Saturday, 16 November 2024

What doctors wish patients knew about sciatica

From ama-assn.org

Imagine a sharp, shooting pain that starts in your lower back and travels like an electric shock down your leg, making it difficult to stand, sit or even walk. This is the reality of sciatica, which is a condition that affects millions of people and can turn even the simplest daily tasks into a painful struggle. But sciatica doesn’t have to be a life sentence of pain. There are ways to manage the symptoms and regain control. 

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this instalment, Kevin Taliaferro, MD, an orthopaedic surgeon at Henry Ford Health, took time to discuss what patients need to know about sciatica. Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

“Sciatica is a big catchall term that’s frequently got multifactorial issues, but is often misattributed,” Dr. Taliaferro said. “Generally, what people would call sciatica is pain in the back and buttock that could—or could not be—radiating down further into the leg.”

“That’s why it’s this weird thing that everybody thinks any back pain is sciatica,” he said. “The sciatic nerve comes from the nerve roots of the back, but it doesn’t necessarily mean it always causes back pain. That’s why it’s this catchall term that frequently gets misattributed, similar to what happens with the flu.”

“Most people, when they have sciatica, it’s acute to start off. It’s acute, sudden back pain that can sometimes radiate into the buttocks and generally develops into leg pain,” Dr. Taliaferro said. “That’s the typical pattern that people experience—that pain where it’s either something flares up or you have a disc herniation, you have a sudden onset and then it slowly evolves into leg pain if it’s a pinched nerve.”

“Atypical symptoms that you should see a doctor about are anything where there’s numbness or weakness in the legs, or bowel or bladder dysfunction,” he said. “Those are red flags that are not typical of sciatica and should be evaluated.”

“Generally, numbness and weakness in the legs means that the nerve is getting very compressed where it’s not functioning; it’s not just irritated and causing pain. It means that there’s enough compression to cause it to be dysfunctional,” Dr. Taliaferro said. “Then the bowel and the bladder function, that’s usually a very large disc herniation that’s pushing on the nerve roots, specifically the sacral nerve roots that are running through the low back. 

“Those are the nerve roots that control the bowel and the bladder,” he added, noting that “those are symptoms that are not normal and should be evaluated.”

In the U.S., about 40% of people experience some form of sciatica during their lifetime. Yet it rarely happens before 20 years old unless it is injury related.

“Most studies say people will experience back or buttock pain at least once in their life,” said Dr. Taliaferro. “Certainly, there are people who experience it more than others. 

“But unfortunately, one of those unifying things of being human is having back and or buttock pain in the sciatica family,” he added.

“It’s people who have back-predominant or buttock-predominant pain,” Dr. Taliaferro said. “In my practice, those people are generally more in pain from the joints of the lower back. That’s the more common of the two. 

“When people have sciatica that radiates down the legs, usually past the knee, that usually can be more coming from a pinched nerve in the back,” he added, noting “they overlap each other significantly.”

“Typically, it’s degenerative changes that can happen as we age,” said Taliaferro. “That’s one of the more common types where if you have arthritis in the back, that can cause the back and butt pain.”

“But that arthritis can also irritate the nerve roots going to the legs, especially if they’re causing narrowing or stenosis,” which is a condition that occurs when the space inside the backbone is too small, he said. “The other common cause is a disc herniation where people have a small disc herniation or even a large disc herniation that pinches the nerve up in the back. But because that nerve is wired in our brain to our legs, our brain interprets that as leg pain.”

“As we age, gravity is constant, so it wears and tears on the low back and that’s the biggest risk factor for sciatica,” Dr. Taliaferro explained. “But certainly, young people can have disc herniations as well.”

“So, in general, it is aging and wear and tear on the structures of the low back, but certainly can happen in younger patients as well,” he said. 

Pregnant people can have sciatica

“When you have the child, that’s away from your centre of gravity and pulling everything forward,” Dr. Taliaferro said. “Having a large mass at your waist that’s forcing you forward is going to put a lot of stress on the joints of the low back.”

“Also, during childbearing in preparation for delivery, ligaments in the woman’s body generally get more lax to allow for childbirth and sometimes that can allow for a little bit more instability of the low back,” he said. “Now, you could also have compression of nerves where people have disc herniations in pregnancy, so that’s slightly different. 

“But for the most part, run-of-the-mill sciatica in pregnancy is just due to the fact that you have a large mass in front of you that puts a lot of stress on the joints of the low back,” Dr. Taliaferro added.

