Dr. Roach: Surgery is a last resort for chronic back pain

From eu.detroitnews.com

Dear Dr. Roach: I am a 70-year-old man with chronic back pain. I first started having serious back pain in college after spending much of my time hunched over a drawing board. Later, as an architect, my back pain reoccurred frequently. About 20 years ago, after having terrible sciatica in my left leg, I had a surgical procedure done called a laminectomy, which successfully relieved my back pain for many years.

Now I have developed pretty serious arthritis in my lower back, and I am in pain constantly. I can no longer lie flat in bed to sleep. I started having to sleep in my recliner, which helped, and then I bought an adjustable bed, which was also helpful. I have had to rely on taking large doses of Percocet to manage my pain. Since I also have heart flutter issues, I cannot take any anti-inflammatory meds. I am having trouble getting opioids prescribed, but they seem to be the only thing that helps me. Walking and back stretching only cause more pain. Recently, my back surgeon suggested that spinal fusion might help me. What do you advise?
— D.A.P.

Dear D.A.P.: The sciatic nerve is a surprisingly large structure, roughly the size of one’s little finger. It exits the back and provides the nerve supply to the lower leg. When it is pressed on -- by a herniated disc or by bony material in people with arthritis -- it usually causes pain, and with more severe compression, numbness and weakness. Medications, physical therapy and surgery are possible options. I’m not sure whether you have given PT an adequate trial since there is a great deal more to spine PT than stretching and walking.

I consider referring patients to a back surgeon when their pain is bad enough to affect daily activities and when they are unable to get relief or require large doses of opiates. The surgeon evaluates the anatomy and provides a opinion, but the ultimate choice is the patient’s.

Back surgery is usually effective, but sometimes fails to relive pain. In a few cases, it makes things much worse. Back surgery should never be entered into lightly. However, it does sound in your case that a consultation was appropriate. I would suggest you consider getting a second surgical opinion, as it seems you are also a little reluctant. If the second surgeon also recommends a fusion procedure, that would be stronger evidence that surgery may be beneficial. It is likely that the arthritis process may cause problems to recur years from now.

https://eu.detroitnews.com/story/life/advice/2020/08/28/keith-roach-surgery-last-resort-chronic-back-pain/113592558/

How to decompress the lower back?

From gildshire.com

Most of us deal with lower back pain due to an improper posture, sitting in front of the computer, and other similar causes. Figuring out how to decompress the lower back sounds like a very good idea, but how can you do that? In this article, we will share some information about Spinal Decompression, how you can do it, and why it might be able to help improve your life!

Does Spinal Decompression Really Work?

Spinal Decompression is motorized traction designed to help you obtain back pain relief. It helps you stretch your spine and change the position and force of your spine. This means you will have less pressure on your spinal disk.

The herniated or burling disks will start retracting. That means you will have less pressure on spinal structures and nerves. You will have more nutrients in the spinal disks, not to mention Spinal Decompression helps promote oxygen and water movement naturally and with great success. Once you learn how to decompress the lower back, you will feel better and you will find it easier to treat injured spinal nerve roots, worn spinal joints, sciatica, herniated disks, and many other issues.

Benefits of Spinal Decompression

Why should you try out Spinal Decompression? The main advantage is that you can start eliminating the unwanted lower back pain very quickly. On top of that, it’s not time-consuming and non-invasive as well. This treatment delivers a natural relief, so you don’t have to rely on chemicals or any unwanted solutions.

With help from Spinal Decompression, you will be able to avoid addiction or side effects generated from painkillers. This type of treatment works great if you have the facet syndrome, degenerative disc disease, herniated discs, or even spinal stenosis and sciatica. It’s a very cost-efficient and effective solution, one that can make a massive difference.

Spinal Decompression Exercises

You will find a vast range of different Spinal Decompression exercises out there. Each one of them is very good, but since we all have a different metabolism, some are better than others. Here you have a list with some of the best:

• Bar hang-ups are great because they make it easy for you to work on your muscles and the lower back. You can use this for Spinal Decompression, while also being able to alleviate most symptoms naturally.
• Cat and camel exercises basically require you to take the position of a cat and then the one of a camel. Switch from one to the other as many times as you can. This is an exercise that puts a lot of pressure on your back.
• Prayer stretches are simple to do. You just need to take the position as you prepare for praying, and then you just stretch your hands in front of you as much as you can. It will help decompress your back, and you will feel better too.
• Overhead stretches are the simplest stretches you can do. They are also very efficient, and you will get quick pain relief thanks to them.

