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Experience GERONTOLOGY (NURSING ISSUES RELATED TO THE ELDERY) I have 20 years experience working with the elderly. I would be pleased to offer any assistance I can. My areas of expertise include: Gerontology / Geriatrics, Long Term Care, Community Nursing, Palliative Care, Private Nursing Services, Intermediate / Extended Care. I also have a personal interest in Homeopathic and Eastern Medicine. If I can not answer your question I'll do my best to direct you to an appropriate resource. Thank you. Experience in the area 20 years of Long Term Care and Community Nursing, specialising in Geriatrics, Gerontology and PalliativeCare.
Education/Credentials Registered Nurse , Certified Gerontological Nurse, Bachelor of Science in Nursing
Question I have got Sciatica nerve which starts from the back and down my right leg. I also have thrombosis in my right leg. What is a good pain relief?
Thank You.
Answer Hi Hazel and thanks for writing,
As you are no doubt aware, Sciatica is nerve pain caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these factors. Typical non-surgical sciatica treatments include one or a combination of medical treatments and alternative (non-medical) treatments, and almost always includes some form of exercise and stretching. The goals of non-surgical sciatica treatment should include both relief of sciatica pain and prevention of future sciatica symptoms.
During an episode of sciatica, there are a number of non-surgical treatment options available to help alleviate the sciatic pain and discomfort. For acute sciatica pain, heat and/or ice packs are most readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated to help with sciatica pain relief.
Over-the-counter or prescription medications may also be helpful in relieving sciatica. Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can be helpful in reducing the inflammation which is usually a contributing factor in sciatica.
If the sciatica pain is severe, an epidural steroid injection can be performed to reduce the inflammation. Acupuncture has been approved by the U.S. FDA as a treatment for back pain, and the National Institutes of Health recognized acupuncture as effective in relieving back pain, including sciatica. Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers). Spinal adjustments and manual manipulation performed by appropriately trained health professionals (e.g. chiropractors, osteopathic physicians, physical therapists) are focused on providing better spinal column alignment, which in turn should help to address a number of underlying conditions that can cause sciatic nerve pain. Manual manipulation done to address the right indications by appropriately trained health professionals can create a better healing environment and should not be painful.
When the sciatica pain is at its worst, patients may need to rest for a day or two, but resting for longer periods of time is usually not advisable. In fact, inactivity will usually make the sciatic pain worse. This is because regular movement and exercise is necessary to nourish the various structures in the low back and encourage the strength needed to support the low back.
Many sciatica exercises focus on strengthening the abdominal and back muscles in order to give more support for the back. Stretching exercises for sciatica target muscles that cause pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and can help to prevent future episodes of pain.
Low impact aerobic exercise, such as walking or swimming (or pool therapy) is also usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment. Aerobic conditioning also has the added benefit of releasing endorphins, the body’s natural pain killers, which is a natural way to alleviate sciatic pain.
There are a number of types of non-surgical spine care professionals who specialize in treating sciatica symptoms, including chiropractors, physiatrists (physical medicine and rehabilitation specialists), pain medicine specialists, and physical therapists, all of whom have specialized training to provide pain relief and to help prevent future recurrences of sciatica. It is always advisable to have a qualified medical professional oversee any sciatica treatments.
To be effective, the sciatica exercises recommended for specific conditions must be done regularly (typically two times daily) and correctly. Close attention to posture and body mechanics is the key to getting the maximum benefit from the exercises. Continuing with a program of gentle exercise and stretching is beneficial for a current episode of sciatica but also for overall back health and for preventing future back problems.
Caring for sciatica should be considered part of one's daily living, not just something to add to the routine at the end of the day. In addition to an exercise routine, patients with sciatica should minimize everyday stress on the lower back, including using good ergonomics while lifting, maintaining good posture, making sure the lower back is supported while sitting, and avoiding standing for long periods of time.
Specific sciatica exercises depend on the cause of the pain
A physical therapist, certified athletic trainer (ATC), chiropractor, physiatrist or other spine specialist who treats the back pain and leg pain associated with sciatica may recommend exercise as part of a treatment program. It is important to first get an accurate diagnosis for the cause of sciatic pain, as the specific exercises recommended will depend on the cause of the sciatica. It is also important to get a diagnosis before starting any sciatica exercises because, while rare, sciatic pain can be caused by some serious medical conditions (such as an infection or tumor) that require prompt medical attention.
Most types of sciatica will benefit from a regular routine of hamstring exercise, especially hamstring stretching. The hamstrings are muscles located in the back of the thigh. They help bend the knee and extend the hip. Tightness in the hamstrings will place increased stress on the low back and often aggravate or even cause some of the conditions that result in sciatica.
When doing the hamstring stretches, patients should avoid bouncing, which can trigger a muscle spasm.
Hamstring stretch while lying on the back
Most patients with back pain will benefit from hamstring stretching exercises done while lying on the back. These are the least stressful types of hamstring stretch:
• Lie on the back, supporting the thigh behind the knee with the hand or with a towel, slowly straighten the knee until a stretch is felt in the back of the thigh, trying to get the bottom of the foot to face the ceiling, one leg at a time (Figure 23). Hold the position initially for 10 seconds, and gradually work up to 20-30 seconds.
• Another low stress hamstring stretch is to lie back on the floor with the buttocks against a wall at a corner or by a door jamb. Keeping one leg on the floor, place the foot of the alternate leg against the wall and try to gently push the knee straight so raised leg and the leg on the floor make a 90 degree angle. Hold the position for 10 to 20 seconds.
Hamstring stretch while sitting
Although they are less gentle than lying on the back, hamstring stretches can also be done in a sitting position, where the degree of stretch can be varied based on the placement of the leg:
• While sitting at the edge of a chair, straighten one leg in front of the body with the heel on the floor. Then, sit up straight and try pushing the navel towards the thigh without leaning the trunk of the body forwards. Hold this stretch for 30 seconds, then repeat 3 times for each leg.
• Many people – and especially women – tend to be more flexible and may need to elevate the foot on a stool or chair to get a deep enough stretch.
Certain hamstring stretches are more comfortable for some patients
The hamstring stretches done while lying on the back are gentler and place less stress on the back than those done while sitting. Depending on the patient’s specific medical condition and level of pain, the lying down position may be preferable and comfortable. In particular, patients with low back should choose whichever position is most tolerable for their back while still giving a gentle stretch.