“People think that for any back and leg pain that you need to run to get an MRI [magnetic resonance imaging] immediately, but that has led to a lot of overuse of MRIs and a lot of extra cost to the system,” Dr. Taliaferro said. “It’s not great for looking at bones very well. It looks more at soft tissues than anything else.

“There’s information that you can get out of a plain old X-ray that you can’t get out of an MRI,” he added. “So, what’s really important is not all diagnoses need to be made with an MRI. It certainly has its role but talking to an orthopaedic or spinal surgeon—either operative or nonoperative—is important and not just rushing to get an MRI.” 

“Most of sciatica improves no matter what you do, especially the run-of-the-mill low back pain when you overdo it,” Dr. Taliaferro said. “That gets better no matter what you do and running to get an MRI every time is really overkill and a pretty big cost to the system.”

“The vast majority of run-of-the-mill sciatica—where it’s back and buttock pain—can be treated nonoperatively,” said Dr. Taliaferro, noting that “multimodal pain therapy is the best for that.”

For example, “if people have inflammation, you want to treat that with anti-inflammatory medications such as Aleve, Motrin, Mobic, ibuprofen,” he said. “But we also know that people get really stiff because if they’ve had back pain, their back doesn’t want to move.”

That is when “muscle relaxants are used to allow your back to start moving again because the key is getting moving again,” said Dr. Taliaferro. “And then sometimes if it’s really bad nerve pain, we add gabapentin or neurontin to improve nerve pain.”

Another option is “topicals such as lidocaine, which absorbs through the skin and numbs up the area,” he said. But “the vast majority of these episodes will be treated with physical therapy.”

“There are also other nonoperative treatments—and this is where our pain-management colleagues come into play—where you can do epidurals or you can do more joint-based injections, depending on what the symptoms are,” Dr. Taliaferro said. “Most people get better over two to six weeks, but surgery in this scenario, if there’s no neurologic findings, generally is always the last option and that’s after you’ve exhausted other treatments.”

“A lot of people think that you should stay in bed for a long time if you have sciatica pain,” Dr. Taliaferro said. “It’s fine to relax and take it easy for a day or two, but you really want to start getting up and moving because that shortens the length of duration of symptoms.”

“It’s fine to take a break, but then you need to start getting up and moving to keep that light aerobic activity working,” he emphasized.

“When our back tightens up and we have pain, our hamstrings get really tight because we don’t want our pelvis moving very much,” Dr. Taliaferro said. “So, doing hamstring stretches is really important.”

“Then isometric core strengthening is also important,” he said, noting that means “strengthening the abdominal and back muscles without moving the joints of the low back.”

For example, that’s “planks, which everybody hates. No one is super comfortable, but that gets your back muscles strong,” Dr. Taliaferro said. But the key is without moving the joints because the whole goal is to keep you steady.”

Beyond that is “light aerobic activity. When people are actively hurting, the best thing is if you can get into a pool because that takes the weight of gravity off, but allows you to keep moving against resistance,” he explained. “Other ones that are great are yoga and Pilates for the same reasons—it’s a lot of isometric holds and a lot of stretching.  

“And that’s been shown to get people a shorter timeframe of pain in this scenario is the quicker return to light aerobic activity,” he added. 

“Always lifting properly is really important, not deadlifting with your back. Instead, soft lifting with your legs, not with your back,” Dr. Taliaferro said. “If you’re lifting a laundry basket off to the side and twisting at the same time, it’s usually a combination of things that provokes this pain or twisting while doing something active. 

“It’s the combination that causes this to flare up, but it’s hard to predict because I’ve had people get flareups sneezing,” he added. “We use our back for everything and that's the problem. You use it to sleep, use it to eat, you use it to do anything. There’s never really one thing, but generally the main provocateur is the bad lifting techniques.”

“Whenever anybody feels uncomfortable, it’s a good idea to visit your doctor,” said Dr. Taliaferro. “I don’t think people need to run to spine surgeons by any stretch of the imagination, but at the same time, whenever someone’s not getting better with routine care—taking an anti-inflammatory over the counter, relax for a few days, stretch, keep aerobic activity going—over a course of a week or two, then that’s the time to involve your physician.”

“Most sciatic cases get better with time, but the caveat to that is numbness, weakness, bowl or bladder dysfunction. That’s never normal, so that’s always when you go in sooner,” he reiterated. “But if nothing is working and it’s still severe, that’s the time to visit your doctor because then we can get a little bit stronger medication and try other things such as injections.”

https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-sciatica 

Saturday, 2 November 2024

Have chronic low back pain? Try virtual yoga, study suggests

From upi.com

NEW YORK, Nov. 1 (UPI) -- Virtual yoga can be a successful and accessible way to manage chronic low back pain -- a common ailment with major consequences, a new study suggests. The study was published Friday in JAMA Network Open.

