Low Back Pain – Sciatica
Low back pain – Sciatica
What it is
Low back pain and sciatica are symptoms of various diseases and not a disease.
Low back pain is pain in the area of your back from the bottom of your ribs to the top of your legs. It can come from any of the many structures that make up your back. These include bones, joints, muscles, ligaments, nerves and tendons. Muscle strain is often the cause of back pain from heavy lifting or vigorous exercise. But sometimes it’s due to small jelly-filled disks meant to protect the space between vertebrae. When one of these disks bulges or breaks, it can push on a nerve. When it’s the sciatic nerve, pain runs from the buttock down one leg. This is sciatica. Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the buttocks and down each leg. This pain may go down the back, outside, or front of the leg. It most often happens when a herniated disk or an overgrowth of bone puts pressure on the lumbar spine nerve roots. It is usually due to a nerve root injury, causing the pain to radiate down the leg and extend from the hip to the toes. This causes inflammation, pain and often some numbness in the affected leg.
Low back pain (LBP) is classified by the duration of symptoms into acute low back pain (0-3 months), sub-acute low back pain (3-6 months) and chronic low back pain (from 6 months and more). It can also be classified into two different ways: specific low back pain and non-specific low back pain. Specific LBP is pain that is caused by a certain disease or structural problem in the spine, or when the pain radiates from another part of the body (structural anatomical damage, mechanical, inflammatory, metabolic, neoplastic). Non-specific LBP is when it isn’t possible to identify a specific disease or structural reason to explain the pain.
Symptoms
Sciatica – Low back pain
The symptoms of both low back pain and sciatica include pain and, depending on the intensity, prolonged bed rest and immobilization of the patient in bed (functional disability).
Risk factors
Some people are more likely to have lower back pain and sciatica than others. The most common risk factors are the following:
1.
Older age
2.
Female sex
3.
Physically strenuous or sedentary work
4.
Incorrect (bad) posture
5.
Incorrect (bad) posture
Sciatica – Low back pain
Causes
1.
Intervertebral Disc Herniation
The vast majority of patients with a herniated disc will recover conservatively. However, when there is confirmed sciatica which is persistent and does not subside after 3 – 6 months, then surgery is indicated. In addition, when paresis occurs for a long period of time then surgical repair will benefit the patient by restoring his/her mobility and functionality.
2.
Synovial cyst
The best treatment for synovial cysts is generally non-surgical care, including over-the-counter pain medications, activity modification, and injections. But in some patients, the synovial cysts, despite their temporary relief with conservative treatment methods, seem to persist. In these cases, the surgical excision of the cyst is strongly recommended.
3.
Lateral Stenosis – Foraminal Stenosis
It happens when certain joints between the vertebrae degenerate. The pain is intense and may radiate to the lower extremities. Aggravation of pain is observed when walking. If in this case the nerve root compression has been confirmed radiologically and the pain is continuous, then a corticosteroid injection or surgical treatment is recommended.
Sciatica – Low back pain
Diagnosis
Sciatica and low back pain are mainly diagnosed by history taking, physical examination and the clinical picture with the neurological evaluation. Then, the doctor may recommend a variety of tests to check your spine for injuries and assess your health in other ways. Another imaging test that is essential for the management and treatment of sciatica and low back pain is lumbar spine MRI test. If a neoplasm is suspected, other tests should be done.
Low back pain
Treatment
1.
Conservative treatment
In the case of non-specific low back pain, the treatment is always non-surgical.
At first, conservative treatment is recommended to treat low back pain. The patient limits his/her physical activity such as lifting weights as well as the amount of time spent being sedentary and he/she tries to improve his/her sleeping posture under the doctor’s guidance. Based on the above guidelines, the majority of low back pain patients will feel better. The exercise also plays a very important role in relieving pain. Aerobic exercise that does not stress the spine (such as swimming) is a good choice to start with.
Gradually, the patient should start a muscle strengthening program under the guidance of the physical therapist.
2.
Invasive Techniques
Epidural perineural injections
The technique concerns the administration of drugs through injection, selectively in the spine, in order to find the trigger point. In other words, these injections have both a diagnostic and therapeutic purpose. They are performed in an operating room environment, without anesthesia, under radiological guidance and last for about 10 minutes.
Spondylolisthesis surgical correction
Spondylolisthesis surgical correction can be performed by several methods. It aims to relieve pain and in cases of major slippage in the realignment of the spine. The surgical approach that is chosen depends on the type of deformity.
3.
Minimally Invasive Intradiscal Procedures
Spinal fusion
Low back pain – Sciatica
Frequently asked questions (FAQs)
What group of people is usually suffered from low back pain (LBP)?
Most people experience low back pain (LBP) at some point in their lives. The peak in the number of cases occurs at 40–60 years, and women experience LBP more frequently than men. In younger patients the pain is transient. Several factors have been implicated in the occurrence of low back pain such as heredity, general health status and gender.
From time to time, researches have also shown that smoking is as an aggravating factor for low back pain and obesity increases the odds of the presence of chronic low back pain (LBP). Finally, heavy manual work and sedentary lifestyle are also aggravating factors.
What can a patient do during pain-free remission periods in order to prevent low back disorders?
- Frequent physical exercise always in consultation with the orthopedist. The best exercise option for low back pain and sciatica is swimming in combination with other types of light exercise, such as walking, jogging, cycling, yoga, tai chi or pilates.
- Muscles strengthening that support the waist area.
- Smoking reduction if the patient cannot stop smoking immediately.
- Weight loss
What is the proper rehabilitation for sciatica?
There are many precautions that can protect you against sciatica pain.
You can lower your risk of sciatica by protecting your back, for example, by:
- maintaining good posture
- trying not to sit or stand for a long time — change positions frequently to reduce stress on your back
- maintaining a healthy weight
- getting regular exercise to improve your general fitness
- doing exercises to strengthen your core muscles
- lifting safely — bend your knees, not your back
You can also take steps to relieve your pain at home. A heating pad or a rubber hot water bottle can be especially soothing. Heat treatments will increase the flow of blood to the area, which can speed healing. Heat also will relax the muscles to allow for gentle stretching that can help to relieve the pain.
Then with the help of a physical therapist, you can find specific exercises to properly stretch the back muscles, without aggravating the sciatica.
In more serious cases, the orthopedist will recommend corticosteroids injections into the spine area in order to reduce the inflammation.
Finally, if sciatica is caused by a herniated disc and does not respond to the conservative treatment, surgery is the only option.
Are epidural steroid injections good for low back pain?
Yes, they can reduce the intensity of pain significantly. If you’ve had back pain for more than 6 weeks and your pain is very bad, your doctor might recommend a shot (injection) of corticosteroid, or steroid medicine, into your spinal canal. This is called an epidural injection. A lumbar epidural steroid injection (lumbar ESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the epidural space around the spinal nerves in your low back. The main goal of lumbar epidural steroid injections is to manage chronic pain caused by irritation and inflammation of the spinal nerve roots in your low back (the lumbar region of your spine) due to certain conditions or injuries. These injections must be combined with other treatments (physical therapy, exercises) so as to be effective. However, for the pain relief by the injection, a correct diagnosis is required so as to find the trigger point.
