Ask Your Spine Doctor : Dr Niraj Vasavada

From ahmedabadmirror.com

I would like to know if I have acute sciatica or back pain. What should I do as first aid before consulting an expert?

Most cases of acute back pain or sciatica follow a benign course. The first step you should take is to introduce a break into your fast-paced schedule. By “relative rest,” I mean reducing your activity level to 50-60% of your normal intensity. Over-the-counter pain medications like paracetamol can help control pain. Avoid prolonged sitting and make frequent changes in your posture. Following these steps, most back pains resolve within 3-4 days. If the pain persists, it’s advisable to consult with an expert.

I am a 65-year-old male experiencing numbness in my fingers. Does this mean I will be paralysed?

It’s a common misconception that numbness is an early sign of paralysis. In most cases, feelings of numbness are non-specific. It’s recommended to wait and observe for a few days, as numbness often resolves on its own. If it persists, consulting an expert is advised. However, there is no need to worry about paralysis.

I am a 71-year-old female diagnosed with Lumbar Canal Stenosis. Can it be cured without surgery? Everyone says I shouldn’t undergo surgery.

Lumbar canal stenosis refers to narrowing or blockage of the space for nerves in the spinal canal, leading to symptoms such as back pain, leg pain, numbness, imbalance, and difficulties in movement. Initially, we typically manage the condition with a short course of anti-inflammatory medications and physiotherapy and many  patients show improvement. For those who do not improve, surgery may be required to address the disability. Concerning the advice you’ve received about avoiding surgery, it’s essential to understand that not everyone offering opinions is a subject expert. 

https://www.ahmedabadmirror.com/ask-your-spine-doctor/81867383.html 

You’ve got some nerve: How and why sciatica causes pain

From veronews.com

Sciatica refers to irritations – sometimes severe – of the sciatic nerve, the body’s largest nerve. According to the Harvard Health newsletter, as many as 40 percent of the population will suffer from sciatica during their lifetime.

Dr. Shivam Upadhyaya, an orthopaedic surgeon at South Florida Orthopaedics, says nature and nurture both come into play for those dealing with sciatica. “Genetics can definitely play a role,” he says. “Add to that our American lifestyle that includes lack of core strength and flexibility, being overweight and sitting a lot for work, and it’s a challenging combination.”

He adds that even the type of shoes we wear can contribute to the development or worsening of sciatic pain. Flip flops and high heels both offer little or no support and many popular styles force your body and feet into unnatural positions.

According to PennMedicine, the University of Pennsylvania’s website, the most common causes of sciatica involve trauma to the nerves higher in the spine that combine to form the sciatic nerve. The correct treatment depends on the cause, which may include a slipped or herniated disc, spinal stenosis, piriformis syndrome (a pain disorder involving the muscles in the buttocks), pelvic injury or fracture, pinched nerve or late stages of pregnancy.

Upadhyaya says age probably affects the cause of your sciatica. “When someone in their teens or 20s experiences sciatica, it’s usually because of sports, exercise or workplace injuries.” Active people who lift a lot or twist their lower body may experience herniated discs that lead to sciatic pain.

For older patients, he says, “decades of wear and tear cause your discs to flatten out, which leads to a different set of issues.” Mayo Clinic concurs, advising that age-related changes in the spine, including bone spurs and herniated discs, cause sciatica. If you are over 50, chances are good your sciatica is due to nerves, muscles and bones degenerating. The inflammation of your nerves leads to sciatica as you advance in age.

Generally, symptoms include a dull, aching, shooting or “burning” pain that starts in your lower back and/or buttock and radiates down one of your legs. Back pain accompanied by leg pain is the key symptom that suggests you have sciatica rather than another type of back pain. You may also feel neuropathies such as numbness, a “pins and needles” tingling sensation, muscle weakness or altered reflexes.

Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.

MedicineNet says that, depending on symptoms and the extent of the condition, sciatica can be categorized into four types: acute, chronic, bilateral and alternative.

