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12345!"#$%&&What You Need to Know About Sciatica

ntroduction ( )ommon causes ( )onser*ati*e care ( +ur,ery (

Dia,nostics ( natomy cti*ities Sciatica: & *er*iew / )ausesof sciatica/ 0reatments nimations of: / 1umbar discherniation / +inal stenosis / +ondylolisthesis elatedinformation: / 1umbar disc herniation / +inal stenosis /

De,enerati*e disc disease / sthmic sondylolisthesis...

http://www.spine-health.com/topics/cd/d_sciatica/sc01.html%#2%2 2$#23 bytes

Sciatica exercises


Dia,nostics ( natomy cti*ities Sciaticae6ercises: &ntroduction / 7erniated disc / +inal stenosis / De,enerati*e disc

disease / sthmic sondylolisthesis / 7amstrin, stretchin, elated

information: / *er*iew of sinal cord and ner*e roots / 8hat you

need to 9now about sciatica/ 7ow a hysical theraist can helwith e6ercise ...

http://www.spine-health.com/topics/conserv/sciaex/sciaex01.html%#2%2 $"%2 bytes

Sciatica information and illustrations

Sciaticacti*ities rticle directory... natomy uto accidentsDe,en. disc disease Dia,nostic tests Disc herniation ailed bac9

sur,ery ibromyal,ia njections ;ids and teens 1ower bac9 ain

Medications Misc conditions Misc treatments Muscle strain


2/11


Dia,nostics ( natomy cti*ities Sciatica: / *er*iew / )auses ofsciatica& 0reatments nimation of: / 1umbarmicrodecomression / 1aminectomy / Aidural steroid injection

elated information: /


3/11

Dia,nostics ( natomy cti*ities Sciaticae6ercises: /ntroduction / 7erniated disc / +inal stenosis & De,enerati*e disc

disease / sthmic sondylolisthesis / 7amstrin, stretchin, i,. $$?lar,er *iew@ i,. $2 ?lar,er *iew@ i,. $3 ?lar,er *iew@ i,. $%

?lar,er *iew@ i,. $4 ?lar,er *iew@ i,...

http://www.spine-health.com/topics/conserv/sciaex/sciaex04.html%#2%2 23"$$ bytes

12345!"#$%&&

1999-2002 Spine-health.comThe information in Spine-health.com is not intended as a substitute for medical professional help or advice but is to be used only as an aid inunderstanding bac pain and nec pain. ! physician should al"ays be consulted for bac pain or any health problem. Spine-health.comprovides lins to other organi#ations as a service to our readers and is not responsible for the information$ services$ or products provided by

these "eb sites$ health professionals$ or companies. See Terms and %onditionsand &rivacy &olicy.

7ome( urnin, or tin,lin, down the le,

8ea9ness numbness or difficulty mo*in, the le, or foot
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4/11

constant ain on one side of the buttoc9s

shootin, ain that ma9es it difficult to stand u

8hile sciatica can be *ery ainful it is rare that ermanent ner*e dama,e ?tissue dama,e@will result. Most ain syndromes result from inflammation and will ,et better within twowee9s to a few months. lso because the sinal cord is not resent in the lower ?lumbar@sine a herniated disc in this area of the anatomy does not resent a dan,er of aralysis.+ymtoms that may constitute a medical emer,ency include ro,ressi*e wea9ness in thele,s or bladderbowel incontinence. =atients with these symtoms may ha*e cauda eEuinasyndrome and should see9 immediate medical attention.ny condition that causes irritation or imin,ement on the sciatic ner*e can cause the ainassociated with sciatica. 0he most common cause is lumbar herniated disc. ther commoncauses include lumbar s$inal stenosis& de%enerati+e disc disease& oristhmic

s$ond#lolisthesis.


5/11

What causes sciatica(

0he sciatic ner*e is the lar,est ner*e in the body. t starts in the low bac9 at lumbarse,ment 3 ?13@. 0he ner*e roots run throu,h the bony canal and at each le*el a air ofner*e roots e6its from the sine.

