Archive for the ‘Sciatica’ Category

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Viewer Question: What is nerve root irritation?

Monday, November 15th, 2010

Larry from Ontario sent me this question:

“I have had sciatica for several months, and my doctor told me it was due to nerve root irritation, and he wants to give me an injection in my back. What does nerve root irritation mean, and will an injection fix the problem? I’m a little nervous about having a needle in my spine.”

Thanks for your question Larry.

I can totally understand you concern about getting an injection, but it may provide you some relief from your pain.

Nerve root irritation is an inflammation at the point where a nerve exits the spinal cord. In your case, this is the L5-S1 nerve root. You see, the hole the nerve exits through is very small, and even small changes to this hole, or exit foramina, can compress or irritate this nerve. These changes can be due to arthritis- which can deposit small bits of extra bone, osteophytes, along the edge of then foramina. They can also be from a disc bulge extending into the hole, or simply due to small amounts of inflammation which cause swelling to the tissue around the nerve.

It is this last example which is most responsive to an injection. Under x-Ray guidance, a physician will inject a combination of a pain medication and a steroid, which functions as an anti-inflammatory, into the space around the nerve. Often, this will decrease the swelling, and help reduce the pain, breaking the cycle of inflammation and provide longer term relief. Sometimes, a series of up to three injections are needed to get the long term benefit.

I hope this answers your question, and please keep me posted on your progress should you decide to get the shot.

Best,

Andy



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Sciatic Pain- Viewer question via video.

Wednesday, September 22nd, 2010

rosaquestion

Thank you so much for your question Rosa.

Sciatic injury is sort of an open ended definition. To best answer your question, I should first give you two definitions. First, the sciatic nerve is a thick nerve which runs down the back of your leg, and exits the spine between your 5th lumbar vertebra and your sacrum. Sciatic pain, or sciatica is a global term which relates to any pain associated with that nerve. Some people mistakenly call any pain radiating into the leg sciatica- it is really only pain going down the back of the thigh (The front and sides of your thigh are actually a different nerve.)

There are lots of ways in which a nerve can be injured, but sciatic pain is less often the result of nerve injury than it is due to irritation of the nerve by one of its adjacent structures. There are three common causes of sciatic pain. One is L5S1 disc herniation, where the disc has extended beyond its’ normal location, and encroached upon the space where the nerve travels. The second is stenosis, where arthritis, disc degeneration, or other anomaly has caused the hole through which the nerve travels to become reduced in diameter. The third, and in my practice the most common is when a short thick triangular muscle called the piriformis goes into spasm, causing it to thicken in its center and compress the pathway through which the nerve travels through the buttocks.

An actual injury to the nerve can be caused by a trauma, and prolonged compression from any one of the three sources above can cause damage as well resulting in pain, altered sensation, and in really bad cases loss of muscle strength associated with that nerve.

I hope that answers your question. There are some great posts here on how to reduce sciatic pain including this one which describes an effective piriformis stretch. Check back periodically for new tips & suggestions.

Again, thanks for your question.

-Andy

Stay tuned for a new "One Thing" tomorrow featuring an expert from the Ayengar Institute.

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Ice versus heat for back & neck pain, sciatica, and other painful areas…

Wednesday, May 5th, 2010

At least a few times a day, patients ask me about whether they should be using ice or heat to help relieve their back pain. It’s a good question, and unfortunately, if you asked 10 doctors, you might get 10 different explanations for why one is better than the other.

There is only one steadfast rule regarding ice & heat: For the first 48 hours immediately following an injury, ice is better. Ice causes some vasoconstriction (the reduction in the diameter of the blood vessels) in the area being treated, helping to reduce swelling and promote healing. It also can partially numb the area for a short time, providing some pain relief.

In this doctor’s opinion, after the first 48 hours, it boils down to a matter of personal preference. Ice provides some of the pain relieving benefits, but heat can help to relax tense muscles- so there are potential benefits to either. Personally, my muscles recoil from cold and send me right into spasm, so I cannot really tolerate ice- so for me it’s heat, but I hear the opposite from plenty of people as well.