Chronic low back pain may lead to physical and emotional suffering, while increasing healthcare costs, decreasing productivity and burdening healthcare professionals, according to the study.

Although clinicians first recommend trying nonmedical interventions, such as yoga, obstacles exist to practicing this mind and body technique, researchers said.

"If you have chronic low back pain and your doctor feels it's not urgent that you need surgery, then yoga classes like these may be a safe and effective approach for you," the study's senior author, Dr. Robert Saper, told UPI.

Among the two groups of study participants, those who did yoga had more significant reductions in pain intensity than those who waited to try the intervention.

Pain dropped by 42% in the first group compared to 2% in the comparison group. The ability to do daily activities, such as climbing stairs and carrying groceries, also improved 51% in the yoga group compared to only 11% in the control group, researchers found.

Surgical, oral medications and injections may not work well or could pose side effects, but the low-cost virtual option can empower people in managing chronic low back pain, said Saper, who is chair of the department of wellness and preventive medicine at the Cleveland Clinic in Ohio.

As a family physician, he has studied yoga's benefits for controlling chronic low back pain since 2007.

About 80% to 90% of adults will experience at least one episode of this type of pain, and as many as 20% may suffer from ongoing or recurrent aches, Saper said.

Surgical, oral medications and injections may not work well or could pose side effects, but low-cost virtual yoga can empower people in managing chronic low back pain, the study indicates. Photo by KoolShooters/Pexels

To conduct the study, Saper and his team divided 140 study participants into two groups.

Half engaged in 12 consecutive weekly, 60-minute, virtual, live-streamed hatha yoga group classes, while the other half waited to take the 12-week course.

The wait-list -- or yoga later group -- could pursue the virtual intervention after the study, but without assessments.

Researchers recruited adults ages 18 to 64 years old with chronic low back pain from the self-insured Cleveland Clinic Employee Health Plan.

They included people with a low back pain intensity score of at least 4 on an 11-point numerical rating scale, with higher scores indicating worse pain and daily back pain interference about half or more of the days.

"This study is different than previous ones because we offered the yoga classes virtually," Saper said.

Cleveland Clinic's instructors led the classes using a manual with yoga and breathing exercises developed for people with chronic low back pain, he noted.

"The yoga that we used was designed to be safe, gentle, easy for somebody to do who has never been exposed to yoga," Saper said, adding that participants had access to a handbook and videos to practice at home in between the weekly classes.

Other experts noted that the study demonstrated how well virtual yoga can treat chronic low back pain and improve function, while reducing the need for pain medication and enhancing the quality of sleep.

Dr. Brian Ralston, a family and sports medicine physician at Loyola Medicine in Berwyn, Ill., said the study confirmed what he already suspected -- that virtual yoga can decrease chronic low back pain, a common source of suffering. He was not involved in conducting the new research.

Technology has changed how people get and stay fit, said Ralston, who has practiced yoga for more than three decades and now does all types of workouts virtually.

A shift toward virtual fitness has intensified since the COVID-19 pandemic and "has boosted people's awareness and comfort with meeting remotely, and I think that also includes exercise," he said.

The study's publication in a very reputable medical journal adds credibility, said Dr. Ram Alluri, a spine surgeon at Keck Medicine of USC -- the University of Southern California in Los Angeles.

"Back pain is one of the leading causes of disability for people in the United States and worldwide," Alluri said.

"Access to yoga virtually shows immense promise as a treatment," he said, because it serves people who can't access a studio or afford in-person classes, which tend to cost more due to overhead expenses.

Virtual yoga can be as effective as in-person practice, said Radha Metro-Midkiff, executive director of Integral Yoga Institute NY in Manhattan's Greenwich Village neighborhood.

"Particularly, we find that when people are in their own environment, it can help them relax, be more mindful of their own bodies," Metro-Midkiff she said.

"It prevents them from overdoing it. That's because they have a tendency to not compare themselves to others."

https://www.upi.com/Health_News/2024/11/01/lower-back-pain-virtual-yoga-study/4961730422930/ 

Friday, 25 October 2024

"Sciatica ended my rowing career, but I'm just getting started in cycling"

From cyclingweekly.com

From rower to runner to Rás winner in four short years, Dom Jackson is making waves in UK cycling. Shane Stokes finds out more about his amazing switch from oars to pedals 

Dom Jackson joined an exclusive cadre of riders in May. Only seven British riders have won the Rás Tailteann - an annual international cycling stage race, held in Ireland - in its 69-year history. The Foran CT rider became part of that exclusive group, winning the five-day race outright after a superb display. That’s a big achievement for any rider, but given Jackson had been racing for just four seasons, having previously competed in a completely different sport, his victory was all the more extraordinary.