0he ner*e is named for the uer *ertebral body that it runs between ?for e6amle thener*e that e6its at 14-15 is named 14@. 0he ner*e assin, to the ne6t le*el runs o*er awea9 sot in the disc sace which is the reason discs tend to herniate ?e6trude@ ri,ht underthe ner*e root and can cause le, ain.0he symtoms ?ain numbness tin,lin, wea9ness@ are different deendin, on where theressure on the ner*e occurs. or e6amle a lumbar se,ment 5 ?15@ ner*e imin,ementcan cause wea9ness in e6tension of the bi, toe and otentially in the an9le ?foot dro@ ?+eei,ure $@.)ommon conditions that can result in ain alon, the sciatic ner*e include:

3umbar herniated disc4 herniated disc occurs when the soft inner core of the

disc ?nucleus ulosus@ e6trudes throu,h the fibrous outer core ?annulus@ and thebul,e laces ressure on the conti,uous ner*e root. n ,eneral it is thou,ht that a

sudden twistin, motion or injury can lead to an e*entual disc herniation. herniateddisc is sometimes referred to as a slied rutured bul,in, rotrudin, disc or ainched ner*e.

o +ee also 1umbar disc herniation

3umbar s$inal stenosis40his condition in*ol*es a narrowin, of the sinal canal. t

is more common in adults o*er a,e % and tyically results from enlar,ed facetjoints lacin, ressure on the ner*e roots as they e6it the sine.

o +ee also 1umbar sinal stenosis

.e%enerati+e disc disease48hile disc de,eneration is a natural rocess that

occurs with a,in, in some cases it can also lead to ain alon, the sciatic ner*e. 0he

condition is dia,nosed when a wea9ened disc results in e6cessi*e micro-motion atthe corresondin, *ertebral le*el and inflammatory roteins from inside the disc can

become e6osed and irritate the area.o +ee also De,enerati*e disc disease

5sthmic s$ond#lolisthesis4elati*ely common in adults ?aro6imately 5G to !G

of adults@ this condition rarely causes ain. t occurs when a small stress fractureoften at the fifth se,ment allows the 15 *ertebral body to sli forward on the +$

*ertebral body. )aused by a combination of disc sace collase the fracture and the*ertebral body sliin, forward the 15 ner*e can ,et inched as it e6its the sine.

o +ee also sthmic sondylosthesis

!iriformis s#ndrome40he sciatic ner*e can ,et irritated as it runs under the

iriformis muscle in the buttoc9s.o +ee also =iriformis syndrome- another irritation to the sciatic ner*e

Sacroiliac oint d#sfunction4rritation of the sacroiliac joint can also irritate the

15 ner*e which lies on to of it and cause sciatica.o +ee also 8hat is sacroiliac joint dysfunctionH

>ac9 to common causes Next reatments
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6/11

1999-2002 Spine-health.com

7ow is sciatica treated(

0he ,ood news is that if ain alon, the sciatic ner*e is ,oin, to ,et better on its own it willusually do so within a coule of days or wee9s. n fact the *ast majority of this tye of bac9

andor le, ain usually heals on its own within si6 to twel*e wee9s.'onser+ati+e care

Durin, an eisode of sciatic ain there are a number of conser*ati*e care otions a*ailableto hel alle*iate the ain and discomfort.

Heat/iceor acute ain alon, the sciatic ner*e heat andor ice ac9s are most readily

a*ailable and can hel alle*iate the ain esecially in the acute hase. Bsually ice orheat is alied for aro6imately 2% minutes and reeated e*ery two hours. Mosteole use ice first but some eole find more relief with heat. 0he two may be

alternated.o +ee also hh...ce massa,e

Medications*er-the-counter or rescrition medications may also be helful.


7/11

Microdiscectom$ %microdecompression&n cases where the ain is due to a disc herniation a microdiscectomy may beconsidered after 4 to wee9s if the ain is not relie*ed by conser*ati*e means.Br,ent sur,ery is only necessary if there is ro,ressi*e wea9ness in the le,s orsudden loss of bowel of bladder control. microdiscectomy is tyically an electi*erocedure and the decision to ha*e sur,ery is based on the amount of ain and

dysfunction the atient is e6eriencin, and the len,th of time that the ain ersists.ro6imately #%G to #5G of atients will e6erience relief from their ain after this

tye of sur,ery.o +ee also Microdiscectomy

'mbar laminectom$ %open decompression&1umbar sinal stenosis often causes ain that wa6es and wanes o*er many years.