The one recommendation I will make here is to limit the time of either. If you are using ice, wrap your bag of ice in a thin towel or napkin so the cold gets applied gradually, and without ‘shock.’ Apply for 20 minutes on, 20 minutes off. With heat, the timing is not as critical, but prolonged heat can cause too much relaxation to the area, will cause vasodilation (an increase in the diameter of the blood vessels in the injured area,) and if there is still some underlying inflammation- could increase swelling. So 20 on and 20 off here is probably a good rule as well.

Hope this helps!

Insurance nightmares…

Last week, I asked you to share with me some of your health insurance nightmares. My wife and I have been dealing with a pretty complicated problem, which thankfully seems to be largely resolving. I am amazed by how many of you have had serious issues with your health insurance. I am preparing a piece or two on this topic- not strictly a back pain thing, but I felt important enough to discuss here on BackWords. Check back.

As always, thanks for visiting,

Andy

Coming soon: Back pain tips for riders of mass transit.

Coming soon: Back pain tips for riders of mass transit.

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Piriformis stretch for sciatica and low back pain….

Friday, April 16th, 2010

Sciatica is one of the most nagging types of pain you can have- it is like a toothache in your leg! Here’s a simple self-stretch you can do to help alleviate it, but before I share it, you should probably understand a little about sciatica…

Sciatica is a blanket term for pain associated with the sciatic nerve- the nerve which exits your spine between L5 and S1, and innervates part of your leg. Irritation of the sciatic nerve can cause pain which radiates down the back of the leg. If pain radiates down the front or side of the leg, you are talking about a different nerve.

Now, there are a few things which can irritate this nerve, most predominantly a bulging or herniated disc, or compression of the  nerve by the piriformis muscle. It is this piriformis spasm or piriformis syndrome which is the focus of this stretch. Lets talk about the anatomy for a moment.

The sciatic nerve goes down the back of your leg, through your buttocks, where it passes beneath the short, thick piriformis muscle. The space through which this nerve traverses is kind of small, so when the piriformis is in spasm, or contracts- it reduces the size of the space through which the nerve travels- and compresses or irritates it, causing sciatic pain.

For this stretch, find a comfortable chair without too much padding, and which allows you to sit evenly with good lower back support. Take the painful leg, and cross it over the other, with the ankle resting on the knee of the non-painful leg.

Slowly lean forward with your upper body, resting your arms on your legs, until you feel the beginning of the stretch and then go just a little further. Hold this position for a few seconds, then return to a neutral position.

Repeat this a few times each session for 2-3 sessions a day. Give it a shot- you may surprise yourself how much this simple stretch can help. This stretch should not exacerbate your discomfort. If it does, it is possible that your pain is coming from a different source. If your pain lasts more than a couple of days, and you haven’t had it accurately diagnosed- you should definitely see your physician.

Be well, and have a fantastic weekend!

-Andy

I am on a serious Alphonse Mucha kick- I think I may start Summer painting early this year.

I am on a serious Alphonse Mucha kick- I think I may start Summer painting early this year.

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B.T.T.o.D: For low back pain & sciatica, try crossing the other leg!

Friday, April 16th, 2010

We almost all have a tendency cross one leg predominantly over the other when we are sitting (If I don’t think about it, I almost always have my right leg crossed over my left.) Lower back pain, and sciatica can be worsened by a pelvic shift one way or the other. In much the same way I ask you to switch the side you carry your handbag or briefcase- try alternating which leg you cross, if you do cross your legs at all. This will help to even things out.

BT Signature

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Spinal Surgery- an introduction to disc replacement surgery, live from Masada, Dead Sea Valley

Friday, March 5th, 2010

The latest installment of my introductions to the different types of spinal surgery. I thank my daughter for working as cameraman during our trip- sorry for the shaky video.

discreplacement2

As I related in the video post, the disc replacement is a relatively new compared to most of what’s out there. It is a pretty elaborate procedure, and the recovery time will vary largely based upon the overall health, weight, age, and fitness of the patient prior to the surgery.

