Sciatica

Definition

The long and very large nerve named sciatic which supplies the muscles of the thigh, leg, and foot, and the skin of the leg, running the entire length of the leg becomes inflamed to cause sciatica. The pain is felt in the thigh and other areas associated with the sciatic nerve, buttocks, knee, leg, and even foot in severe cases. It may be caused by a slipped disk, or an inflammation in or around the vertebral bones. An abnormal condition in nearby blood vessels may press on the nerve. Hardening of the arteries can cause reduction of blood supply and pain in the nerve. Poor muscle tone, or contracted ligaments, may also cause a problem with sciatica.

Prevention

• Learn to hip bend not waist bend.
• Learn not to sit on one foot.
• Avoid a one-sided twist to do any commonly done task, such as reaching for toilet tissue; getting out of bed; or reaching for the telephone. Change your furniture around to avoid a constantly repeated twist to the same side.
• Avoid sustained flexion of the back as stooping to cook, write, or drive a car. Avoid long sitting. Do not put your hamstrings (large muscles at the back of the thighs) on a prolonged stretch, as in sitting while the knees are straight in front of you such as in driving a car for hours.
• Get out of bed correctly. A side bend in getting out of bed may eventually lead to pain on the opposite side in sciatica.

Evaluation of Sciatica

• Is it sometimes better or well; or is it constant? If the latter, it needs vigorous treatment to prevent its progressing to acute inflammation and disability.
• Is it felt in the buttocks, knee, or foot? The greater the distance from the low back to the end of the pain, the more difficult to treat.
• Is it now all the way down to the foot (the low response type below the knee)? The severity of the case is reflected by the length of the leg involved.

Treatment

The treatment is in several phases. The first phase is aimed at centralizing the pain (bringing it to the back, if possible, from the thighs, legs, or foot).

• Phase A — used in acute and disabling sciatica
  1. Lie on the abdomen with enough pillows under the chest for neck comfort.
  2. Then put the same number of pillows as you have under the chest plus one more pillow under the abdomen, so that the lumbar spine is in the neutral or slight flexion position.
  3. In such a position, put heat on the back. The objective is to get pain out of the ankle area even if it is worse in the thigh. Patients often describe it as, “The pain moved up my leg”.
  4. While still on the abdomen, put both the painful leg and the other leg over toward the painful side so that the patient is in a sidewise bend toward the painful side. Remain some time in this position, 15-60 minutes. Increase the degree of the bend toward the pain and hold for 15 minutes if possible, or decrease the bend if the patient complains severely, depending on whether the pain is less or more.
  5. If the patient gets centralization of pain to above the knee or even above the thigh, or even significant lessening of pain in leg or foot, then you are ready to slowly reduce the flexion of the spine. Do so by reducing the number of pillows under the abdomen, or by putting another pillow under the chest. Do Not Move Off The Pillows, but simply do a pushup to get readjusted. You can now go back to the neutral position of the side wise bend.
  6. Then gradually put the back in slight extension (head and shoulders back, hips back to make a backward bend). Make no abrupt change to get in extension. You may need to go very slowly. This part of the treatment takes quite a lot of time in some patients, an hour or more, so be prepared to be patient.

   

• Phase B —used when pain is better and more tolerable
  
  1. Stretching exercises such as given for leg cramps. Face a wall standing two feet away from it. While keeping the heels flat on the floor, lean the chest into the wall for ten seconds. Push away for five, and repeat three times. Then turn the side to the wall from the two foot position, and lean the hip into the wall, ten seconds in and five out, three times. Turn the opposite hip toward the wall and repeat with the opposite hip. If this side movement causes pain, move closer to the wall to do the exercise. Gradually increase the distance day by day from the wall.
  2. Winging and bridging exercises to strengthen the back. Lie on the back and support the body on heels and shoulders, keeping all other parts off the floor (bridging). Lie face down, and support the body on the abdomen keeping all other parts off the floor (winging). Hold each of these three seconds on the first day. Build up to 30 seconds three times daily for 90 days.
  3. Hot compresses over the buttocks, thigh, leg, and ankle, over the area of the pain. Make the hot portions 20 to 30 minutes, interrupted every 3 to 5 minutes for 30 to 60 seconds of ice cold compresses.
  4. Try using an ice pack to the back to control pain. Crush ice, put it in a plastic bag within a second bag.

   

• Phase C — used at all stages
  1. The diet should be free from free-fats, and dairy products. The totally vegan diet - no milk or egg products, and no meat - is the most favorable, both in the treatment phase as well as in prevention.
  2. Give a trial of omitting the nightshades (tomatoes, potatoes, eggplant, and peppers), as an irritation from food sensitivity may also be a part of the problem.