June 22, 2014
I see many patients who suffer from sciatica. These shooting pains in the lower back and legs can be debilitating. Sometimes surgical treatment is necessary to relieve this pain, but sometimes it can be brought under control or even eliminated with the proper exercises. Sometimes patients can be treated non-surgically with anti-inflammatory medications and pain relievers or steroids. These non-surgical treatments for sciatica are often paired with physical therapy so that the body can be trained to support the spine and protect the back from further damage or recurrence of sciatica. A program of gentle stretching and strengthening can often be paired with massage to help restore muscles that often stiffen or spasm due to back injury. A combination of pain and inflammation relief with physical therapy and massage or other soft tissue relief is ideal for returning the sciatica sufferer to normal daily activities and restoring range of motion.
While each physical therapy program is tailored to the individual patient, they often have many elements in common. People with back problems often have weakened abdominal muscles and tight back muscles. The hamstrings are also often tight in sciatica patients, so both massage or TENS treatment as well as stretching can be used. Strengthening the back and abdomen helps to support the spine and keep it in proper alignment. Weight training is often combined with stretching, Pilates, and low or no impact exercise to rehabilitate the body gently while medication controls the pain and inflammation. Ideally this treatment can postpone or prevent the need for surgery. Often this kind of conservative treatment brings the patient a good deal of relief from his or her symptoms and surgery is not necessary.
If the patient does need surgery, a minimally invasive approach combined with the above rehabilitative treatment can effectively treat the pain of sciatica. Depending on the cause of sciatica, a surgical patient often needs either a microdiscectomy or discectomy, or a laminectomy or laminotomy. All of these procedures can be performed using minimally invasive techniques, which allow for less anesthesia, little to no hospital stay, and a much faster healing time than traditional open surgery. Minimally invasive procedures do much less damage to the soft tissue surrounding the damaged disc or discs causing the symptoms, so physical therapy can begin soon after the surgery, which greatly increases a positive outcome.