Sciatica Stretches

Sciatica stretches can consist of exercises to loosen muscles in the buttock area that can cause sciatic nerve compression and/or mimic the symptoms of it, they may be used to reduce disc bulging in the lumbar spine, or they may be used for the purpose of relieving soft tissue adhesions around the nerve. All of these approaches have their benefits, but using certain stretches improperly can make things worse rather than better.

Stretching of the muscles that can produce sciatica symptoms is most often directed at the piriformis. This muscle in the lower buttock has different orientations relative to the sciatic nerve in different people. The nerve may run over the muscle, under the muscle, or even go through the middle of it. In cases where it runs under or through the piriformis, abnormal tightness of the muscle can compress the sciatic nerve and cause pain and other symptoms.

There are a few variations of stretching for the piriformis muscle. In all cases, the mechanics of the stretch require flexion and inward rotation of the hip joint. The basic idea is to bend the leg, pulling the knee towards the chest and across towards the opposite shoulder.

Another group of sciatica stretches are commonly referred to as McKenzie exercises, named after physical therapist, Robin McKenzie. The most often used of these exercises involve extension or backward bending of the lumbar spine. Spinal extension is used with the intention of squeezing bulging disc material forward and away from nerve branches that form the larger sciatic.

Finally, there are actual sciatic nerve stretches. That is, the purpose is to actually place tension on the sciatic nerve to eliminate various soft tissue adhesions and allow the nerve to be more mobile. This approach is sometimes called "nerve flossing". The technique involves stretching the symptomatic leg, alternately bending and straightening it. While this can be helpful in long-standing cases of sciatica, it can cause considerable irritation of the sciatic nerve and may make symptoms worse. For this reason, this type of stretching for the sciatic nerve should really only be done by those experienced with its use and/or under the supervision of a health care provider.

All of the types of stretching exercises for sciatica symptoms can be very helpful. In fact, for many sufferers with this type of pain, their symptoms can be effectively alleviated and prevented with the appropriate use of sciatica stretches.

Cervical Disc Replacement: Risks and Benefits

People who have tried and failed conventional non-surgical treatments such as exercise, anti-inflammatory medication, chiropractic, physical therapy, etc. to relieve their neck pain can benefit from cervical disc replacement surgery.

Discs in the entire spinal column, which are 23 in total, 6 of which are cervical discs, act as cushions or shock absorbers between the bones (vertebrae) of the spine. These discs may deteriorate due to cervical disc diseases like failed cervical fusion and degenerative disorders in the cervical, which can cause neck pain, arm pain, arm weakness or numbness.

When non-operative methods like physical therapy and drugs fail to provide back or neck pain relief, patients suffering from neck (cervical) disc disease often turn to replacement surgery as a last resort.

The Surgical Overview
Cervical disc replacement involves inserting an artificial disc in the space between two vertebrae (spinal bones) to replace the painful, diseased or damaged disc while keeping your normal neck motion. The artificial disc mimics the function of a natural spinal disc.

In the surgery, the damaged disc is completely removed including any impinging disc fragments or osteophytes (bone spurs) and the disc space is returned to the height it was prior to disease.

The cervical disc(s) may degenerate or damage as a result of direct trauma, arthritis, gradual changes or an unknown cause, leading to neck pain from inflammation or muscle spasm and severe pain, weakness and numbness in the arms from pressure on the cervical nerve roots.

Surgical replacement of a disc with an artificial device is a relatively new procedure. The first replacement surgery for the low back (lumbar spine) was approved by America's Food and Drug Administration in June 2004 for use in the country.

As a matter of fact, disc replacement surgery is not a procedure suitable for everyone. Patients with brittle bones from osteoporosis or other significant diseases may not be good candidates for this type of surgery. Problems like infection or severe degeneration of the spinal joints may also keep a patient from having this operation.

Potential Risks and Complications
As with any spine surgery, cervical disc replacement surgery is not without risk. A variety of complications with an artificial disc may occur, either alone or in combination. Although rare, but these complications can be severe.

The potential surgical complications may include:

Wound infection
Allergic reaction to the anesthesia
Spinal fluid leak
Blood loss
Nerve injury or paralysis
Need for further surgery
Injury to the spine's nerve tissue and veins, and arteries near the spine
The injured spinal cord or the nerves can result in impairment or complete paralysis of all four limbs.
Paralysis of certain muscles in the arms or legs may also occur following the injury to the nerves.
Inability to resume routine activities, including sexual activity, following the surgery.

Benefits

Normal neck motion can be maintained
The artificial disc absorbs some of the daily stresses of the neck.
The procedure eliminates the need for a complex and painful bone graft, which can be difficult to heal and has a risk of an infection transmission from grafting material.
Following cervical disc replacement, the adjacent spinal discs don't have to bear the extra stress (versus a fusion procedure).
The artificial disc surgery patients recover more quickly than the spinal fusion patients.
The surgery has lesser chances of requiring a revision surgical procedure.
The chances of device failures (breakages) are significantly less.
Lesser number of cervical disc replacement patients need a hard collar surgery.
Since the healing time from a cervical disc replacement is quicker, the patient is able to return to almost every type of activities faster.