• Acute – caused by sudden irritation to the nerves due to pinching, compression or a combination of both. Symptoms as outlined above may also include difficulty sitting as symptoms get worse. Pain can last one to two weeks.
• Chronic sciatica – can last months or years and may occur intermittently. Conditions that can worsen the pain include inflammatory conditions, injuries, infections and spinal misalignment issues. May resolve temporarily but can recur without treatment or lifestyle and activity adjustments.
• Bilateral sciatica – a rare type of sciatica that affects both legs. May be caused due to multiple herniated discs or disc degeneration. Pain may be felt in both legs and buttocks at the same time or be more severe in one leg.
• Alternative sciatica – a rare type of sciatica that can cause pain in both legs alternatively. Can result from degenerative problems in the sacroiliac joint or sacroiliac arthritis.
  Sciatica usually heals on its own with rest and time. To help relieve the pain, treatment may include:
• Nonsteroidal anti-inflammatory (NSAIDS), medicines such as ibuprofen.
• Heat or cold applied to the sore muscles.
• Movement (keeping your body in motion minimizes inflammation).
• Osteopathic manipulation.
• Surgery (to repair a herniated disc if the condition persists).
  “If your pain isn’t responding, by all means see an orthopaedist if you can’t meet with your PCP,” he says. You’ll definitely want to consider a doctor’s visit if:
• You are under age 20 or older than 55 and having sciatica for the first time.
• Your symptoms are severe.
• You have weakness in a leg or foot.
• You have a fever in addition to your pain.
• You have a history of cancer.

Dr. Shivam Upadhyaya has a BA in Medical Sciences from Boston University and a medical degree from Boston University School of Medicine. He completed his internship at Massachusetts General Hospital and his orthopaedic surgery residency at Harvard Medical School. He also completed a fellowship at Norton Leatherman Spine Centre in Louisville, Kentucky, and is a member of American Academy of Orthopaedic Surgery. South Florida Orthopaedics is located at 9401 SW Discovery Way, Port St. Lucie: 772-288-2400.

https://veronews.com/2023/11/10/youve-got-some-nerve-how-and-why-sciatica-causes-pain/ 

What is the best muscle relaxer for sciatica?

From expresshealthcaremgmt.com 

Sciatica is a condition characterized by pain that radiates along the path of the sciatic nerve, which runs from the lower back through the hips and down each leg. It is often caused by a herniated disc, spinal stenosis, or other spinal conditions that put pressure on the nerve. Muscle relaxers can be an effective treatment option for relieving the muscle spasms and tightness associated with sciatica. But with so many options available, which one is the best?

FAQ:

Q: What are muscle relaxers?
A: Muscle relaxers, also known as skeletal muscle relaxants, are medications that help reduce muscle spasms and relieve muscle pain. They work by blocking nerve impulses or reducing the excitability of the muscles.

Q: How do muscle relaxers help with sciatica?
A: Muscle relaxers can help alleviate the muscle spasms and tightness that often accompany sciatica. By relaxing the muscles, they can reduce the pressure on the sciatic nerve and provide relief from pain.

Q: What are some commonly prescribed muscle relaxers for sciatica?
A: There are several muscle relaxers commonly prescribed for sciatica, including cyclobenzaprine, methocarbamol, and baclofen. These medications work by targeting the central nervous system to relax the muscles.

When it comes to determining the best muscle relaxer for sciatica, it ultimately depends on the individual and their specific needs. Different muscle relaxers may work better for some people than others, and it may require some trial and error to find the most effective option.

Cyclobenzaprine, also known by the brand name Flexeril, is one of the most commonly prescribed muscle relaxers for sciatica. It is known for its sedative effects and can help relieve muscle spasms and pain. However, it can also cause drowsiness and may not be suitable for everyone.

Methocarbamol, sold under the brand name Robaxin, is another muscle relaxer that is often prescribed for sciatica. It works by depressing the central nervous system and has a milder sedative effect compared to cyclobenzaprine.

Baclofen, available under the brand names Lioresal and Gablofen, is a muscle relaxer that acts on the spinal cord to reduce muscle spasms. It is often used for conditions such as multiple sclerosis and spinal cord injuries but can also be prescribed for sciatica.

In conclusion, there is no one-size-fits-all answer to the question of which muscle relaxer is the best for sciatica. It is important to consult with a healthcare professional who can evaluate your specific condition and medical history to determine the most suitable option for you.

https://www.expresshealthcaremgmt.com/news2/what-is-the-best-muscle-relaxer-for-sciatica/280026/

Management of low back pain in pregnancy

From dailyexcelsior.com

By Dr Rohit Lahori

Low back pain (LBP) is a common complaint amongst women during pregnancy, having a great impact on their quality of life. Most women consider LBP as an inevitable, normal discomfort during pregnancy.