Below is an image of the prosthetic device itself.

One type of replacement disc prosthesis.

One type of replacement disc prosthesis.

Thanks for visiting, in the next installment of this surgery series, I will review the foraminotomy and a brief wrap up. Look for more posts from Israel this week.

Best,

Andy

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Mini Series on Spinal Surgery: The Spinal Fusion, and Overview…

Friday, February 26th, 2010

Last week, I gave a brief introduction to spinal surgery, which can be viewed here. In this mini-series, I want to provide a brief overview of these procedures so viewers will have a basic understanding of what’s involved.

Of all of the procedures I want to review in this series, the spinal fusion is the one my viewers seem to be most interested in- likely because it has been around for some time, and many people coming to this site have either had one, know someone who has, or may be a candidate for one in the future.

Spinal fusion is used when an intravertebral disc has been so compromised, that the spinal segment (the combination of the two vertebra, linked by the disc between them) has been destabilized. This destabilization can be painful, as the associated structures of this segment can rub up against the nerve roots at that level- or alter the body mechanics at that level causing irritation to the facet joints (the small joints which articulate the spine.) So patients with this type of compromise can have back pain as well as radicular pain- like sciatica

Like most spinal surgeries, it is usually only considered when all other conservative options have been either tried or ruled out.

In this procedure, the surgeon will go to the spinal segment in question, and ‘clean up’ the area around the disc from debris which may be causing irritation as best as they are able. Then, either utilizing stabilizing hardware or a ‘glue’ made from the patients own bone (A small fragment of the patients bone is harvested, usually from the crest of their pelvic bone, which is crushed into a gravelly mixture.This mixture of live cells then ‘heals’ back into a solid structure) the affected segment is ‘fused’ into a neutral position, resulting in a reduction of pain. Below is an x-ray from a patient whose segments have been fused with hardware.

image of spinal fusion

Recovery from this surgery varies in length depending upon the overall health of the patient, and their level of conditioning prior to the procedure. Most surgeons will tell their patients not to expect the full benefits, for up to a year.

I have a fair number of patients who have had spinal fusion, and many have done well with it. There are patients for whom this is the best option, but it does have its downsides, which can become a larger issue based upon the patients age, and their overall activity level. The two most notable from a mechanical standpoint are:

-A loss of flexibility at the level of the fused segment.

-Because each disc absorbs external stress and shock- the forces which would be absorbed by the fused segment are passed onto the adjacent discs, and may cause premature wear and tear on them.

Because of these two considerations, surgeons began to look at other options to help fix the pain associated with a damaged discs for patients who are more active and wish to maintain the highest level of flexibility. In the next part of this series, we will look at one of these options, the disc replacement.

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Spinal Surgery for Back Pain: Part 1: Introduction

Wednesday, February 17th, 2010

I received so many questions about the post I did a couple of weeks ago on the surgical procedure known as a foraminotomy, and many of those questions had to do with other surgeries as well. I thought I would take the opportunity to review the basics of some of these procedures in order to get a better understanding of how these procedures work.

Surgery is the most aggressive treatment option available for relief from back pain, and should be considered only after all more conservative options have been weighed. Many patients in my own practice have come to me as a last resort before deciding whether or not to have surgery.

If you google information about the outcomes of spinal surgery, you may find that the statistics are a little discouraging. The overall statistics for patients in my own practice who have had surgery for their back pain is not too different from most of the numbers you see out there- I have observed that about 30% of patients get some relief from the surgery, 30% have virtually no improvement, and about 30% report that they actually felt worse following surgery. Now, while these numbers sound kind of dismal, they improve significantly when patients are well screened, and when you are dealing with a particularly talented surgeon (and no, I ain’t namin names!)

In the next posts, I will review a few of the more common surgical procedures for treating back and neck pain as well as radicular pain such as sciatica. We will review the foraminotomy, spinal fusion, disc repair, and disc replacement.