Can Spinal Decompression Hurt You?

When you start doing a Spinal Decompression, you will feel that pressure in your back. However, you won’t experience any pain. That means Spinal Decompression won’t hurt you, but you will slowly feel better. That’s why you want to stick with this treatment because it works very well. For some people, it might take a while, but it’s going to be worth it.

We recommend you to give Spinal Decompression a try and make sure that you stick with the right exercises. Results can be extraordinary, just see what Spinal Decompression exercises work for you. Remember to adjust and adapt everything according to your own metabolism and lifestyle!

https://www.gildshire.com/how-to-decompress-the-lower-back/

Sciatica – A Common “Pain in the Nerve” for All Ages

From newswise.com
By Jonathan Yun, M.D.

Newswise — COVID-19 stay-at-home guidelines have created many lifestyle changes, including new home workout routines and do-it-yourself home improvement projects. Doctors warn, however, that increased activity for those not used to certain exertion levels can lead to strains and pains, including one of the most common nerve conditions, sciatica (sy-at’-ick-uh).

“While there are many reasons sciatica can occur, it’s a pain that is often associated with injuries from over-activity,” said Jonathan Yun, M.D., neurosurgeon with the Montclair Neuroscience Institute at Mountainside Medical Centre. “With people staying at home, not working and finding more time during the day to be active, especially during the summer, I have noticed an increase in patients experiencing sciatic nerve pain.”

What is sciatica?
Sciatica, also known as radiculopathy, occurs when the sciatic nerve, which begins in the lower back and splits to run down each leg, is pressed or pinched. Associated pain is described as traveling down the leg to the foot and can vary from a dull sensation or soreness to severe stabbing, radiating pain. In some cases, the pain can be so intense that it becomes difficult to walk or stand.

“Sciatica can affect people at any age, including those who are older and are prone to arthritis,” said Yun. “While the most common cause may be a herniated or slipped disk causing pressure on the nerve root, sciatica symptoms can also be triggered by years of wear and tear, bending, twisting and stretching for long periods of time.”

The most common symptoms of sciatica include:

• Lower back pain spreading from a person’s bottom and back of thigh
• Pain that travels from the bottom toward the foot
• Numbness or weakness (in severe cases)

“One misconception about sciatica is that this type of leg pain always comes with back pain,” said Yun. “This is not always the case. Usually pain is more severe in the leg than the back. You can also experience no back pain at all. If a patient comes in with pain that goes down a certain part of their leg, I can almost guarantee I know exactly what nerves are involved, simply based on the pattern of pain.”

Who is at risk for sciatica?
While certain health conditions, such as obesity, can trigger sciatica, several other factors may contribute to a person having a higher risk, including:

• A current or previous injury to the lower back or spine
• Weakened core muscles (of the back and abdomen)
• A job that requires heavy lifting or prolonged periods of sitting
• Improperly lifting objects, such as when weight lifting or picking up a heavy box
• Osteoarthritis

The good news is with the right treatment, sciatica can often be relieved.

What are common treatments for sciatica?
If symptoms of sciatica have been persistent and ongoing, it’s important to be evaluated by a physician because sciatica involves irritation or injury to the nerve. If it goes untreated, it could lead to a higher degree of nerve injury.
Common treatments for sciatica include:

• Nonsteroidal anti-inflammatory (NSAIDs) medications, such as ibuprofen
• Heat or cold applied to the sore muscles
• Movement, which helps reduce inflammation
• Physical therapy
• Minimally-invasive surgery

“Surgery is really at the end of the treatment spectrum. It’s always an option, but it’s never the first option. We always try to relieve pain from sciatica first through conservative measures, like medications and therapy,” said Yun. “We explore surgical options if those measures do not work. In many cases, surgery has provided immediate relief and allowed patients to return home the same day and get back to enjoying life virtually pain free.”

https://www.newswise.com/coronavirus/sciatica-a-common-pain-in-the-nerve-for-all-ages/?article_id=736275

Pregnancy sciatica: Natural ways to get relief

From thehealthsite.com

Pregnancy sciatica is a temporary condition. But since it is not feasible to take an over-the-counter pain reliever now, try out these natural remedies instead

When you get pregnant, your body undergoes many changes to accommodate a growing foetus. This can indeed by an overwhelming time for you. You may experience intense food cravings, morning nausea and lethargy on a daily basis. Sometimes, your blood pressure may fluctuate, you may get gestational diabetes and also have trouble breathing. Other than this, swollen ankles, trouble sleeping, and heartburn may cause you distress. Backache is also a common occurrence during this time. But some women also experience sciatica pain during their pregnancy.