+ur,ery may be offered as an otion if the atientFs acti*ity tolerance falls to anunaccetable le*el. ,ain sur,ery is electi*e and need only be considered for those

atients who ha*e not ,otten better after conser*ati*e treatments. fter an lumbarlaminectomy ?oen decomression@ aro6imately !%G to "%G of atientse6erience ain relief from their ain.

o +ee also 1umbar laminectomy

"# Ste$hen 7 7ochschuler& ).'arch (0$ 2000)pdated *ctober 9$ 2001

>ac9 to common causes

Sciatica exercises

+ciatica is a commonly used term for ain ori,inatin, from the bac9 that is felt alon, one ofse*eral ner*e distributions in the buttoc9 hi thi,h le, an9le or foot. +ciatica in*ol*es

comression or irritation of one or more ner*es e6itin, the lower sine that ma9e u thesciatic ner*e. 0he sciatic ner*e branches off as it tra*els down the lower e6tremity and thus

ain can be e6erienced alon, this route. hysical theraist certified athletic trainer ?0)@ or other sine secialist who treats the

bac9 ain and le, ain associated with sciatica may recommend e6ercise as art of atreatment ro,ram. 0he secific e6ercises recommended will deend on the cause of the

sciatica. 0he major causes include: 7erniated disc

+inal stenosis

De,enerati*e disc disease

sthmic sondylolisthesis

0hese e6ercises are recommended for secific conditions. 0hey must be done re,ularly?tyically two times daily@ and correctly to be effecti*e. )lose attention to osture and bodymechanics is one 9ey to ,ettin, ma6imum benefit from the e6ercises.

)arin, for your sciatica should be considered art of your daily li*in, not just somethin, toadd to your routine at the end of the day. t is recommended that you consult with yourhysician or hysical theraist rior to be,innin, any e6ercise ro,ram.>ac9 to conser*ati*e care Next 7erniated disc
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8/11

7erniated disc

7erniated discs commonly in*ol*e dis9 material rotrudin, bac9wards and irritatin, orcomressin, a ner*e root.

+ee *er*iew of lumbar disc herniation

+ee nteracti*e sine animation lumbar disc herniation

A6ercises to treat this condition are rescribed accordin, to which ositions will cause thesymtoms to mo*e u the lower e6tremity and into the low bac9.or many atients this is accomlished by ,ettin, into a bac9wards bendin, osition.

0he low bac9 is ,ently laced into e6tension by lyin, on the stomach ?rone osition@

and roin, the uer body u on the elbows 9eein, his on the floor ? i,ure [email protected] should be started slowly since some atients can not tolerate this ositioninitially.

0his osition is tyically held from fi*e to 3% seconds er reetition for $% reetitions.

fter racticin, this e6ercise the sine secialist may recommend a more ad*anced form of

the e6tension: rom the rone osition ress u on the hands while the el*is remains in contact

with the floor ?i,ure 2@. 0his osition is tyically held for $ second reeated $% times.

similar e6ercise can be done standin, by archin, bac9ward slowly with hands on his if theatient is unable to lie flat ?i,ure 3@. 7owe*er the rone osition is usually referred.0hese Ie6tensionJ e6ercises are done re,ularly about e*ery two hours. More imortantlythe sine secialist may recommend that the erson with this condition should a*oid ,ettin,into a forward fle6ed ?bent o*er@ osition. 0his tends to counteract the effects of the

e6tension e6ercises. 0he secialists may as9 the atient to correct forward fle6ed ositionsimmediately with an e6tension e6ercise.

s the ain wor9s out of the lower e6tremity the e6ercises tyically are ad*anced tostren,then the low bac9 and abdominal muscles to re*ent recurrences of the condition. 0o

stren,then the low bac/muscles: n the rone osition and hands clased behind the lower bac9 raise the head and

chest sli,htly a,ainst ,ra*ity ?i,ure 4@ while loo9in, at the floor ?stay low@. n the rone osition with the head and chest lowered to the floor li,htly raise an

arm and oosite le, slowly with the 9nee loc9ed 2-3 inches from the floor ?i,ure5@.

