Osteopathy: Sciatica and Herniated Disc

Herniated Lumbar Disc and Sciatica

Your lower back is known as the lumbar spine, and consists of 5 vertebrae stacked on top of each other. In between each vertebra is a disc; it is like a cushion that absorbs force, helps with movement, and separates each vertebra. As the disc degenerates and wears down, the inner core can end up leaking out through the outer part of the disc, which is known as a herniated disc. The disc can bulge and press onto a nerve root. The nerves run directly down the legs, so any type of pinched nerve in the spine can cause pain to radiate through the buttocks and down the legs. A herniated disc is often called similar names, such as a prolapsed disc, slipped disc, or a bulging disc, and all of these terms are inter-changeable. Herniated Lumbar Disc Anatomy Whenever walking or running, these shock absorbers prevent your vertebrae from bumping into one another. They work alongside the facet joints to aid the spine in movement, twisting and bending. These discs are round and flat, roughly 9-11mm in thickness. Two components make up the discs. The annulus fibrosus is a tough, flexible outer ring of the disc. It works to connect the vertebrae together. The nucleus pulposus is the soft, jelly-like venter of the annulus, which provides the disc with its shockabsorbing capabilities. How to Treat a Herniated Lumbar Disc:

1. Therapy Physical therapists will be able to show you the proper exercises and positions that are designed to help minimize the pain accompanying a herniated disc. They will likely perform treatment to your back to improve mobility, and reduce the pressure of the disc on the nerve. As therapy progresses, you should notice the leg pains reducing or the leg pain coming up the leg (i.e. more towards the buttock or back). As your pain diminishes, therapy will help to advance you into a rehab program that consists of core stability and strengthening exercises to maximize the health of your back and protect against additional injuries. Chiropractors, osteopaths, physiotherapists and sports related manual therapists are all capable of successfully treating herniated discs.

2. Cortisone Injections Inflammation suppressing corticosteroids given in an injection directly into the affected area will help to provide you with some degree of relief. It helps to reduce the inflammation around the nerve root. This reduces swelling and can reduce the compression on the nerve, giving you relief from back pain and leg pain. If the leg pains are severe, the consultant might wish to do an epidural which is a steroid and anesthetic placed in the epidural space next to the spinal cord, and this can significantly reduce leg pain.

3. Medication If the pain is mild to moderate, you might find relief with an over-the-counter medication. It will often help to reduce inflammation and pain, but make sure to check on how much you should be taking at any given time. Discuss dosage and length of time to take the medication with your doctor, GP, or pharmacist.

4. Muscle Relaxant and Osteopathy If you are suffering with back and limb spasms, a muscle relaxant might be provided to help ease the pain. One such medication is diazepam. Using these meds should be short term only.

5. Stop Aggravating Your Back It sounds simple enough right? Well then listen to your body and look closely at things you are doing during the day that might be aggravating your back. Typical aggravating factors include repetitive forward bending (like cleaning your teeth, making the bed, reaching down or bending over low surfaces to work or clean). Reduce the length of time you sit and get up regularly to loosen up your back.

6. Surgery Only a small number of individuals with a herniated disc will end up needing surgery as many respond well to therapy, but this often depends on the severity of the disc prolapse (i.e. how much disc material has come out, and how badly it is pinching the nerve). If you are having trouble walking or standing, the symptoms have lasted more than six weeks or a disc fragment becomes lodged in the canal, you might not have any other choice beyond surgery. In many instances, the part of the disc protruding can be removed and the rest can remain in-tact. In rare instances, the entire disc has to be removed. The disc is replaced with an implant.

Tips:

 Individuals who are between the ages of 35 and 65 tend to be more prone to developing a herniated disc in the back, which is often attributed to age-related degeneration.

 If you have excess body weight, losing it will help improve your back condition.

 Try to avoid working in a job where you are placing a lot of undue stress on the back, especially forward bending.

 Maintaining proper posture will help to alleviate pressure on the discs and spine. Keeping the back straight, especially when sitting for an extended period of time, will help to alleviate undue pressure on the spine.

Sciatica is nerve pain that travels down the back of the leg. It is less commonly known as either sciatic neuritis, lumbar radiculopathy or sciatic neuralgia. This is a particular set of symptoms that includes pain and is caused by an irritation or compression of the sciatic nerve. Some of the symptoms can include pain in the lower back and/or buttocks as well as pain, weakness and/or numbness of varied parts of the foot and leg. There are times when tingling or pins and needles are felt in the foot or leg. In rare cases, patients report a burning pain or a spider type tickle in the leg. Generally this occurs only on one side and it may or may not radiate beyond the knee.

Sciatica Anatomy The sciatic nerve happens to be the longest and largest nerve in the body. At the point where it is the largest, it has the width of a thumb. The sciatic nerve begins in the lower back as the nerve roots leave the spinal cord through the gaps in between the bones in the lower (lumbar) spine. The nerve then extends the entire length of the leg and into the foot. The sciatic nerve is made up of five nerve roots, which start at the bottom two lower vertebrae. The sciatic nerve travels down the back of the leg and then it branches out to different parts of the leg providing sensory and motor functions along the way all the way down to the foot.

Common Causes of Sciatica  Disc prolapse – a “slipped disc” is one of the most common causes of sciatica. As the disc bulges or prolapses backwards, it can touch the sciatic nerve sending pain down the back of the leg.

 Spondylolisthesis – this is a slippage in the vertebrae (usually a slippage forwards) which can pinch the sciatic nerve or narrow the spinal canal.

 Piriformis syndrome – the sciatic nerve can become trapped by the piriformis syndrome if the piriformis (buttock) muscle becomes too tight.

 Space occupying lesion – anything that occupies a space around the nerve could cause sciatica, such as a tumour or cyst. This is less common that the three causes above.

How to Treat Sciatica: There are methods to treat sciatica at home. However, because this could also be a symptoms for a different medical condition, you should always get this checked out. In some cases of sciatica, o treatment at all is necessary and the condition will go away all by itself.

 In the short term, you could take an anti-inflammatory medicine such as ibuprofen or aspirin. You may also want to treat the area with ice and heat. If treating in this method you should apply ice to the injured site for 5 – 10 minutes at a time three to five times per day. Do that for the first 2 or 3 days and then switch to heat.

 Reduce your activity for a few days and then begin to slowly work back up to your usual level.

 Avoid twisting your back or any heavy lifting for at least 6 weeks after the pain starts.

 Avoid ALL forward bending (or as much as possible).

 In 12 weeks you can resume exercising paying special attention to movements that will strengthen both your abdomen and the flexibility of the spine.

 Physical therapy, osteopathy and/or chiropractic is also an option that is recommended.

 If physical therapy is unsuccessful, it may be that the nerve is too severely pinched. The next step is usually an MRI scan to determine how bad the pathology is.

 Following an MRI, a consultant may wish to do an injection or epidural into the spine to reduce inflammation on the sciatic nerve roots.

Tips:  Don’t sit for more than 20 minutes without getting up and moving around for a few minutes.

 Don’t forward bend – that includes leaning over a sink to wash your face, bending to pick objects from the floor, reaching across a table, or making the bed.

 Do move. Exercise usually helps.

 Do go to work. Resuming normal day-to-day activities and a normal routine can help after the acute stage.

 Do cycle and swim as part of your rehabilitation and under guidance from your doctor or therapist.

 Don’t lift anything heavy.

 Don’t bend and twist at the same time.

 Be careful running – it can cause compression through the spine and might make some people worse.