This is basically a shooting pain that originates in your hips and radiates down your foot. It happens when your sciatic nerve is compressed. This nerve runs below the uterus and it may get compressed when the growing foetus pushes against it. At times, this pain can be so severe, that it may be a problem for you to walk around, sit or even lie down. Since during this time, pain medications are usually not allowed, you can try to get relief from this pain naturally.

Symptoms of pregnancy sciatica pain

If you have this condition, you will experience pain on one side of your buttocks or leg. It may be continuous or occasional.  This sharp or burning pain may radiate from the buttocks down the back of your thigh and on to the foot. You may also experience numbness or weakness in the affected leg and difficulty walking, standing, or sitting. Pregnancy sciatica is a temporary condition, and, at any other time, your doctor would have prescribed an over-the-counter pain reliever. But these non-steroidal anti-inflammatory drugs are usually the last resort during pregnancy as it can cause certain complications. Therefore, here are a few natural remedies for this condition.

Get regular prenatal massages

Prenatal massages are important not only to get rid of aches and pains but also for healthy fetal development. If you have pregnancy sciatica, this can help you avoid the compression of the sciatica nerve. Regular deep tissue massages, especially on the hip and lower back, will help. But get the massage done by a professional and under the guidance of your doctor to avoid complications.

Stay physically active

Regular exercise during this time can offer relief from sciatica pain. It will reduce inflammation, improve blood flow and realigning your joints and muscles. During pregnancy, your body secrets a hormone called relaxin. This loosens your ligaments to allows your pelvic girdle to spread more easily in preparation of a normal delivery. This may also cause sciatica pain. But exercise can help significantly. But be sure to consult your doctor before starting your fitness routine.

Take magnesium supplements

The mineral magnesium corrects nerve function. You can have this in the form of supplements or source it from foods. Alternatively, you can also use magnesium oil to massage your legs. This promotes nerve regeneration and decreases inflammatory response.

Adopt prenatal yoga

This can offer relieve from sciatic nerve pain. However, you need to first consult your doctor and the proceed. Once you get the go-ahead from your doctor, you can join a certified prenatal yoga class.

https://www.thehealthsite.com/pregnancy/pregnancy-sciatica-natural-ways-to-get-relief-762201/

Sciatica: what it is and how to treat it

From 220triathlon.com

Sciatica’s debilitating, making every little task painful, never mind training for a triathlon. Here, physio Christos Kostas explains causes, symptoms, treatment and prevention

Some triathletes might be at more risk of sciatica than others and, for those athletes, it can put them out of sport for weeks at a time and be hard to work around. But what exactly is sciatica, what are the warning signs, how do you treat it and, better still, how do you prevent it in the first place?

What is sciatica?

Sciatica is named after the origin of the pain it causes – the sciatic nerve. The sciatic nerve is the largest nerve in the body, starting in the lower spine, going deep in the buttock and down to the feet.

Sciatica generally flares up for four to six weeks, but in some individuals it might last longer. As the sport of triathlon has continued to grow, increasing numbers of triathletes have checked into neurosurgery clinics with complaints related to various spinal issues (1).

What causes sciatica?

Sciatica is generally caused by the nerve being trapped, whether it be by a herniated disc, bone spur on the spine or, most commonly, a tight muscle trapping the nerve. For triathletes, muscle compensation from past injuries (that haven’t fully recovered) is the most common cause of sciatica.

The condition is actually relatively common in athletes and the general population alike. One questionnaire directed at triathletes specifically found that lifetime incidence of lower-back pain was 67.8% with 23.7% of cases possibly starting with disc problems (1). Of the three sports incorporated in triathlon, cycling seems to have the major risk factor for lower-back pain in triathletes (2).
It’s important to note that most people over the age of 35 have a disc bulge and feel no symptoms. Indeed, even if you have sciatica and a disc bulge, it’s relatively rare that that is the cause of your sciatica. So don’t panic.

