If we look at the human backbone or spine , we can see that the vertebrae rest upon one another similarly to a stack of cotton spools .
The spine is divided into regions. There are seven vertebrae in the cervical region (neck), twelve vertebrae in the thoracic region (upper back), and five vertebrae in the lumbar region (lower back) ..
Beneath the lumbar vertebrae are found the sacrum and the coccyx. It is the lower back or lumbar and sacral regions that concern us most.
Each vertebra has a solid part in front, the vertebral body, and a hole in the back .When lined up as in the spinal column, these holes form the spinal canal. This canal serves as a protected passageway for the bundle of nerves which extends from head to pelvis-the spinal .Special cartilages, called the discs, separate the vertebrae. The discs are located between the vertebral bodies just in front of the spinal cord . Each disc consists of a soft semi-fluid centre part, the nucleus, which is surrounded and held together by a cartilage ring, the annulus or annular ligament. The discs are similar to rubber washers and act as shock absorbers.
The are able to alter their shape, thus allowing movement of one vertebra on another and of the back as a whole.The vertebrae and discs are linked by a series of joints to form the lumbar spine or low back. Each joint is held together by its surrounding soft tissues-that is, a capsule reinforced by ligaments. Ligaments can be likened to the stays that hold a mast in place on a sailing ship. If a stay were to give way, the mast will likely fall when subjected to extra strains.
Muscles lie over one or more joints of the low back and may extend upward to the trunk and downward to the pelvis. At both ends each muscle changes into a tendon by which it attaches itself to different bones.
When a muscle contracts, it causes movement in one or more joints.Between each two vertebrae there is a small opening on either side through which a nerve leaves the spinal canal, the right and left spinal nerve . Amongst other tasks, the spinal nerves supply our muscles with power and our skin with sensation. In other words, it is through the nerves that we can move ourselves and feel temperature, pressure and pain. The nerves are really part of our alarm system: pain is the warning that some structure is about to be damaged or has already sustained some damage.In the lower part of the spine some of these nerves combine on each side to form the right and left sciatic nerves. The sciatic nerves service our legs, and when compressed or irritated, they may cause pain in the leg which often extends below the knee. This is then called sciatica.
Functions of the lumbar spine:
In animals that walk on all fours, the weight of their body is distributed evenly by DISC their four legs. Most of the time the spine is held in aIl more or less horizontal position and the compressive forces that exist in upright man do not occur.
In human beings, the spine is held in a more or vertical position, at least during waking and working hours. When we are upright, , lumbar spine bears the compressive weight of the body above it transmits this weight to the pelvis when sitting and to the feet when standing, walking and running. Thus the lumbar spine, providing flexible connection between the upper and lower half of the body protects the spinal cord and also has a greater function in weight bearing. In the evolution of the horizontal-spine posture of animals to the vertical-spine posture of man, the discs between the vertebrae have adapted to support heavier weights. In addition, the spinal column has developed a series of curves that ingeniously allow for better shock absorption and flexibility.
However, piriformis syndrome does not involve a radiculopathy - a disc extending beyond its usual location in the vertebral column that impinges or irritates the nerve root - so it is technically not sciatica.Instead, with piriformis syndrome, it is the piriformis muscle itself that irritates the sciatic nerve and causes sciatic pain.See What is Piriformis Syndrome?
The piriformis is a muscle located deep in the hip that runs in close proximity to the sciatic nerve. When the piriformis muscle becomes tight and/or inflamed, it can cause irritation of the sciatic nerve. This irritation leads to sciatica-like pain, tingling and numbness that run from the lower back, to the rear and sometimes down the leg and into the foot.
Supine piriformis stretches
Lie on the back with the legs flat. Pull the affected leg up toward the chest, holding the knee with the hand on the same side of the body and grasping the ankle with the other hand. Trying to lead with the ankle, pull the knee towards the opposite ankle until stretch is felt.
Do not force ankle or knee beyond stretch. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.Lie on the floor with the legs flat. Raise the affected leg and place that foot on the floor outside the opposite knee. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed , until stretch is felt. Do not force knee beyond stretch or to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.Lie on the floor with the affected leg crossed over the other leg at the knees and both legs bent. Gently pull the lower knee up towards the shoulder on the same side of the body until stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.
Typical features of any sciatica exercise program include:Core muscle strength. Many sciatica exercises serve to strengthen the abdominal and back muscles in order to provide more support for the back. Stretching exercises for sciatica target muscles that cause pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and are less likely to experience future episodes of pain.Specific diagnosis. Most exercise programs will be tailored to address the underlying cause of the patient's sciatic pain, such as a lumbar herniated disc or spinal stenosis. Doing the wrong type of exercise can worsen the sciatic pain, so it is important to get an accurate diagnosis prior to starting a program of sciatica exercises.
1. Piriformis Stretch: Laying on your back, place both feet flat on the floor with knees bent. Rest your right ankle over the left knee and pull the left thigh toward your chest.Hold stretch for 30 seconds. Repeat on the other side.Remember to keep the top foot flexed to protect your knee.
