Anyone know about Sciatica?

[Gandalf]

Not me this time but my daughter-in-law.  All weekend she was unable even to stand up with the pain down one leg.  There are only one or two ludicrous prone positions she can adopt to relieve the pain slightly

She has been to her GP several times, who just prescribes military grade pain killers, which to my untrained mind seems simply to be masking the problem.

[numbnuts]

physio can help

[Chris S]

Osteopath.

I've had several episodes over the years - always due to a prolapsed disc which then aggravates the nerve. Osteopaths have succeeded in treating it - sometimes in conjunction with GP prescribed Diclofenac or Volterol.

It is horribly debilitating. The pain is excruciating.

Each episode is different - but I have found on a couple of occasions, adopting a sitting position but with my back on the floor, and legs on the seat of a chair (a position I called "slying" because you are in a sitting position, but lying down) quite helpful.

Hope she finds relief from it soon.

[Rich753]

I had sciatica for quite a while, it's horrid, sympathy to your dil.

The "million dollar roll" (where osteopath clicks lower vertebrae back into position) took away the pain, core and lower back strengthening exercises stopped recurrence.

[Jaded]

Hope it isn't teaching granny to suck eggs, but because of the evolutionary mess that is the human spine and spinal cord sciatica is usually caused by a major problem in the lumbar area of the back. The pain is felt in the leg because the pressure is on the nerve that supplies the leg.

As Rich753 says, the solution is usually in the back, and then followup to try to prevent it recurring.

[Sergeant Pluck]

I had problems with this some years ago.

She has been to her GP several times, who just prescribes military grade pain killers

If this is seriously debilitating then the next step would be to properly diagnose the problem. In my case I had an MRI scan which clearly showed the prolapsed intervertebral disc that was at fault. I had surgery a few weeks later which resolved the problem immediately. That's probably 6 or 7 years ago now.

However, my understanding is that the culprit is not often as clearly identifiable as it was in my case, and overall surgery of this type (microdiscectomy) does not have a wonderful success rate. The surgeon clearly warned me that there was a significant chance that it would not work - I can't recall the figures now. 

I also understand that the risk of a repeat prolapse (of an adjacent disc) is fairly high. 

At the time I was virtually immobilised at times so I felt I had no option but to go ahead and thankfully it worked really well.

I've followed this up with specific exercises to strengthen the muscles of the lower back at a gym that deals with this sort of thing.

My feeling now is that perhaps the need for surgery might have been avoided with proper physio, even after the disc prolapse, but at the time I needed something done fairly urgently.

My advice, then: ask GP to refer for an MRI scan to see if the cause can be visualised and take it from there rather than chucking painkillers at it. In my case I cannot recall any painkiller that worked for me aside from diamorphine. 

[wajcgac]

I had this just over a year ago - pain gradually got worse for a week until it got so bad it took a major effort to get out of bed. The pain was the worst I've ever felt - to the point I was feeling physically sick. Was like this for a week and then slowly got better. I was off the bike for 2 months.

Went to see my GP who prescribed painkillers - though they didn't seem to help.

I had xrays done to check for any spinal problems and nothing was  found. Sciatica has a range of causes. Mine was muscular problems in and around the lower back, probably the least serious of all the causes.

I had a couple of sessions with a  physio who stressed the need to keep active as this does help, even if you don't think so at the time. He also showed me some Pilates based excercises to strengthen the core muscles.

Since then other than minor backache I've had no further trouble and have done 200km rides with no problem.

I think your wise to keep up the excercises though to help prevent reoccurence - something I ought to practice as well as preach!

[her_welshness]

I had a problem with this about 8 or 9 years ago. I would thoroughly recommend going to see an osteopath in the first instance and not the GP, as its just not their area. It sorted out the piriformis syndrome (literally means a pain in the arse and is related to the gluteal muscles impinging on the sciatic nerve). Subsequently I have visited a deep tissue therapist/masseuse and that was an unforgettably harrowing and amazing experience, I felt like a new person! Hope your dil find some relief soon Gandalf, many sympathies!

[Tail End Charlie]

DO NOT UNDER ANY CIRCUMSTANCES GO TO SOMEONE (EITHER ON RECOMMENDATION OR NOT) WHO SAYS "I'LL JUST CLICK YOU BACK INTO PLACE". THIS CAN DO MORE HARM THAN GOOD. IF ANYONE TRIES TO GET YOU IN A POSITION WHERE YOU ARE ON YOUR SIDE AND THE TOP HALF OF YOU IS FLAT, AND THEY ARE ABOUT TO PUT THEIR WEIGHT ON YOU, TELL THEM TO STOP.