What are the symptoms of sciatica?

Common symptoms of sciatica include:

• Back pain
• Pain in the back of the leg
• Hip pain
• Burning or trickling sensation
• Shooting pains in the lower body

More often than not, the pain will fire through one side of the body if the legs or feet are affected, not both.

Sciatica might be diagnosed immediately if it follows a significant accident or injury. If it’s more of a slow onset that worsens over time, it might take a little longer to get a treatment plan in place. Initial assessment will involve questions and being asked to ease into a few different stretches or exercises to determine which results in the most pain.

Further tests can involve examining nerve impulses and imaging of the spine to look for abnormalities such as a slipped disc.

How can you treat sciatica?

Most people will reach straight for an over the counter painkiller such as Ibuprofen when pain and inflammation strike. This can certainly be a tool used in the short term to allow for sleep and day-to-day life to continue without being impeded too much, but we also need to look into longer-term solutions.

Hot and cold treatment can also be useful for short-term relief. An ice pack wrapped in a towel can be applied to the area for 20 minutes a day to relieve swelling and inflammation, especially after a competition or training session has caused sudden pain. After two or three days, you may find heat application is more beneficial. The two can be alternated to determine which is most effective.
If you have a prolapsed disc that doesn’t need urgent surgery, your best cause of action is to build the muscles of the lower back – strong things rarely break!

If it’s muscular, a good physiotherapist would identify the muscles in spasm and release them in two or three sessions. Only then would they prescribe a specific stretching programme (stretching can make acute sciatica worse), followed by strengthening exercises to further support the back. A strength programme with barbells – not bands or bodyweight – is the secret to preventing repeat injuries.

Stretches to improve posture and relieve some of the tension of the nerve can be helpful in treating sciatica. These might include cobra poses, prone arm and leg lifts, and upper pigeon poses. Core strengthening can also be useful. A qualified physiotherapist will be able to advise on the best stretches and exercises for you depending on the severity of your sciatica.

If lumbar disc herniation is the culprit, acupuncture has great success rates of 96.7% in a trial of 30 patients. Acupuncture is a treatment of traditional Chinese origin where fine needles are inserted into the body – in this scenario, into the sciatic nerve trunk – for therapeutic benefit. Treatment can be available through a GP or physiotherapist on NHS referral, or through private appointment.

In rare cases, sciatica cannot be repaired with these options. Surgery is the last resort for about 5-10% of people with sciatica. The two most common types of surgery are discectomy, which involves removing the part of the disc putting pressure on the nerve, or microdiscectomy, which uses a microscope to remove the disc through a small incision.

How can you prevent sciatica?

The two main risk factors for long-term spinal problems include sports-related injuries and overuse. For this reason, it can be beneficial to work on factors such as form and technique while running or on the bike to prevent unnecessary pressure on the spine and nerve. This is where a good strength programme focusing on your hips, glutes and lumbar erectors – the muscles that support your spine – will help. When we repeat the same action thousands of times our body fatigues, causing our technique and posture to fail. The stronger we are, the longer we can keep in an optimal position. This protects the back and spine and leads to faster times.

It’s also key to have a programme that allows adequate rest between training sessions. This might mean periodising training so that volume and frequency change over the season.
The chance of developing sciatica can also be increased by being overweight. Assuming most reading this are healthy and active, this is more something to be mindful of for later life if you’re already experiencing some symptoms. Age and inflammation are also risk factors for sciatica. As you age, be sure to maintain mobility in your hips and ankles. Two good tests are your ability to sit comfortably cross-legged on the floor for five minutes and to perform bodyweight squat below parallel without your heels lifting off the floor.

As you age, be sure to maintain mobility and flexibility in your back. Also, be sure to combat inflammation with antioxidants from eight or more portions of fruits and vegetables. I’d also recommend the use of dietary supplements such as a daily dose of omega-3.

Like with any health issue, if you have any concerns at all, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist. 
Christos Kostas is a physiotherapist with salecca.co.uk

https://www.220triathlon.com/training/injuries/sciatica-what-it-is-and-how-to-treat-it/