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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29642
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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For about three weeks Ive had sciatica , and for the last

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For about three weeks I've had sciatica , and for the last 10 days or two weeks intensely painful, so that I can't sleep at night, except with pain pills. Acupuncture helps a little, as does Feldenkrais, but it persists. A friend suggested rehab medicine (physical therapy?), someone else gave me a book of exersizes by PeteEgoscue "Pain Free". I am about 70 and in good physical shape. Can you give me some advice? Gyana Pendleton
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello Gyana Pendleton,

I am Dr. Phophalia and would assist you today.

Physical therapy definitely helps in the sciatica. Though other measures too are necessary for the comprehensive management. Following measures would be helpful;

1) Back care in the activities of daily living, which is an integral component of the treatment of sciatica and back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

 

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

 

3) Local analgesic gels or sprays / ointment

 

4) Hot fomentation

 

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

 

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

 

7) Lumbosacral corset or support or brace

 

8) If obese or over weight, reduce weight for long term benefit.

 

9) Epidural steroid shots

 

10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;

 

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

http://www.mayoclinic.com/health/back-pain/LB00001_D

You can consult following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation

Following investigations would be required;

1) X-ray of the lower back

2) MRI of the spine

3) Nerve conduction velocity (NCV) study

4) Electromyography (EMG)

 

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using JustAnswer.

 

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Customer: replied 1 year ago.

Does daily walking help in this case? I am usually active, walXXXXX, XXXXXcing, gardening. Should I do some of these even if there is some pain?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello Gyana,

Pain is our protective phenomenon and guides us to avoid the painful activities. So Any of these activities which you had mentioned should be avoided if these are painful or induce pain. The initial management of the sciatica is rest (it reduces the pressure on the pinched nerves and also decreases the swelling / inflammation around the nerve). Once the pain is better, very slowly you may increase the activities. A decrease in the pain by rest, physical therapy, back brace, back care, deep electrotherapy, acupuncture etc would guide that you can start small walking than the other activities very gradually. So pain is your guiding factor, here.

It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29642
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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