Only 50% of women suffering from pregnancy related LBP will seek advice from a health care professional and 70% of them will receive some kind of treatment. It has been estimated that about 50% of pregnant women will suffer from some kind of low back pain at some point during their pregnancies or during the postpartum period (post pregnancy 6 weeks). Literature clearly indicates that LBP in pregnancy may be disabling, limiting everyday activities, impacting productivity and should not be ignored or left untreated. Pregnancy related low back pain, seems to be a result of quite a few factors, such as mechanical, hormonal and others. Low back pain presents either as pelvic girdle pain (PGP) or as a lumbar pain (LP) . The source of the pain should be diagnosed and differentiated early. The appropriate treatment aims to reduce the discomfort and the impact on the pregnant woman’s quality of life.

PGP and LP are two different patterns of LBP during pregnancy, although, a small group of women suffer from combined pain. PGP is common during pregnancy and postpartum period and approximately four times as prevalent as LP. It is described as deep, stabbing, unilateral or bilateral, recurrent or continuous pain, presenting below umbilicus and hip area and sometimes, possibly going into lower limb, but not to the foot. PGP is more intense during pregnancy than during postpartum period. LP during pregnancy is very similar to low back pain experienced by women who are not pregnant and it appears as pain over and around the lower back . It may or may not radiate to lower limb, in contrast with PGP. LP aggravates at postpartum period and usually exacerbates by certain activities and postures (e.g. prolong sitting) but it seems to be less disabling than PGP . 

Pregnancy related LBP usually begins between the 20th and the 28th week of pregnancy, however it may have an earlier onset. One of the most frequent mechanisms suggested, is associated with the mechanical factors, due to weight gaining during pregnancy, to the increase of the abdominal sagittal diameter and the consequent shifting of the body gravity centre anteriorly causing lordosis and increasing stress on the lower back, a biomechanical process suggests that the abdominal muscles of the pregnant woman stretch to accommodate the enlarging uterus, causing muscle fatigue and resulting to an extra load on the spine. Some pregnancy induced hormones like Relaxin causing ligamentous laxity, in pelvic joint, and also generalized discomfort. Sciatica is rare clinical entity of LBP during pregnancy, appearing in only 1% of women.

The diagnosis of LBP during pregnancy and the differentiation between LP and PGP is usually based on symptoms, due to the few existing diagnostic tools. Physical examination, can distinguish LP and PGP, since these entities present differences in the location of pain and the results of provoking tests. . It is not possible to estimate the risk, or to predict who will suffer from LBP during pregnancy, however, women with a history of LBP before pregnancy, are most likely to suffer from more severe pain and of a longer duration after childbirth. LP is more strongly connected with back pain history before pregnancy, compared to PGP

Early identification and treatment, taking under consideration the individuality of every woman and pregnancy, provide the opportunity for the best possible outcome. Pregnant women should be educated on how they can maintain a proper posture, while doing everyday activities, so that their back is not overloaded and misaligned. That can be easily performed if practiced and can be enhanced by exercises and Yoga under guidance. Physical activity before pregnancy is correlated with a decreased risk of developing LBA. It is also very important for women to learn how to lift weights without stressing their backs, a habit that can prove very useful throughout pregnancy. Women should be advised to use proper seats, cushions and beds, as well as techniques for getting in and out of bed, so that the body maintains in a proper position and the spine is supported and not stressed. Women are also encouraged to take a midday rest to relieve their muscles and to avoid prolonged walking or standing. Everyday activities and exercising, which aggravate symptoms, should be avoided. A good nutritious diet less of fat rich in vital minerals is the key for good health in pregnancy. 

During acute episodes of PGP, brief rest and lying in bed can be useful. Some exercises for bed rest, such as using pillows to support the legs and squeezing the legs together when rolling, can be useful as well. Over flexion of the hips and the spine should also be avoided, while sitting. The use of a sacral belt helps to alleviate symptoms. In the line of an individualized treatment program, massage might be helpful. Conservative management of LBP is the treatment of choice. A correct diagnosis and a differentiation between PGP and LP are of the utmost importance, since the treatment is different. Weight loss strategies during postpartum and prevention of weight gain may help to prevent the risk and the severity of LBP.

(The author is Pain Specialist Govt Hospital Gandhinagar Jammu)

https://www.dailyexcelsior.com/management-of-low-back-pain-in-pregnancy/ 

What's Causing That Pain in Your Butt?

From healthcentral.com

About a third of all lower back or butt pain is related to piriformis syndrome, and can be relieved with stretching and strengthening exercises

A deep ache or pain in your glutes, which may also radiate down one leg, is one tipoff that you might have something called piriformis syndrome. In this disorder, radiating pain originates in the piriformis muscle, a band of tissue that stretches from the front of your sacrum (the triangular-shaped bone at the base of your spine) to the top of your thigh bone (the femur) on each side.

