Sciatica first aid

The term sciatica (sometimes misspelled "ciatica" or "siatica") is used to describe pain that radiates down the course of the sciatic nerve, which starts from each side of the lower back, extends down the back of the thigh, and into the foot.

This type of pain is caused by compression of nerve roots in the lower part of the spine, which merge together to form the sciatic nerve in the pelvis. Pain may result from a variety of conditions, including disc problems. The good news, however, is that most cases of sciatica are not serious and will get better within a few days or weeks.

When the sciatica pain flares up, it is helpful to know several options that can be used to help alleviate the pain and discomfort and help you to quickly return to your normal activity.

Cold and heat treatment for sciatica
Ice and heat sources are easily available, inexpensive, and usually quite effective in treating sciatica.

• A cold pack or ice application can reduce inflammation and numb sore tissue, alleviating some of the pain in the sciatic nerve. This should be used initially when pain is sharp and intense, usually for 2 to 7 days, depending on the severity of the pain.

• Heat dilates blood vessels, increasing the flow of oxygen and nutrients to the area, which assists in healing. Applying heat also stimulates sensory receptors in the skin, so the brain focuses less on the pain of sciatica. This is best used after the acute, sharp pain has subsided, typically 3 to 7 days after the start of the condition.

For some people, alternating between ice and heat is the most effective sciatica treatment.

One option for applying cold is to utilize an ice massage. This is most easily accomplished by freezing water in a paper cup and after its frozen, cut the top half of the cup away exposing the ice (like a Popsicle). The ice cup is then applied directly to the skin, usually in a circular motion over the course of the painful area. There are 4 stages of cooling, of which the second to last is a burning sensation, similar to eating ice cream too quickly. The last stage is numbness after which time frostbite can occur so stop when the burning turns into numbness. This process usually takes between 3 to 6 minutes, depending on the thickness of the area being treated. 

The ice massage can be given by someone else with the patient lying on his or her stomach or side. The ice should be gently applied to the six-inch area where the pain is felt, and massaged using a circular motion, using care to avoid the bony portion of the spine. The goal is to numb the area of discomfort, at which time gentle, minimal movements can be made to stretch out the sciatic nerve and relieve the compression that is causing the pain. When the numbness wears off, the ice can be re-applied and the procedure repeated. This treatment can be done two or three times a day.

An ice pack is another approach where the ice is wrapped it in a towel or, a commercial ice pack can be used. This is usually kept in one spot, such as the low back, for 15 to 20 minutes per application, and repeated for three times (15 minutes on-off-on-off-on, which takes 1 hour, 15 minutes = 1 session). For sciatica, the pack is placed over the lower back as that is where the sciatic nerve is usually pinched. Several sessions can be performed throughout the day.

Heat should also be applied carefully to avoid burning. The temperature of the heating pad, hot water bottle, (or water for a bath), should be warm, not hot, and is frequently buffered with a towel so the skin does not get too moist. In addition to the benefits stated above, heat relaxes the muscles, which again, allows for some pain relief, allowing the patient to stretch out the sciatic nerve and diminish the compression that is causing the sciatica.

Medications to treat sciatic pain
The pain associated with sciatica may also be reduced and sometimes relieved with the use of over-the-counter or prescription medications. Because some of the pain is coming from inflammation of the sciatic nerve, treatment using non-steroidal anti-inflammatory drugs (NSAID's) can be very effective. Aspirin can also help reduce the inflammation, but NSAID's have fewer gastrointestinal side effects (such as gastritis or ulcers).

There are many options to consider when choosing NSAID's. Each is somewhat different and it is always advisable to discuss the benefits and drawbacks of each with a physician or pharmacist. NSAID options include:

• Ibuprofen—such as Advil, Nuprin, Motrin

• Naproxen—such as Naprosyn, Aleve

• COX-2 inhibitors—such as Celebrex or Bextra (which require a prescription)

Acetaminophen (such as Tylenol) can also be used for relief of sciatic pain. Because NSAID's and acetaminophen work differently, the two medications may be taken at the same time or staggered (i.e., NSAID's followed by acetaminophen, etc.).

Other, stronger pain medications are also available through a prescription from a physician and may be necessary to help alleviate the pain from irritation to the sciatic nerve.

Exercise for long-term pain relief
Once pain control has been achieved, gentle stretching of the affected area, and low-impact exercise, (such as walking two to three miles) will help bring healing nutrients to the affected area and help to restore function. As with any back treatment, care should be taken to not further aggravate the situation. It is always advisable to consult with a doctor with any questions or concerns that may arise during the course of care.

For long-term relief of sciatica pain, most experts agree that a regular routine of stretching and exercise is crucial.

• Stretching. Patients may find it takes several weeks or months to develop flexibility in the spine and soft tissues, but may also find that the stretching helps bring sustained pain relief. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and limitations in this motion can accentuate pain and make one more susceptible to re-injury.
  
  Stretching exercise should focus on increasing flexibility in the disc, muscles, ligaments, and tendons. Additionally, it is important to stretch muscles not directly involved with the injured area, such as the arms and legs. For example, the hamstring muscles play a major role in lower back pain, as it is clear that hamstring tightness limits motion in the hip, which increases stress across the low back, especially during forward bending.

• Strengthening. Building strength is also important to help prevent and/or lessen future recurrences of sciatic pain. Specific exercises designed to strengthen the “core” or trunk muscles are most important in the management of low back pain.
  
  Depending on the underlying cause of sciatica (such as a herniated disc vs. a degenerated disc), different exercises may be prescribed. Two common forms of strengthening exercises to treat sciatica are McKenzie exercises and Dynamic Lumbar Stabilization exercises. Learning which exercises to do, as well as how to do them correctly, is typically best learned with the help of a qualified spine specialist.

Manipulation and physical therapy
Another treatment option that can be helpful for many causes of for sciatica is manipulation by a qualified health care provider (most commonly a chiropractor or an osteopath). The type of manipulation, amount of force, the direction of the manipulation and the frequency of application are taken into consideration when managing patients complaining of sciatica. Combining this with various forms of physical therapy such as exercise therapies can be very effective.

Other considerations with sciatic pain
Though uncommon, when the sciatic condition worsens, it is most important to obtain a prompt evaluation. This is especially true if progressive muscle weakness, foot drop, or loss of bowel or bladder control occur, as these symptoms require immediate emergency attention and permanent problems can result if not managed promptly. In general, whenever questions arise about the course of care and associated signs and symptoms, health care provision should be obtained and the questions answered.

The good news is that most cases of sciatica will resolve naturally within a few weeks. The treatments described here can help alleviate pain until things return to normal, and help speed recovery, as well as avoid recurrence. Every patient is different of course, and not all sciatica treatments will work for all cases of sciatica.

By: Randall Schultz, MD
May 24, 2004