A good sports physio is what you need, but it's really hard to find one. I was lucky I was seen by someone who a few months later was head hunted by Chelsea FC, but it was pot luck really. As someone has said the causes are many and only an MRI can really determine what is best to do. It would be worth paying for it privately. 

[Tigerrr]

Depending on what caused it - it can really help to hang upside down for a while, preferably having had a valium to relax muscles.  You can get special ankle hooks from good ortho chemists, and just hang her up for a while.

[keepontriking]

I had this come on about five months ago.
I could not stand or walk for several days. The pain was excrutiating and the Dr visited, prescribing strong paracetemol/codeine painkillers and diclofenac.
This eased the pain - a bit.

I was then sent to the local physiotherapy dept who passed me for an MRI scan.
They lost the discs (no pun intended) then couldn't open them due to the encryption - great :-(
But that's another story!

Eventually got sent to a consultant (who could read them) who is recommending:
20% get better just leaving it,
60% get better with a series of injections,
80% get better with Surgery involving nuts bolts, bits cut, filed and clamped, but 3-4 months recovery needed.

That was a month ago and I still don't really know what to do.

Meanwhile left leg is very weak and it is difficult to carry things upstairs (like bikes) without it almost collapsing. Cycling up hills is hard but possible. Shin is numb below knee and still occasionally have pain in buttock.
Advice everywhere is to keep active, and I ride every day.

In a quandary, so I'm watching this thread with great interest.

[hellymedic]

True sciatica is pain in the distribution of the sciatic nerve, which runs down the back of the lower limb.

Numbness and weakness below the knee is usually caused by compression of the S1 root by the L5/S1 disc. When a disc prolapses, it does not really 'slip'. Stiff, jelly-like goo exudes between rings of gristle. Whilst the symptoms may settle in time, the jelly will no more 'go back' than you'd get toothpaste back into a tube.

I'd go for surgery if I had weaknees and numbness below the knee for more than three months, personally but there is no guuarantee that nerve damage will recover.

[Tail End Charlie]

The advice to keep active is good, but do not think this means you should hobble or try to compensate in other ways as this means you will end up with pain elsewhere aswell. The advice I was given was to walk and when I felt the need to hobble, stop and do some flexion exercises. The first time I couldn't even get once round my garden before having to stop. After I could do 10 times round the garden I risked going round the block. This process takes time and cannot be rushed.
Personally I would avoid surgery (unless the disc has burst). I had excruciating pain and couldn't even walk, never mind ride a bike at its worst and even had muscle wastage on one side but eventually you get to a stage where you can manage and recognise the symptoms. I was off work for 3.5 months and a time after that before I was fully mobile. 8 years later I can much better understand my limitations and recognise when I need to change posture etc.

[mrcharly-YHT]

Do you actually have a prolapsed disk, only really diagnosable by scan?

It is possible for the nerve to be compressed by inflammation, or for the disk to be 'squeezed' on one side so that it bulges out the other (not actually burst as helly described, just bulging out).

[pdm]

As with all things medical, IT DEPENDS!

Rules of thumb:

The younger the patient, the more likely there will be full spontaneous recovery. In young people, acute disc prolapses tend to be of hydrated material and the body is very good at resorbing it. Young large disc prolapses tend to resolve spontaneously and completely in >90% of cases. The bigger they are, the more likely they are to resolve. Complete resolution can take up to 2 years although symptoms resolve long before that. Young large discs do respond very well to surgery but then they would have got better anyway! No "manipulation" will suck a disc back into its place - the body (or surgeon) has to remove it.

Older people (>50) tend to have smaller and more chronic disc prolapse or "bulge" but, even in these, more will recover than not but symptoms can take 9 months or more to do so and may not resolve completely.

Above 70, it is extremely unlikely to suffer a "disc prolapse" - by then most normal discs have dried out and cannot go anywhere - Sciatica in the elderly tends to be due to foraminal or spinal stenosis - usually due to arthritis of the spine.

The only way to diagnose a prolapsed disc is with imaging - usually MRI. This is only done in cases with actual "sciatica" and preferably only in those where symptoms are not resolving after an interval if treatment or there are concerns about nerve compression and damage (wasting, fasciculation, anaesthesia, etc.)

