogram using dye injected between the vertebrae - to determine if a vertebra or disc is causing the pain

Treatment:
Primary treatment consists of self-care and non-surgical strategies. The aim is to correct the underlying problem, restore function and prevent re-occurrence.

• Self-Care: Sciatica may resolve with rest, ice or heat, massage, pain relievers and gentle stretches. Muscle inflammation and pain can be reduced by application of an icepack for 20 minutes several times a day during the initial 2-3 days. Thereafter a hot pad may be applied to relax muscles. If the self-care exercises aren’t working within the first couple of days you must consult your doctor.
• Medication: Over the counter Nonsteroidal anti-inflammatory drugs (NSAIDs) can bring pain relief. Muscle relaxants may be prescribed for spasms.
• Physiotherapy: A normal schedule is recommended physical therapy can help you return to full activity as soon as possible and prevent re-injury. Physiotherapists will show you proper lifting techniques / postures, walking techniques, exercises to stretch and strengthen your back muscles.
• Massage, ultrasound, diathermy, heat and traction may also be recommended for some time.

1. What is a Pacemaker? 

Pacemaker is a small battery operated device that can be used to keep the heart beating when the normal electrical conduction of heart becomes diseased. It consists of one pulse generator which contains the battery as well as software and is implanted under muscle or skin under the shoulder. And wires which are connected to the heart and act as electrical wires for conduction. 

2. What are the types of pacemakers? 
There are many types of pacemakers available today. 

1. Temporary Pacemakers - these are used temporarily when there is a reversible cause of disease or as a bridge before the permanent pacemaker can be implanted. 
2. Permanent pacemakers - these are small devices which can be implanted permanently in the body by making a small cut in the body. They are available in many different types. 
3. Capsules pacemakers - These are small capsule shaped devices which can be put in heart and control the conduction from there. 

3. What are the different types of permanent pacemakers? 

Many varieties of Permanent pacemakers are available in the market and are advised depending on the type of disease. The cost varies depending on the type and models. Single chamber pacemakers - which pace only one chamber of the heart. requiring only one wire. Dual chamber pacemakers - which pace both chambers of the heart and require two wires. MRI compatible version of all these pacemakers are now available as well. 

4. How is pacemaker implanted in the body? 

The procedure is done with local anaesthesia, in a cath-lab and can take 2-3 hrs. A small cut is put under the shoulder and the device is put beneath the muscle plane. The cut is then stitched and dressing is done. The stitches are cut or dissolve (if dissolvable sutures are used) in 5-10 days and the patient is discharged the next day after implantation on some pain killers and antibiotics. A small 5 cm scar can be seen at the implant site, and in case sutures are done by a plastic surgeon even that may not be visible. 

5. Can I do normal activities after getting a pacemaker implanted?

Yes. The patient can walk and travel right from the next day after the procedure. There are few precautions that are advised for a month and after that you can do all of your routine normal activities. You can use electrical equipments, microwaves, phones etc. In fact people play tennis, do swimming and other sports after pacemaker. You will be provided with a list of precautions post procedure. And will need to get routine follow up every 3-6 months with your cardiologist for checking of device parameters and battery life. 

When the battery of device becomes low the cardiologist will advice you for a pulse generator replacement. In case you have a concern or query you can always consult an expert & get answers to your questions!