Now, in this introduction, let me give you some basics that apply to all types of spinal surgery;

-If you have exhausted all conservative approaches to your pain, and you are considering surgery- as with any surgery, when possible get a second opinion.

-In your area, try to find people who have had surgery, and gather information about their experiences- not only about their own outcome, but about their experiences with the surgeon, their hospital, recovery, therapy, etc…

-As with any surgery, there are inherent risks such as hemorrhage, infection, etc… I am wary of any physician which describes anything as ‘risk free’ or ‘minor surgery.’ In the world of spinal surgery, there is no such thing as minor surgery- only degrees of ‘major.’

-Be prepared to do any post operative therapy your surgeon recommends- for many procedures, the follow up is just as important as the procedure itself when it comes to a favourable outcome.

-Try and recruit friends and family members to provide a network of support both pre and postoperatively. There can be significant anxiety as well as pain & discomfort associated with any of these procedures. Having emotional support before and after surgery can help hasten recovery.

These are just a few considerations when gearing up for surgery. Over the next few installments, I hope to provide you a basic understanding of what these procedures entail. If you have had surgery for back or neck pain, please share your experiences.

Best,

Andy

sugery

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VIDEO: Viewer Question re: Foraminotomy & Siatica

Wednesday, January 20th, 2010

foraminotomy

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A response to a viewer question regarding the surgical procedure known as a foraminotomy. In this procedure, the hole where a nerve exits the spine is enlarged in an effort to relieve impingement of the nerve, and subsequent pain. Stenosis, or reduction in the size of this hole is a common source of sciatica, and other radiating types of nerve pain. Below is an image of the neural exit foramina between two vertebrae.

foramina

Stay tuned for updates on the Fitness Challenge, and coming next week Pilates instructor Amanda Mitchell shares her One Thing.

Thanks for all of the great feedback, and be well.

-Andy

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Product review: Back To Life back pain system, and a simple free technique.

Thursday, January 14th, 2010

I don’t usually do reviews of products directly claiming to reduce back pain, as I don’t want to have a perceived bias- having my own back pain reducing products.

I feel compelled to write on the Back To Life device for two reasons:

1) You can’t turn on the TV without seeing their infomercial PROMISING relief from your back pain.

2) Two of my patients have purchased them, and wanted to know my thoughts.

I suppose I should start off by saying that one patient actually did get some relief from the device. I asked him to bring his in so I could take a look at it. If you aren’t familiar with Back To Life, it is a white and blue plastic machine, about 20 inches tall that looks like a small stool:

UnitBasically, you lie on your back, place your legs on the leg rests on the top, and the device slowly moves in a combination of circular and flexion/extension movements.

For patients who have issues with mobility, or dysfunctional lumbar segments (vertebra in their low back which don’t move properly) this could potentially reduce your pain. If however you have disc herniation, or severe muscle spasms caused by nerve root irritation, spinal stenosis, or a few other common spinal conditions- it won’t do much, and in some circumstances could make things worse.

So, in short- if you have mobility or stiffness issues, it might be of some benefit. That being said, there is a great FREE alternative if you have a partner to work with- and the advantage is that you and your partner can communicate to see if you can make the technique better, or if it is hurting too much- and stop. The Back To Life device provides no such feedback.

Lie on your back- on the floor, preferably on a soft carpet or yoga mat (a bed or couch is too soft, and a really bad idea.) Ask your partner to gently raise your knees up to your chest. They should rotate your knees in small circles, a few times in each direction, getting larger in diameter with every few rotations. Try to make the circles large enough that you begin to feel slight resistance at the left, right, and upper extreme ranges of the rotation. Take a look at the video below:

leg circle video hd

As with any technique, clear it with your physician if you have not been doing exercises already- or if you do not have a clear diagnosis for your pain. Don’t do it at all if you have cancer not in remission, or an unhealed fracture.

Try this one out- it looks simple- but it really does help with low back pain and stiffness.

Enjoy,

Andy

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