2. Seated Hip Stretch: While in a seated position, cross your right leg over your straightened left leg.Hug your right knee with your left arm, making sure to keep your back straight.Hold this stretch for 30-60 seconds, and then repeat on the opposite side.
3. Pigeon Pose Start in Downward-Facing Dog pose with your feet together: Draw your right knee forward and turn it out to the right so your right leg is bent and your left leg is extended straight behind you. Slowly lower both legs.Hold the position for five to ten breaths, then switch to the other side.
4. Self-Trigger Point Therapy: Performing self trigger-point therapy using a lacrosse or tennis ball can be very effective at delivering sciatica pain relief.All you have to do is find a painful spot in the glutes, place the ball at that location and then relax your body into the ball.Hold this position for 30-60 seconds or until you notice a significant reduction in pain. Move to the next painful spot. The total time spent on this exercise should be between 5-10 minutes.
Practicing these four exercises once or twice a day can definitely bring you much needed sciatica pain relief.
Ever faced a nagging low backache that won't go away? You could be dealing with sciatica. Sciatica or sciatic nerve pain is not a diagnosis, but is a symptom of a deeper problem. Sciatica is a pain in the lower limb and back due to compression or inflammation of nerves exiting from the lower vertebrae due to disc prolapse/herniation/ protrusion. Discs in vertebrae provide cushioning to the vertebrae during movement. The spinal nerves of the lower limb emerge from both sides and get inflammed due to disc prolapse. Inflammation can be controlled by depositing anti-inflammatory drugs with a non-surgical technique using fluroscopy, called spinal root block. If the disc prolapse is severe it can cause weakness of the lower limb or difficulty in controlling bladder/ bowel movement, surgery is performed to remove offending disc. Many times symptoms dissolve with nerve medications along with physical therapy.
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.
I Standing Hip Flexor Stretch
Your hip flexors are a group of muscles responsible for raising your knee to your chest and moving your leg from front to back and side to side. Tight hip flexors are a common cause of low back pain due to their anterior pull on the pelvis.You may want to find more than one hip flexor stretch to work this area from several angles.
1.Stand with your feet staggered, your right leg forward and left leg behind, and both knees bent.Place your hands on your hips,and keep your torso tall and shoulders squared.Move into the stretch by gently lowering your right knee, and raise your left arm overhead.
2.Put most of your weight on the front leg and open the back hip until you feel tension in the left thigh and right hip. Hold for 15 to 20 seconds and repeat on the opposite side.
II Seated Leg Crossover
The hip muscles are vital to keeping your pelvis and low back strong, flexible,and properly aligned. Weak or tight hip muscles can place more work on the back and lead to pain and injury. Master this basic stretch to build strong muscles in the hips and buttocks.
1.Sit with your left leg extended out in front and your right leg crossed over.Use your left arm to support the right leg. Keep your back tall, spine aligned, and core engaged.With an exhalation, rotate your torso to the right.
2. Press your right thigh toward your chest and feel the stretch in the outer right hip. Lengthen the spine on the inhalation and rotate slightly more with each exhalation.Hold for 20 to 30 seconds and repeat on the opposite side.
III Standing Piriformis Stretch
A tight piriformis can lead to pain in the lower back, buttocks, and leg. This can be caused by overdoing an activity such as running, or even sitting for an extended time. This stretch can be performed on a table or riser that’s close to the height of your hip. Try several positions until you find the one that’s best for you.
1.Lay your right leg as flat as possible on the riser, bending inward so your foot is pointed to the left. Your right knee should be in line with the foot and your hands rest on the riser.
2.Keeping your core tight and back flat,slowly bend forward at the hips. Move as far forward as is comfortable until you feel the stretch in the hips and buttocks.Hold for 15 to 20 seconds.
3.Contract your outer hip muscles by pressing the knee down toward the surface for 5 seconds relax and move further into the stretch. Repeat 2 or 3 times and switch legs.
I Glute and Piriformis Foam Roll
Foam rolling helps you make the best use of your time by massaging muscles,improving flexibility, and preventing injury. The muscles of the glutes and piriformis can greatly benefit from this combination, as they’re used frequently throughout the day.
1.Sit with your left legs lightly bent in front of you and your foot on the floor. Cross your right leg over with your right foot resting on your upper left leg, and place the foam roller under your hips.Put your hands on the floor behind you to prop up your upper body.
2.Roll up and down the right side of the hips and buttocks. If you feel a spot that’s tender or tight,spend more time working that particular area. Perform the rolling movement for 15 to 30 seconds and repeat on the opposite side.
II Hip Flexor Foam Roll
Targeting the hip flexor muscles utilizing the foam roller is a great way to alleviate tightness and help prevent injury. These muscles are often hard to isolate when strengthening and stretching, but are used readily throughout the day.