Low back pain on its own is usually not imaged.

Someone with sciatica should see a professional with experience in the field and be properly examined and advised on a course of physio and, if needed, medication as well as a proper plan for the future in terms of diagnostic and treatment options depending on response. In my patch (North Derbyshire) this is done by a dedicated back pain and sciatica physiotherapy service that has access to both medical and imaging advice.

[Wowbagger]

I've been suffering for a day or two with what I think is probably sciatica. I've had some lower back trouble for two or three weeks and pretty suddenly, after yesterday's bike ride, I've been having some moderate pain in my left buttock and the back of my left thigh.

I found that walking round the park this morning eased it a lot, but it has come back since. I'm not sure whether to drive or cycle to my choir practice this evening.

[closetleftie]

Good luck, Wow.

Standard advice is to keep as active as you can within the limits of your pain. Painkillers are OK to take. "Masking the problem" is really not an issue. With backs, the pain IS the problem.

[Wowbagger]

I've had an appointment with an osteopath. He did a few tests and pushed me around a bit.

There was definitely a loss off reflex in my left achilles tendon. Both knees performed well as did the right ankle, but not the left.

The worst was that he's told me not to cycle for the moment and to restrict walking to about 20 minutes a time. C & M Hilly 50 is right out, and my participation in our tour early next month is in jeapardy. Not surprisingly he told me I was likely to have damaged a disc and it's putting particular pressure on a nerve, hence the loss of reflex. He told me some alphanumeric code for which nerve route is was . I think there was a 5 in it somewhere. He thinks I might need up to half a dozen appointments.

This is a monumental PITA.

[Jurek]

I've had an appointment with an osteopath. He did a few tests and pushed me around a bit.

There was definitely a loss off reflex in my left achilles tendon. Both knees performed well as did the right ankle, but not the left.

The worst was that he's told me not to cycle for the moment and to restrict walking to about 20 minutes a time. C & M Hilly 50 is right out, and my participation in our tour early next month is in jeapardy. Not surprisingly he told me I was likely to have damaged a disc and it's putting particular pressure on a nerve, hence the loss of reflex. He told me some alphanumeric code for which nerve route is was . I think there was a 5 in it somewhere. He thinks I might need up to half a dozen appointments.

This is a monumental PITA.

Much sympathy Wow.
 

[hellymedic]

Probably L5 or L5/S1.

My left ankle jerk has been absent since my student boyfriend applied his newly-purchased reflex hammer in the '70s. Never did work out how or why.

Hope symptoms settle soon.

[Wowbagger]

I'm finding more about sciatica than I want to.

Whereas the agonising shooting pains have largely subsided, they have been replaced mostly with a dull ache and also some odd numbness in my thigh and buttock. Sometimes it feels as though the dog has left a tennis ball on my chair, but he hasn't. My calf also aches, but I think this is muscular, due to pronounced limping. I have recently developed a dull ache in my genitals, which is most unpleasant.

[Chris S]

Sounds grim.

Are you on NSAIDs? Last serious episode I had (well over 10 years ago now) Volterol did it for me, though it plays havoc with my digestion which could only be fixed by eating yoghurt when I took the pills  . A diet designed to reduce inflammation might help too - so lots of whole food, fruit & berries, and no sweeties, boozahol or highly processed stuff. I suspect you do a lot of this already.

I can still remember the nights, being in so much pain and desperate for sleep. Back and Back induced pain is hateful.

[Wowbagger]

I've generally not found sleeping too bad, fortunately. Lying on my right side with my knees up is quite a relief, and that's my preferred sleeping position anyway.

I'm on diclofenac, which is pretty gut-ache inducing. I had porridge this morning and it's not been so bad. The osteopath has just phoned and has a cancellation for 1 p.m. so I'll go in for an other manipulation.

[nuttycyclist]

Last person I knew with sciatica was suffering badly (not first attack) and booked osteo.  I gave them a lift down there in the old BMW.

The seats were so comfy in that good old car that when they got out they said they felt cured, and that's before they went into the osteo!



I want my BMW back    Never should have sold it.

[mrcharly-YHT]

Sometimes it feels as though the dog has left a tennis ball on my chair, but he hasn't.

I get that a lot (but not from sciatica).  Sitting on an orthopedic seat wedge helps a lot.  One of these http://www.posturite.co.uk/PosturiteSite/product/4033.htm