The piriformis muscle externally rotates your legs and helps stabilize the hips. But when the muscle gets irritated, often from trauma or overuse, it can cause pain. And since the sciatic nerve, which exits the spine in the same general area as the piriformis and extends down the back of each leg, runs close to the muscle (in almost 25% of people it even penetrates piriformis muscle fibres), when the piriformis is aggravated, it can irritate surrounding nerves as well, causing pain down the leg (a.k.a. sciatica), says Nadya Swedan, M.D., a physiatrist in New York City. “It can be so severe it will keep people up at night or make it difficult to sit for long periods,” she adds.

Causes and Risk Factors

Piriformis syndrome is implicated in up to one third of cases of low back and sciatica pain, according to a review in Practical Neurology. Overuse is a key contributor to piriformis syndrome, says Dr. Swedan. “It’s especially common in people who spend long hours commuting in their car in traffic—pressing on the brake, then the accelerator, which requires you to turn your foot in and out.” But even sitting at a desk for several hours a day can do it, especially if you often shift to one side or sit with your foot tucked beneath your butt.

Runners and walkers can also be at risk, especially if they have an underlying weakness in their glutes. “When you land [while running] on the side with the weak glute, the leg rotates in, which stretches the piriformis,” says Laurel Proulx, D.P.T., Ph.D., a clinical assistant professor at Baylor University’s Department of Physical Therapy in Waco, TX. This process repeats every time you bring that leg forward.

Certain other workouts can also be to blame. “We also see it frequently in people who do a lot of barre classes because they spend so much time with their hips in external rotation,” notes Proulx.

Finally, direct trauma to the area—such as falling on your backside—can cause an inflammation in the muscles and trigger the injury.

Why Women Are at Higher Risk

Simply being female raises your risk of experiencing piriformis syndrome. In fact, women are diagnosed with it six times more often than men. This may be due to a few anatomical differences: First, women tend to have a wider Q angle than men. This is the angle between the thigh muscles (a line drawn from the front hip bone down to the knee) and the patellar tendon (a line drawn through the knee and down the front of the shin). The greater angle may alter the balance of the stabilizing muscles around the hip, which can aggravate the piriformis. Second, a study of 224 Japanese athletes, published in the Journal of Physical Therapy Science, found that the female athletes had almost 50% greater internal rotation of the hip joint than men (and a 40% higher incidence of lower limb sports injuries), which may also alter piriformis mechanics.

Finally, research published in the journal Surgical and Radiologic Anatomy found that in many people—especially women—the piriformis muscle attaches in a spot on the sacrum that can potentially compress sacral nerves, in addition to the sciatic nerve.

Signs and Symptoms

In short: It’s a pain in the backside. The main symptom of piriformis syndrome is an aching pain deep in the buttock, just to one side of the sacrum, and sometimes closer to the “sit bone” area. You might feel it while sitting, going up stairs, or moving from a sitting to standing position. When you (or your doctor) press into the area or place a tennis or lacrosse ball there, it can be tender. “It often feels tight and knotty when we palpate it,” says Dr. Swedan. There may also be numbness or burning, shooting, or tingling sensations down back of the leg and even into the lower leg, which reflects the path of the sciatic nerve and its branches.

Getting the Right Diagnosis

Piriformis syndrome is really a diagnosis of exclusion, notes Proulx—which means your doctor may diagnose it after eliminating other potential problems through different tests and exams. “It’s called a ‘syndrome’ because it can involve multiple tissues and movement patterns,” she says. “[The term] is really explaining the region of the pain, not the dysfunction causing the pain. That’s why it’s important to differentiate it from back pain and rule out other causes.”

All of these issues can potentially aggravate nerves and cause pain in the hip and down the leg:

• Arthritis of the low back

• Bursitis around the hip joint

• Herniated disc

• Sacroiliac joint problems

• Spinal stenosis (a narrowing of the spinal canal)

“We’ll also check to see if there is sciatic nerve involvement,” says Proulx. “A lot of times we think of it as irritation, inflammation, and pain of the piriformis muscle, but that can affect the sciatic nerve, which is nearby.”

If your case is unclear or isn’t resolving, an MRI can confirm a diagnosis, although you may be required by your insurance to try physical therapy first before getting an MRI.