1. Lie on your left side with your left leg extended on the floor and your right leg crossed over.Place the foam roller under your outer left hip. Keep your arms in front of you to prop your upper body up off the floor
2. Roll up and down the front and outer part of the left hip. If you feel a spot that’s tender or tight,spend more time working that area. Perform the rolling movement for 15 to 30 seconds and repeat on the opposite side.
III Lateral Leg Swing
Many sports require the ability to complete quick lateral moves for success.Use this dynamic stretch to warm up the hip muscles that perform these moves to maximize performance and minimize injury.
1.Lean into a wall or sturdy object for support.Keep your core engaged and back straight. Put your weight on the back leg with a slight bend in the knee.Draw in your abs and raise your right leg.Keeping a bend at the right knee, swing your right leg inward at the hip.
2.Then bring the knee outward across your body, and back to the start position in a continuous sequence. Do this 8 to 12 times,and then repeat using the other leg.
I Advanced Piriformis Stretch
An excellent stretch for the entire body, this pose especially targets the hips and piriformis muscle but is only for those who have sufficient flexibility.When performed properly, this stretch can help prevent injury and relieve pain through increased range of motion
1.Keeping your torso upright, extend your left leg behind and bend your right leg inward across the front of your body.Lower your torso to the floor until you feel the stretch in the hips and glutes.
2.Keep your lower body in the start position with your arms out in front for support.Hold the stretch for 20 to 30 seconds and repeat on the opposite side.
II IT Band and Glute Rope Stretch
If you’re prone to IT band syndrome or runner’s knee, this is a good stretch for you. When this band gets tight, bad things can happen to your gait, not to mention a lot of pain and suffering.
1.Lie on your back with both legs extended and the rope wrapped around the mid sole of your right foot. Hold both sides of the rope in your left hand, and extend your right arm to the side.
2.Keeping your right leg extended, pull the rope to the left side to bring the right leg across the body until you feel a stretch in the outer leg. Your right arm and left leg shouldn’t leave the floor. Hold for 15 to 20 seconds and repeat on the opposite side.
III Adductor Rope Stretch
The hip adductors play a big role in everyday movements such as walking and sitting down. They provide stability to the hip joint, allowing better performance in physical activities. Having good range of motion in these muscles is critical for an active lifestyle.
1. Lie fully extended on your back with the rope around the middle of the right foot. Take both ends of the rope over the inside of the ankle and wrap it around to the outside of the calf.Hold both ends of the rope in your right hand.
2.Pull out to the right as far as is comfortable, feeling the stretch along the inside of the right leg. Hold for 15 to 20 seconds and repeat on the opposite side.
Also called as slipdisc pain or sciatica may affect your lumbar or cervical or throracic spine. But most common is l4 5and l5-s1 level or c5-6 level.
Most of painful condition of pertaining to your spine due to bulge, prolapse (protrusion), extrusion, sequestration. In with all condition nucleus pulposus come out from it originally site. Causing pressure over traversing or exiting nerve roots. Most of time patient getting treatment for of slipdisc or sciatica etc without any radiological evidence.
What causes pivd?
*unwanted prolonged exposure to sitting posture
*acute forward flexion
*unwanted weight lifting
*trauma or accident
*keep on exercise for chronic pain condition
What is symptoms?
Paresthesia, numbness, tingling sensation, burning sensation, spasms in thigh's and calf muscles, radiating pain upto knee or foot. Unable to sitting or standing for long hours, bowl or bladder incontinence, motor power affected
What are basic investigation?
X-rays only show alignment and fracture and displacement of vertebrae,
Mri scan shows all soft and hard structure of spine-all disc, nerve, ligaments, joint, vessel and muscles etc can be seen in perfect way
Emg, ncv, neurometry etc
There's two types of options for your spine pain, one is conservative treatment with bed rest, exercises and medicine. But upto certain duration 6week to 6month you can try with. If no red flag sign like loss of motor power. Or bowl bladder involvement should take opinion from surgeon.
Second way is surgical procedure-like conventional open surgery or endoscopic minimal invasive techniques choice of your surgeon. As common man had reservation about spine surgery as thoughts to be risky, chance of bowl and bladder incontinence, or power loss of limbs, because in conventional surgery a small percentage of cases use to face failed back surgery syndrome. Where such complaint were invitable. Big skin incision. Long bed rest. Long hospital stays. Even with expert surgeon these complications were enviably there.
Secondly there is minimal invasive like pin hole stitchless techniques are now choice for spine disc pain problem. Day care surgery with out any blood loss. 24hrs hospital stay, no incision like conventional surgery. Done under local anaesthesia and sedation. Patient can resume daily activities same day. Can go to work with safety measures after 2weeks. And safety precautions to be followed for strengthening your back spine. Now like day care surgery endoscopic discectomy for slipdisc pain can be managed in our hands. All surgery can be seen even by patients on screen, what exactly happened to your spine and disc material.
Post procedure- follow up-
Regular physiotherapy and rehabilitation services is mandatory for strengthening of your spine.
Prognosis-success of procedure is 95%with all precautions and safety measures.