NO. 1 Sciatica Pain Clinic

What is sciatica?

Sciatica is characterized by sensory changes or weakness along the sciatic nerve pathway and is also often called lower extremity (L5/S1) radiculitis or radiculopathy. Those suffering from sciatica describe the sensation as “pins and needles” that affect the posterior buttocks, legs, and feet. Cauda Equina Syndrome is a medical emergency involving the loss of bowel and/or bladder control that results from sciatica. Other symptoms that are cause for concern include lower extremity weakness, bladder or bowel incontinence, or nerve impingement.

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The sciatic nerve is the longest, largest nerve in the body. It is responsible for sensations felt in the lower extremities. It exits the spine through the lower portion of the spinal column, runs behind the hip joint, exits on the backside (posterior) of the lower extremities, and goes all the way to the foot. “Sciatica” refers to pain that is experienced along the sciatic nerve.

Conditions related to Sciatica

There are several conditions that can eventually lead the sciatic nerve to become stretched or pinched. Some of the common conditions include spinal stenosis, facet hypertrophy, herniated or bulging discs, and piriformis syndrome. Spinal Stenosis is a condition where narrowing of the spinal canal causes irritation of the spinal cord or sciatic nerve. Spinal stenosis is marked by persistent pain in the lower extremities and back, difficulty walking, desensitization of the lower extremities, and a decline in physical activity. Facet hypertrophy is what happens when facet joints become arthritic, knobby, and sometimes develop cysts. Larger facet joints can cause sciatica when the nerve endings become irritated or inflamed. Herniated discs are the most common cause of sciatica. When the cushioning discs between the vertebrae become compressed, they often push posterior (backward) to nearby nerves and ligaments. This can cause considerable pain. Piriformis syndrome happens when the piriformis (a large muscle that is part of the pelvis) becomes inflamed or overused, causing the sciatic nerve to become trapped in the buttock.

A Sciatica Diagnosis

In order to diagnose sciatica, a physician will first perform a physical examination in order to demonstrate tenderness over parts of the spine. This will also allow the physician to assess the range of motion in the lower extremities to determine limitations. The doctor will likely order an MRI to see abnormalities in the soft tissue, but might also order other radiological imaging to get the whole picture. 

Sciatica Pain Clinic Treatment

There are several different treatment options when it comes to sciatica. Chances are that combining modalities together will result in optimal results. Some of the options a doctor and patient might consider include:

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• Pharmacotherapy- The most effective pharmaceuticals for treating sciatica include NSAIDs (ibuprofen), Acetaminophen (Tylenol), membrane stabilizing drugs, and muscle relaxants.
• Epidural Spinal Injection- As the name implies, ESI involves the injection of steroids into the epidural space inside of the spine, which spreads to other levels and portions of the spine. This reduces inflammation and irritation.
• Lysis of Adhesions- Also known as “Racz procedure,” has proven effective in the removal of scar tissue in the epidural space of the spine where more conservative options have failed. The procedure is used in vertebral body compression fractures, radiculopathy, post-laminectomy syndrome, and disc disease.
• Deep Tissue Massage- A massage can be beneficial in reducing stress and tension that might contribute to pain symptoms, and can also help relieve muscle spasm and contractions.
• Nutrition and Exercise- Combined with exercise, a healthy diet often reduces the pain associated with sciatica by increasing flexibility and range of motion. This also releases endorphins, which are the body’s natural pain reliever.
• Acupuncture- When small needles are inserted into the skin during acupuncture, the body naturally releases endorphins. Acupuncture can also help people relax, decreasing tension, stress, and muscle spasms.
• Physical Therapy- Physical therapy can be very helpful by building muscles around a degenerated area and reducing pain signals. Physical therapy works best when combined with other modalities.
• Biofeedback- Biofeedback is a treatment that teaches patients to be more in tune with their body and helps them regulate otherwise involuntary processes (such as heart rate or blood pressure). When a patient is more in tune with their body it is easier for them to relax, which can in turn alleviate pain.
• Transcutaneous Electrical Nerve Stimulation (TENS)- TENS works by introducing electrical stimulation through the skin of the affected area. The electrical signals interrupt pain signals causing a tingling sensation rather than pain.
• Botox- Botox works by paralyzing the nerve ending at the site of injection. Although Botox was originally used for cosmetic purposes, it can also be helpful in pain relief, especially if a patient suffers from whiplash injuries and cervical dystonia. This treatment will reduce pain, and often times increase range of motion within the affected area.
• Trigger Point Injections – These injections are an effective treatment for muscle spasms. The procedure involves the injection of local anesthetic and steroids into a trigger point, or the origin of the pain.
• Peripheral Nerve Stimulation (PNS)- This treatment is similar to a spinal cord stimulator. Electrodes are placed near affected peripheral nerves instead of attached directly to the spinal cord.
• Spinal Vord Stimulation- A spinal cord stimulator is an electrical device that is implanted in the body in order to decrease pain by confusing the spinal cord and brain pain processing centers. A trial SCS will be externally placed in order to test how effective it will be to a particular patient. If pain is relieved during a trial period, a permanent SCS will likely bring great back pain relief.

For more information on how we can help treat your sciatica pain, please contact us at 470-424-8888.