Conservative treatment is aimed at pain reduction. Initial treatment starts with cold packs or heat, NSAIDs (eg,Celebrex, Ponstan, Motrin), muscle relaxants, and pain medications.
Education about proper mechanics (bending and lifting), physical therapy, and epidural steroid injections may also help patients return to full activity.
Surgical Treatment
Some patients do not respond to nonsurgical care and experience persistent disabling sciatica. These patients may benefit from surgery.
The role of surgery is to remove the disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. This decompression surgery does not reliably reduce low back pain.
The timing of surgery is multifactorial, based on the duration and severity of symptoms. There is consensus that a cauda equina syndrome (bladder or bowel paralysis) is an absolute indication for immediate surgery. In general, there is a greater than 90% chance of successful resolution of sciatica after surgery.
The surgery can be performed with a microdiscectomy, laminotomy, laminoplasty, or laminectomy technique as indicated by the need for exposure of the affected nerve roots.
In the recent SPORT clinical study (Spine Patient Outcome Research Trial), a randomized, multi-site trial that the HSS Spine Service participated in, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operative treated patients in relief of sciatica, physical function, and bodily pain.
CAM- Acupuncture or Acupressure: Practitioners believe your body has an energy force called Qi or Chi (pronounced "chee"). They think that when Chi is blocked, you can develop physical illness. Both acupuncture and acupressure work to restore a healthy, energetic flow of Chi. (These Eastern approaches to healing are different from Western scientific concepts. That doesn't make them better or worse; it just makes them different.)
In acupuncture, the practitioner inserts fine needles into your body at specific points (it doesn't hurt, honestly). Acupressure is similar to acupuncture— but there are no needles involved. The practitioner uses thumbs, fingers, and elbows instead of needles.
- Biofeedback: This is more than telling your body, "Stop feeling pain." Biofeedback is a mind-body therapy teaches you how to change, or control a habitual reaction to pain or stress. For example, if it's muscle tension causing your sciatica, you could learn deep-breathing techniques and mental exercises to help you to relax.
- Yoga: If piriformis syndrome is the cause of your sciatica, yoga can help. Some yoga movements can gently stretch the piriformis muscle. As a word of caution, some yoga positions can make sciatica worse. Avoid positions that involve forward folds, twisting, or stretching the back of your legs. These movements can further irritate your sciatica.
http://www.emaxhealth.com/2/45/33127/sciatica-symptoms-and-treatment.html
http://www.spineuniverse.com/displayarticle.php/article4127.html
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