Sciatica Prevention and Self Care

Sciatica is pain along the sciatic nerve. It usually results from compression of nerve roots in the lower back.

Common causes include disk disease, osteophytes, and narrowing of the spinal canal (spinal stenosis). Symptoms include pain radiating from the buttocks down the leg. Diagnosis is by MRI or CT. Electromyography and nerve conduction studies help confirm the affected level. Treatment includes symptomatic measures and sometimes surgery, particularly if there is a neurologic deficit.

Prevention
It’s not always possible to prevent sciatica, and the condition may recur. The following suggestions can play a key role in protecting your back:

* Exercise regularly. This is the most important thing you can do for your overall health as well as for your back. Pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. For cardiovascular benefits, try using a stationary bike, treadmill, elliptical trainer or cross-country ski machine. Cycling outdoors also is beneficial, but be certain your seat and handlebars are adjusted properly.

* Maintain proper posture when you sit. A good chair should comfortably support your hips, and the seat shouldn’t press on the back of your thighs or knees. If the chair doesn’t support the natural curve in your lower spine, place a rolled towel or pillow behind your back. When working at a computer, adjust your chair so that your feet are flat on the floor and your arms rest on your desk or the chair’s arms, with your elbows bent at a right angle. Take frequent breaks, even if it’s just to walk around your office.
When you drive, adjust your seat to keep your knees and hips level, and move the seat forward to avoid overreaching for the pedals.

* Use good body mechanics. Being conscious of how you stand, lift heavy objects and even how you sleep can go a long way toward keeping your back healthy. That’s because poor posture stresses your back, leading to fatigue and stress on joints and nerves. If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level instead of bending forward. Before you lift something heavy, decide where you’ll place it and how you’ll get there. Bend at your knees, not your back, so that your legs do the lifting. Carry objects close to your body at about waist level. If possible, set the object down on a surface between shoulder and knee height to avoid lifting objects over your head or bending over too far. Don’t twist at your waist. Instead, turn by pivoting your feet. Be careful moving heavy things when you’re tired — fatigue can cause you to move more awkwardly. Heavy loads pose the greatest risk, so know your limitations. Don’t attempt to lift something you feel is beyond your ability. For the best sleep posture, choose a mattress that feels comfortable to you. Use pillows for support, but don’t use one that forces your neck up at a severe angle.

Self-care
For most people, sciatica responds well to self-care measures. You’ll heal more quickly if you continue with your usual activities, but avoid what may have triggered the pain in the first place. Although resting for a day or so may provide some relief, prolonged bed rest isn’t a good idea. In the long run, inactivity will make your signs and symptoms worse. In addition to resuming usual activities, try the following measures:

* Cold packs. Initially, using cold packs may be able to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least several times a day.

* Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs. * Stretching. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.

* Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and acetaminophen (Tylenol, others) can both be helpful for sciatica. Although they can provide real relief, both types of medication have a “ceiling effect” — that is, there’s a limit to how much pain they can control. If you have moderate to severe pain, exceeding the recommended dosage won’t provide additional benefits. What’s more, NSAIDs can cause side effects such as nausea, stomach bleeding or ulcers, and acetaminophen can cause liver problems if taken in excess. If you use these medications, talk to your doctor so that you can be monitored for problems. In addition, periodically re-evaluate whether you still need them. Exercise, stretching, massage and other nondrug treatments can often provide the same benefits without side effects.

* Regular exercise. It may seem counterintuitive to exercise when you’re in pain, but regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts your body to release endorphins — chemicals that prevent pain signals from reaching your brain. Early in the course of sciatica, water exercise or other low-impact exercise such as a stationary bicycle will help you stay active without worsening your symptoms. Later, as you improve and the pain lessens, combining aerobic activity with strength training and core stability exercises that improve the strength of your back muscles can help limit the effects of age-related degenerative changes in your back. If you’re new to exercise, start out slowly and progress to at least 30 minutes most days. To prevent injury, consider learning proper weightlifting techniques from a certified personal trainer, fitness specialist or physical therapist.

Gangadharan Nair