Treatment Options

There are a few different choices to address the pain from piriformis syndrome. They include:

• Heat. This can help relieve piriformis pain, especially if you’ve had it for more than a couple of days or if it feels tight, says Dr. Swedan.

• Myofascial release (MFR). This includes using a tennis or lacrosse ball, foam roller, or a percussive device such as a Theragun to help release muscle tightness. However, this only really works if you follow up immediately with moves that help retrain the muscle by stretching and/or strengthening it, says Proulx.

• Pain relievers or pain patches. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may temporarily ease inflammation in the affected area.

• Steroid or Botox injections. These seem to work if nothing else is helping, according to a review of piriformis treatment techniques published in Cureus.

But you may need to do more to find long-term relief. “These things will manage the symptoms, but they won’t treat the cause of the issue,” says Proulx. That’s why you want to see a professional, who can help pinpoint other potential causes of piriformis syndrome. They’ll watch how you move (walking, running, squatting, standing on one leg) and check your range of motion and muscle strength, says Proulx. This will help them determine whether there are muscle imbalances or even leg length discrepancies that should be corrected in order to get the piriformis to work properly. A physiatrist, orthopaedist, physical therapist, chiropractor, or acupuncturist who specialises in treating orthopaedic issues can all help.

Preventive Strategies

You may be able to avoid this pain in the rear end with a few proactive strategies:

• Change up your routine. You may love your barre class, but it may be contributing to muscle imbalances. Adding in some regular strength training, yoga, or Pilates can give your hip muscles a more well-rounded workout.

• Get cruising. If you have to spend hours in the car, use your cruise control when you can so you don’t have to constantly be rotating your leg back and forth, says Dr. Swedan.

• Sit right. Try to sit with both feet on the floor, without crossing your legs or having one leg tucked under you. Spending hours a day that way can contribute to muscle imbalances. “If you have to sit, change your seat level so your hips are even with or higher than your knees,” says Dr. Swedan. (This also includes raising the seat height in your car if you can.)

• Stand more. If you have a desk job, schedule hourly (or semi-hourly) walking breaks to stretch your legs.

The Best Exercises for Relief

It’s important to work with someone who can tell you if your piriformis syndrome is due to the muscle being too strong, too weak, too contracted, or too stretched, since all of these can result in pain. Once you have that figured out, the following may help.

Roll Out

Hip Rolling: Place a foam roller on the floor and sit with your hips along the wide part, knees slightly bent (place hands on floor behind you for balance). Cross the ankle of the painful side across the opposite knee and then lean over to the painful side until you feel tenderness. Once you find it, hold for 30 to 60 seconds, then shift and try to find another tender spot and repeat. You can also do this with a tennis or lacrosse (more intense) ball under your hip.

Stretch the Piriformis

Leg Cross: Lie faceup and draw the knee of the painful side toward your chest. Place your opposite hand on the knee and draw it across your body, so you feel a stretch through the hip. Hold for 30 to 60 seconds; repeat on the other side if you need to. Repeat once or twice. (If your piriformis is already overstretched, you don’t need to stretch it, but you may need to stretch other muscles, such as the adductors, or inner thigh muscles.)

Strengthen the Piriformis

Lateral Band Walks: Place a looped resistance band around your upper legs, just above the knees, and stand with your feet shoulder-width apart, hands on hips. Shift your hips back into a half-squat and step out to the right with your right leg. Bring the left leg in so your feet are shoulder-width apart again and continue. Take 10 steps to the right then repeat to the left, staying in the squat and keeping your knees parallel the entire time (don’t let the knees cave together or flare out). Do two sets to each side. (Note: Dr. Swedan recommends avoiding strengthening moves for the piriformis until you no longer have pain, otherwise you run the risk of overworking it and making the problem worse.)

Work Your Hip Stabilizers

Bird Dog: Start on all fours, hands under your shoulders and knees under your hips. Keep your head in line with your spine (don’t tuck your chin or look up). Extend your right arm forward as you extend your left leg back. Your arm, leg, shoulders, and hips should be parallel to the floor. Hold for up to 30 seconds then switch sides and repeat.

Bottom Line

There are many things that can go wrong in the low back and hip, potentially leading to a vague pain in your buttock. The first step to reducing piriformis pain is to spot any potential postural problems or overuse of the muscles with the help of a professional. With the right exercises and professional guidance, you can retrain the muscle to help stabilize your hips, allowing you to get on with your day—pain-free.

https://www.healthcentral.com/condition/sciatica/pain-in-the-butt