“At the start of every year, the team manager Tom Quaid asked for everyone’s goals for the year. The Rás was top of the list by a country mile,” Jackson tells Cycling Weekly. “It was the one thing that I had set my sights on from the end of last year.” Now 26, Jackson’s path into cycling has been an unusual one. He grew up in Kingston-on-Thames and was part of a Sea Scouts group as a child, spending much of his spare time in kayaks and canoes. His interest in watersports saw him take up rowing while at school, but he did not excel straight away.

                                                                                                                             (Image credit: Future)

                                                                                              (Image credit: Dom Jackson)

                                                                                                                       (Image credit: Lorraine O'Sullivan)

Saturday, 19 October 2024

Save your spine

From newindianexpress.com

Poor posture can even trigger sciatica, causing pain that radiates from the lower back down to the legs

CHENNAI: Do you have a colleague who spends all day glued to their chair, consistently turning down chai or coffee breaks? Then this is a warning to that workaholic - get ready to spend your hard-earned salary on health bills! Experts say that prolonged sitting can lead to multiple health issues.

In light of World Spine Day on October 16, experts talk about these problems and gather tips on how to prevent them.

Referring to a recent study published by the International Journal of Health Sciences and Research, Dr Suman Tadagonda, sports medicine physician and specialist in spine and athletes health at nSure Healthy Spine, Hyderabad, said that globally, lower back pain affects more than 540 million people and the condition has doubled in the last 25 years.

“In India, 64% of Indian IT professionals reported symptoms of pain and discomfort. Data suggests that most of the workforce, due to longer sitting hours, develop a lot of musculoskeletal health issues. They suffer from discomfort and pain in the hips, legs, neck, and shoulders. And the concerning part is that they don’t realise the very existence of the problem,” he said. Though this study only refers to IT people, experts believe that the effects of longer sitting hours are the same for everyone.

When you sit for long hours, it’s obvious that your spine will be affected. Highlighting some common spine-related problems, Dr Venkatesh Yeddula, senior consultant neurosurgeon at CARE Hospitals, Hyderabad, said, “One of the most frequently observed issues is chronic lower back pain, often caused by slouched posture or long hours of sitting.

This can lead to disc degeneration or herniated discs.” He added that many young individuals also suffer from neck pain due to leaning towards screens. Other issues, such as shoulder pain and muscle imbalances, arise from weakened core muscles and tight hips. Poor posture can even trigger sciatica, causing pain that radiates from the lower back down to the legs.

Dr Suman added that the pressure on the spine in any form is a starting point for developing not only upper and lower back pain but also leads to scoliosis, kyphosis, and other problems.

But that isn’t all; spine issues often contribute to broader health problems. Dr Venkatesh said that headaches can result from neck strain due to poor posture. Additionally, improper spinal alignment can cause poor circulation, leading to fatigue and muscle stiffness. Over time, spinal misalignment may even affect respiratory function, making breathing less efficient. Chronic pain from spine issues can also contribute to mental health problems like stress, anxiety, and sleep disturbances.


PREVENTION TIPS

Dr Venkatesh Yeddula gives us some tips to care for our spines:

  • Use a chair with proper lumbar support, adjust your screen to eye level, and keep your feet flat on the ground to maintain a neutral posture.

  • Take breaks every 30-40 minutes. Stand up, stretch, and walk around to relieve pressure on the spine and improve circulation.

  • Practice good posture by sitting upright, avoiding slouching, and using pillows or rolled-up towels for additional lumbar support if needed.

  • Apart from regular physical activity like walking, swimming, or yoga, incorporate simple stretches for the neck, shoulders, back, and hips to reduce muscle stiffness and improve flexibility.

  • Engage in core-strengthening exercises like planks or pilates to support your spine and reduce the risk of back injuries.

  • Drink plenty of water to keep spinal discs hydrated. This improves their ability to cushion and support your movements.

  • If needed, use a footrest to ensure your legs are properly supported and reduce lower back strain.


Wednesday, 16 October 2024

Acupuncture helps sciatica in gold-standard clinical trial

From cosmosmagazine.com

A randomised-control trial has found that acupuncture can help reduce leg pain in patients with sciatica.

The study is published in JAMA Internal Medicine.

Acupuncture is a traditional Chinese practice involving the insertion of needles into specific points in the body, known as “acupoints”.