0o stren,then the abdominalmuscles: or the uer addominals lay on the bac9 with 9nees bent fold arms across the

chest tilt the el*is to flatten the bac9 and curl-u liftin, the head and shouldersfrom the floor ?i,ure @. Do not attemt to lift too hi,h and brin, the head and chesttowards the ceilin,. or atients with nec9 ain lace the hands behind the head.

or the lower abdominals ti,hten the lower stomach muscles and slowly raise the

strai,ht le, " to $2 inches from the floor ?i,ure !@ 9eein, the low bac9 held flata,ainst the floor. 8ater e6ercises are also e6cellent e*en just wal9in, in waist-deewater.
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9/11

erobic conditionin, may also be encoura,ed for ,eneral body fitness. 8al9in, is ane6cellent form of e6ercise for the low bac9 wor9in, u to three miles er day at a bris9 aceif able.>ac9 to conser*ati*e care Next S$inal stenosis

S$inal stenosis+inal stenosis can also cause ner*e root irritation or imin,ement throu,h a narrowin, ofthe ner*eFs assa,eway.

+ee *er*iew of lumbar sinal stenosis

+ee nteracti*e sine animation sinal stenosis

8hen treatin, stenosis the sine secialist may encoura,e fle6ion e6ercises. le6in, thelower sine increases the siKe of these assa,eways and allows the irritation or imin,ementto resol*e.0his is accomlished by stretchin, the muscles of the bac9 that hold the sine in e6tension?bac9wards bendin,@ and stren,then the muscles that brin, the sine into fle6ion ?forward

bendin,@.Stretchesfor the low bac9 e6tensors are tyically held li,htly for 3% seconds.

1ay on the bac9 and ,ently ull the 9nees to the chest until a comfortable stretch is

felt ?i,ure "@. rom all fours sit bac9 on the heels with the chest down and arms outstretched

?i,ure #@.

Stren%thenin% exercisesfor the lower abdominal muscles: 1ay on the bac9 and ress the low bac9 into the floor by ti,htenin, the lower stomach

muscles ?i,ure $%@ hold for $% seconds. or a more ad*anced e6ercise hold this osition while marchin, in lace in the hoo9-

lyin, osition slowly raisin, alternate le,s 3 to 4 inches from the floor ?i,ure $$@.

)url-us ?i,ure @ may be recommended by the secialists here as well.

0hese e6ercises alone will not necessarily ma9e the atient better but they will allow theatient to more easily hold a osterior el*ic tilt durin, acti*ities esecially standin, andwal9in,. 0his osture will allow the atient to erform more acti*ities with less ain. 0heel*ic tilt is often *ery difficult for atients to learn and can ta9e a ,ood deal of ractice withthe ,uidance of a hysical theraist before it is used effecti*ely.>ac9 to conser*ati*e care Next .e%enerati+e disc disease

.e%enerati+e disc disease

De,enerati*e dis9 disease can also cause a form of sciatica. +ee *er*iew of lumbar de,enerati*e disc disease

0he form of e6ercise tyically recommended for treatin, disc de,eneration is a dynamiclumbar stabiliKation ro,ram. 0his includes findin, the most comfortable osition for thelumbar sine and el*is and trainin, the body to maintain this osition durin, acti*ities. n

doin, this correctly one can imro*e the roriocetion ?sense of mo*ement@ of the lumbarsine and reduce the e6cess motion at the sinal se,ments. 0his will in turn reduce the
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10/11

amount of irritation at these se,ments relie*in, ain and rotectin, the area from furtherdama,e.0hese e6ercises often reEuire secific hands-on instruction because they offer much lessbenefit if done incorrectly and they tend to be much more difficult than they aear. 0histye of ro,ram is ro,ressi*e startin, with the easier e6ercises and ad*ancin, to the moredifficult e6ercises once the first lower le*el ro,ram is mastered. 0he most imortant asect

is sensin, and controllin, motion in the sine. nce learned the body can e*entually ta9eo*er and do this without the le*el of concentration it ta9es early on.

A6amles of these stabiliKin, e6ercises done while on the bac/include: 7oo9-lyin, march with 9nees bent arms at sides ti,hten stomach muscles and

slowly raise alternate le,s 3-4 inches from the floor ?i,ure $$@. 7oo9-lyin, march with arms lowerin, the oosite arm o*er the head ?i,ure $2@.

>rid,in, from a bac9 lyin, osition with 9nees bent slowly raisin, the buttoc9s from

the floor ?i,ure $3@.

