|Wednesday, September 1
As summer winds down, more people are likely to head indoors to either start or continue a fitness program. If weight training is part of the plan, then it's important to be aware of a condition called sciatica, a nerve irritation that can possibly arise from improper lifting technique.
Sciatica, which causes radiating pain through the back, hips, buttocks, hamstrings and lower leg, can actually have a number of causes. Join Dr. Raymond Reiter, a member of the Association of Professional Team Physicians (PTP) and a team physician for the New Jersey Nets, as he talks about sciatica -- what it is, how it develops and what new treatment options are available.
What is sciatica?
Dr. Reiter: Sciatica is a term that refers to irritation of the sciatic nerve, which is made up of five branches of nerves that come out of your lumbar and sacral spine. All five nerves come together to form one trunk, which is called the sciatic nerve. When people irritate a nerve in the back -- for example, from a disc herniation -- they can irritate one of the five nerves that make up the sciatic nerve. It is the longest nerve in the body, running from the lower back through the back of the thigh, where it divides into two branches just above the knee. It subdivides further to innervate all the muscles below the knee, all the way down to the foot. The sciatic nerve also has branches into the hip, buttock and hamstring regions.
The classic, textbook sciatic-nerve irritation symptoms will have the patient reporting initial back pain that's been problematic, and then as the back pain begins to improve, the patient will then start to feel hamstring or calf pain, perhaps even some numbness in the toes. Depending upon which branch of the sciatic nerve is irritated, the pain will follow a certain distribution pattern.
Specifically, how does sciatica develop?Dr. Reiter: In the back, you can have an impingement of the nerve root from the disc, called a mechanical irritation. Or the disc may not technically be touching the nerve; rather, an irritation to the disc causes a chemical irritation that affects the nerve root. So the nerve root can be irritated without direct impingement.
Besides herniated discs, are there any other ways to develop sciatica?
Dr. Reiter: There are quite a few. Disc problems over the years can cause a degenerative condition in the disc that is really an early form of arthritis. Some people have a small canal where the nerves pass through called spinal stenosis, which can be congenital or acquired. These are usually spur formations that protrude into the canal and can press on the nerves. Another way that people get sciatic irritation is from spondylolisthesis, which is a slippage of a vertebral body in front of another. Bad biomechanics or curvature of the back or weak abdominal muscles can contribute to this slippage, which can press on the nerve.
How is sciatica treated?
Dr. Reiter: It depends primarily on the degree of irritation. Most commonly, getting the patient on anti-inflammatory medication to reduce swelling of the nerve root is a good start. Another treatment is to start the patient on an epidural block, a cortisone injection directly into the spinal canal to bathe the inflamed nerves. Certainly a physical-therapy program for back strengthening or lumbar-stabilization exercises are important.
Another form of therapy is called VAX-D (vertebral axial decompression), which is basically a traction table that separates the end plates of the backbones and allows the disc to return to its normal position.
There is a new form of therapy called IDET (intro discal electrothermy), which is a way to heat up the disc to dry it up. When a disc is herniated, the water content of the inflamed disc presses against the nerve. IDET dries up the disc very quickly; normally it might take weeks or months for the disc to dry up naturally, but with IDET it can take just 15 minutes. This procedure, very benign and done under floroscopy (video X-ray assisted), has only come out in the last nine to 12 months.
As a last option, there is laminectomy and discectomy, which removes the herniated portion of the disc.
How can sciatica be prevented?
Dr. Reiter: The most important thing is to learn appropriate lumbar-stabilization exercises so there is less movement in the pelvis and backbones. This decreases the possibility of abnormal movement of the spine, so there is less chance that the disc will be pushed backwards onto the nerve root. Good biomechanics are also crucial -- good sitting, bending and lifting postures. Our lumbar spines were not meant to pick things up with a straight-leg posture. The knees must be bent.
What is the prognosis?
Dr. Reiter: The prognosis for most people is very good -- it all depends on the amount of nerve irritation and where the disc is located. Most inflamed discs have a natural course of drying up over time, regardless of how aggressive the treatment is, but the patient still has to pay attention to good biomechanics and strengthening exercises.