While there’s evidence it can help treat chronic pain, the researchers say there is a lack of high-quality evidence to support its use with sciatica.

The Chinese team of researchers enrolled 216 patients in the trial, all of whom had chronic sciatica from a herniated spinal disc.

Patients were randomly assigned to either an acupuncture group or a control group, where they received 10 treatment sessions over 4 weeks.

Patients in the acupuncture group were treated by licensed acupuncturists with at least 3 years of experience, while the control group received a “sham acupuncture” treatment from the acupuncturists.

“For the sham group, acupuncturists used nonacupoints away from the meridians, which are considered to have no effect; this is common practice for sham controls in acupuncture research,” write the researchers in their paper.

Patients weren’t told which group they were in, and a blinding test showed they were still unaware after receiving the treatment. The researchers also didn’t know which group the patients were in, with only the acupuncturists being unblinded.

The researchers followed up with the patients 1, 2, 6 and 12 months after the intervention, asking them to rate their pain and capability with surveys frequently used in health research.

They found that patients who had the acupuncture treatment consistently reported lower pain and higher function, both immediately after and a year after the treatment.

While the acupuncture group was still doing better than the sham acupuncture group at the 1-year mark, the difference had narrowed compared to the 4-week mark.

“Given the large effect sizes that this trial found, acupuncture should be considered to be a potential treatment option for patients with chronic sciatica from herniated disk,” write the researchers in their paper.

They also propose doing more research comparing acupuncture with painkillers and surgery, both of which can have mixed results in sciatica patients.

https://cosmosmagazine.com/health/medicine/acupuncture-helps-sciatica-in-gold-standard-clinical-trial/ 

Tuesday, 8 October 2024

Breaks from sitting can stop your back pain from getting worse

From thenewdaily.com.au

We know that prolonged periods of sitting increase the risk of death from cardiovascular disease and cancer.

Along the way to that early death, you have a higher chance of being overweight and experiencing depression.

We’ve been reporting on this issue for ten years, beginning with a cheery story:

‘Do you work in an office? Your job could be killing you’.

One more thing to keep in mind: sitting for hours at a time isn’t great for the back. Your pain while sitting might indicate a challenging condition such as a herniated disc or sciatica.

Chances are, though, your posture is to blame – slumping  more than sitting – along with your overall poor fitness.

                                                                                                       Photo: Getty

Prevailing advice

There’s a lot of advice on how to sit properly, how to set up your chair and desk correctly, and how to remember to keep your feet flat on the floor.

For a long time, we were told that sitting up straight was the preferred posture. Then some researchers said this lacked evidence.

Researchers from the University of Turku in Finland make the sensible point that you’re better off varying your posture than trying to stick to a perfect model.

Much of the research into prolonged sitting looks at consequences and potential ways of lowering your risk of early death.

The Finnish researchers, in a new study, take a real world approach, using overweight participants who already suffer back pain.

The question of the study is a simple one:

Can you prevent back pain from getting worse by reducing how much you sit each day?

Intuitively, the researchers say, “it is easy to think that reducing sitting would help with back pain, but previous research data is surprisingly scarce”.

The new study

Sixty-four adults that were overweight or obese or had metabolic syndrome were randomised into either an intervention group or a control group. These were people who spent most of their days sitting down.

“Our participants were quite normal middle-aged adults, who sat a great deal, exercised little, and had gained some extra weight,” said Turku Doctoral Researcher and Physiotherapist Jooa Norha.

“These factors not only increase the risk for cardiovascular disease but also for back pain.”

The intervention group aimed to reduce sedentary behaviour by one hour a day (measured with accelerometers) over six months. The control group continued their regular sitting habits.

Back pain intensity and pain-related disability were assessed.

The results? Sort of encouraging.

The participants were able to reduce their sitting by 40 minutes per day, on average, during the six-month study.

“Pain-related disability increased during the intervention in both groups,” the authors write.

“Back pain intensity increased significantly more in the control group than in the intervention group in which back pain intensity remained unchanged.

It’s somewhat depressing that, overall, the intervention group failed to get off their weakening buttock muscles for a lousy hour a day.

On the other hand, that they managed to prevent their pain from worsening suggests it may not take much more to actually decrease their pain.

Mr Norha summed it up:

“If you have a tendency for back pain or excessive sitting and are concerned for your back health, you can try to figure out ways for reducing sitting at work or during leisure time.

“However, it is important to note that physical activity, such as walking or more brisk exercise, is better than simply standing up.”

https://www.thenewdaily.com.au/life/2024/10/07/stop-back-pain-from-getting-worse