Sciatica? Herniated Disk? Part 2

EVALUATION AND TREATMENT

Physical therapy evaluation, after taking a thorough history of the injury, starts with the observation of the patient’s gait and transition from one position to another. It continues with the assessment of the lumbar range of motion and the effects of the repeated movements on the location of radicular (going down the leg) symptoms.

The assessment of the pelvic alignment is necessary and the differentiation is made between a shift which is usually a sign of a herniated disk (the patient’s upper body is shifted away from the injured side, thus producing a pelvic shift towards the side of the herniated disk) and pelvic misalignment which is usually a sign of a sacroiliac joint problem. I have treated many patients who experience a dramatic improvement of symptoms after the pelvis was re-aligned.

Major lower extremities joints’ range of motion is assessed and followed by the strength testing of the lower extremities and abdominals, including deep abdominal muscles that stabilize the spine. 

A thorough physical therapy evaluation identifies the cause of the patient’s symptoms and sets up an appropriate treatment plan.

If the symptoms were created by a herniated disc the treatment is focused on the centralization of the pain. This means that the primary goal of the treatment is to get rid of the pain in the leg and centralize it in the lower back. After this is achieved, next goal is to abolish the pain completely.

If the symptoms are caused by mechanical low back problem (such as a sprain or an abnormal movement in one or more spinal joints) or the sacroiliac joint problem, the treatment focuses on manual therapy for restoration of normal joint mechanics, strength, and position sense of lumbar-pelvic area. Core stabilization program is always included in the treatment, regardless of the cause.

Contrary to some opinions, therapy should not be painful but should lessen the pain with every treatment. Effective physical therapy should be based on manual therapy with a hands-on approach to exercises performed by licensed therapists.

If unresolved fast, low back problems become chronic and can be very frustrating for the patients and health care providers. Patients with chronic low back pain or sciatica may become very dependent on narcotic pain medications. However, if rehabilitated timely and properly, low back pain patients recover fast and, with correct postural and body mechanics education, become much more aware of potential problems and learn to avoid new injuries.

Take a quiz and get a chance to win a tube of Biofreeze for fast, drug-free pain relief!

1. True or False: Sciatica is more prevalent in women 30 years and older.

2. True or False: Sitting is great for treatment of most herniated disks.

3. True or False: Primary goal of the treatment is to get rid of the pain in the leg and centralize it in the lower back.

4. True or False: Physical Therapy should be painful.

You can post your answers as comments or you can email them to me at michaelpt.freemotion@gmail.com. First 20 people to respond will be entered to win (3 tubes of Biofreeze will be given away!)

Stay healthy and take care of your back!

Michael Sheynin, PT, Co-owner of Free Motion Rehab Center

Sciatica? Herniated Disk? Similar Symptoms, Different Causes

SCIATICA? HERNIATED DISK?

Some important facts to consider:

•       Back pain and radiculopathy(pain caused by a nerve or a nerve route compression that travels to the buttock or the leg) are symptoms not causes

•       Proper diagnosis and treatment depend on  the understanding of spinal and pelvic mechanics

•       69% of MRIs for Sciatica are negative for spinal causes

•       Bulging discs rarely are symptomatic

•       MRI and x-ray testing do not evaluate the most important factors: the patient’s function and spinal and pelvic movement

•       Muscle relaxers are not the most ideal form of medication for pain.  Spinal muscle spasms are a protective mechanism

•       Bed rest and medication have been shown in studies to be detrimental to the patients’ recovery

•       Studies show that if not properly treated and rehabilitated the patients are much more likely to re-injure and then more severely

Below are some common causes and risks for the herniated disk.

•         Approximately 1 in 32 people experience a herniated disc during lifetime
•         Most common in the patients between ages 30 to 50
•         Less prevalent after age 55 due to disc desiccation (drying up of the disk material)
•         Most common causes are micro-traumas over a lifetime that put the person at risk for an injury from lifting, coughing, or sneezing.

Sciatica is more prevalent in women ages 30 and older. Its causes are typically related to poor pelvic and spinal mechanics. One of the frequent causes is the entrapment of the sciatic nerve by the piriformis muscle (this muscle is located deep in the buttock and serves to rotate the hip).

Symptoms caused by a herniated disk most often include:

•          increased pain in the morning with difficulty bending forward;
•       radiating pain with location that is dependent on the spine level with the herniated disk (see picture below);
•         specific back pain (right vs. left);
•         tenderness to pressure at the level of herniation;
•         increased, but centralized pain with bending backwards;
•         pain that is partially relieved with sitting, but getting worse if sitting is prolonged.
•         it is very common for the patients to have weak hip muscles.

Sciatica symptoms not caused by a herniated disk include: 

• increased pain with standing and prolonged walking;
• radiating pain down the back of the leg; 
• mild (or absent) back pain (typically from altered walking pattern); 
• tenderness to pressure in the buttock and back of the upper thigh (especially, if sciatica is caused by the piriformis syndrome or by the sacroiliac joint inflammation);
• increased pain with putting weight on the affected side; 
• poor balance or inability to stand on the affected leg; 
• weak hip abductors (muscles that bring the leg away from the body).

TO BE CONTINUED...

Next week I will post Part 2: Evaluation and Treatment. You will find the answers to the questions "what's better: pain in the center of the back or pain in the leg" and "how much pain should one expect with physical therapy" among others. And... there will be a surprise! Meanwhile, stay healthy and protect your back!

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center