0hese should all be erformed with a ri,id trun9. 0he el*ic tilt ?i,ure $%@ will be used tofind the most comfortable osition for the low bac9.0his same el*ic osition is maintained while erformin, stabiliKin, e6ercises from the rone9on the stomach:osition:

8ith elbows bent and hands under the shoulders raise one le, 2 to 3 inches from the

floor ?i,ure $4@ 8ith elbows strai,ht and arms stretched about the head raise an arm and the

oosite le, 2 to 3 inches off the floor ?i,ure 5@.

+imilar e6ercises can be done in the 4-oint osition 9on hands and /nees: raisin, thearms and le,s only as hi,h as can be controlled maintainin, a stable trun9 and a*oidin, anytwistin, or sa,,in,:

aise one le, behind with the 9nee sli,htly bent and no arch in the bac9 or nec9

?i,ure $5@

aise one le, with the oosite arm with the 9nee sli,htly bent and no arch in thebac9 or nec9 ?i,ure $@.

>ac9 to conser*ati*e care Next 5sthmic s$ond#lolisthesis

5sthmic s$ond#lolisthesis

sthmic sondylolisthesis can cause ner*e root irritation or imin,ement. +ee *er*iew of isthmic sondylolisthesis

+ee nteracti*e sine animation sondylolisthesis

sthmic sondylolisthesis is tyically treated with a ro,ram that is a hybrid of the fle6ionbased e6ercises ?as in stenosis@ and the stabiliKation ro,ram ?as in de,enerati*e dis9disease@. 0he ,oal of this method is to teach the lumbar sine to remain stable in a fle6edosition. 0herefore the e6ercises are a combination of both ro,rams.

+ecialists treatin, atients with sondylolisthesis freEuently recommend the el*ic

tilt ?i,ure $%@ as it will hold the lower sine in the fle6ed osition. 1ay on the bac9with 9nees bent and flatten the bac9 by ti,htenin, the lower stomach muscles.

+tren,thenin, the abdominals with the curl-us ?i,ure @ will also hel maintain a

roer lower sine osition. 1ay on the bac9 with 9nees bent fold arms across the
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chest tilt the el*is to flatten the bac9 and curl-u liftin, the head and shouldersfrom the floor. Do not attemt to lift too hi,h and brin, the head and chest towardsthe ceilin,. or atients with nec9 ain lace the hands behind the head.

0he hoo9-lyin, marchin, ?i,ure $$@ and hoo9-lyin, combination ?i,ure $2@ are

a,ain useful here as well.

>ac9 to conser*ati*e care Next 7amstrin% stretchin%

7amstrin% stretchin%

nother imortant consideration is hamstrin, stretchin,. 0he hamstrin,s are muscles located

in the bac9 of the thi,h. 0hey hel bend the 9nee and e6tend the hi.0i,htness in the hamstrin,s will lace increased stress on the low bac9 a,,ra*atin, or e*en

causin, low bac9 ain. Most atients with bac9 ain will benefit from hamstrin, stretchin, bylyin, on the bac9 and suortin, the thi,h behind the 9nee slowly strai,hten the 9nee untila stretch is felt in the bac9 of the thi,h tryin, to ,et the bottom of the foot to face theceilin, one le, at a time ?i,ure $!@.

"# Ron S )iller& !+ecember 1,$ 2000)pdated *ctober 9$ 2001

>ac9 to conser*ati*e care

ut$atient bac/ sur%er# for sciatic $ain

Bsin, minimally in*asi*e lumbar microdiscectomy this doctoris able to ,et you out of thehosital the same day and ,reatly reduce the at-home reco*ery time. s someone who sent

3 days in the hosital and a month reco*erin, li9e the sound of it.

(n the new sr)ical procedre* a small incision is made in the spine* and a port or c$linder isinserted. (t splits the mscle as it ma+es its wa$ in* and enlar)es to )ive the sr)eon awor+able space. ,rom there* the pressre is removed rom the nerve.

(n the older procedre* a lar)er incision wold be made and the mscle wold be moved andpeeled awa$ rom the bone. his is the reason or the lon)er recover$ time and ater-sr)er$ pain.

corse* the new sr)er$ is not or ever$one. he best candidate has a standard dis+problem* and is o avera)e wei)ht. #ertain sitations* li+e bein) ver$ overwei)ht can hinderthe procedre.
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