Neck Pain, Back Pain, Sciatica and Pregnancy - The Back Pain Complex, Causes and Treatment

The back pain complex, to include neck pain, back pain and sciatica, is one of the most common complaints among mothers-to-be during pregnancy. The spine is made up of two primary and two secondary curvatures. The secondary curvature of the lumbar region is most affected during pregnancy. The lumbar curvature, established after birth and responsible for our ability to walk upright, comes under tremendous pressure during pregnancy. Back pain is quite common during pregnancy with as many as 80% of all women experiencing neck pain, back pain and/or sciatica in varying degrees. The back pain complex is expressed from mild to acute and may become chronic if not properly addressed. We will discuss some of the reasons why back pain is so prevalent during pregnancy and offer a few solutions, as well.

While women with previous back problems are at greater risk for neck pain, back pain and sciatica, it is common among all women beginning as early as two months and continuing through, and well after, the completion of the pregnancy. During pregnancy the body produces a number of hormones, some in much higher quantities than typically found. One of the principal hormones having the most dramatic impact during pregnancy is called Relaxin. Relaxin's function it is to make the ligaments associated with birth, and the pelvis aperture itself, softer and more pliable. The reasons for this are obvious, it is vitally important for the baby, particularly the baby's cranium or skull, to be able to pass through the birth canal with relative ease, Relaxin makes this possible. Additionally, as the uterus grows and weight shifts forward, the center of gravity changes and the relaxation of the uterine ligaments impacts the spine and the surrounding musculature. The core muscles, to include key abdominal muscles, spinal muscles, and para-vertebral muscles, are also stretched and taxed beyond normal capabilities. The combination of hormonal and structural factors often contribute to varying degrees of neck pain, back pain, and sciatica.

Obesity, always a significant factor in diagnosing and treating the back pain complex, becomes an even greater issue during pregnancy. Normal weight gain, not to be confused with obesity, may also negatively affect mothers-to-be. The combination of an exaggerated spinal curvature, called lordosis in the lumbar region, a shift in the center of gravity, additional weight carried forward, and a weaker core muscle complex are also contributory factors. The core muscles, as well as other synergistic muscle groups, may be strengthened through a program of exercise and stretching. It must be recognized that back pain during pregnancy is the rule rather than the exception, the challenge is to deal effectively with the underlying cause or causes with an intelligent and individualized treatment program.

Two of the most common back pain expressions during pregnancy, are lumbar pain, centered primarily in the lower back, and posterior pelvic pain, with symptoms very much like those associated with sciatica. The low back or lumbar pain is generally centered in the lower back and may radiate unilaterally, one side, or bilaterally, both sides, across the iliac crest, which is the region to each side of the spine at the upper level of the pelvis. Once again, pain may range from mild to acute and grow increasingly intense the deeper into the pregnancy the mother-to-be is. Back pain in this region is exacerbated by extended periods of standing, particularly in one place, sitting for long periods of time, and by poor posture, as in the old military idea of "stomach and chest out" which simply does not work for obvious reasons. Posterior pelvic pain can be quite severe and may be four to five times more prevalent than any other back pain expression during pregnancy. Posterior pelvic pain, as noted above, may be indistinguishable in its expression from sciatica. Pelvic pain may be felt as a deep ache or even a burning sensation, may radiate across the buttocks and into the legs, unilaterally or bilaterally, and in its worst configuration or state may also be felt in the feet and toes, very much like sciatica. The biggest distinction between posterior pelvic pain and sciatica is that posterior pelvic pain is more commonly experienced bilaterally. Sciatica, on the other hand, is generally a unilateral expression affecting the buttocks, legs, feet, and toes.

While quite common, neck pain, back pain and/or sciatica, including posterior pelvic pain, should not be taken lightly. If the back pain complex is not addressed properly, it may have negative consequences throughout the pregnancy and felt in virtually every aspect of the new mom's life. It is not uncommon for women who experience severe back pain throughout the pregnancy to continue to have problems well into the post partum period. Pregnancy can be, and usually is, a wonderful time in both the family's life and in the life of the mother-to-be. However, if back pain is not addressed it may have a negative impact during and afterwards, in some cases for years after the pregnancy.

As noted above, there may be a myriad of causes and consequences associated with the back pain complex, as it relates to pregnancy. An intelligent, individualized, and medically supervised program of exercise and stretching is not only advisable it is absolutely necessary. Certain exercises, such as the pelvic tilt and crunches, at least until the latter stages of the pregnancy, may be appropriate and advisable. However, it is usually the case that such self-treatment programs of exercise are not only misguided but fail to achieve any real and lasting relief or benefit. Additionally, because of the shift in the center of gravity and the exacerbated lumbar curvature, a complete program focusing on the core muscles may be the best approach. Improper posture, standing for long periods of time, sitting for long periods, and even remaining inactive for extended periods of time may have a negative impact, ultimately leading to even greater pain. Finally, it is advisable for pregnant women, particularly those who work deep into the pregnancy or have other children, to take special care when lifting anything heavy. Because of the number of physiological and anatomical changes that take place during pregnancy, a program that seeks to strengthen the musculature and to improve endurance, so fatigue doesn't lead to other problems and injuries, should be initiated as soon as possible. Only through a comprehensive program of treatment and exercise can a prospective mom hope alleviate or eliminate neck pain, back pain, and sciatica.

Should You Have Surgery For A Spinal Burst Fracture?

The thoracolumbar junction in the spine describes the joint that forms between the lowest thoracic vertebra and the highest lumbar vertebra. This is a transitional area in the spine, joining the rigid thoracic spine with the more mobile lumbar spine. The joint acts as a hinge between the two, making it particularly susceptible to injury.

One type of injury common to this spinal segment is the burst fracture. A burst fracture occurs when the entire vertebral body is fractured in all directions. This crushing of the vertebra causes bone fragments to spread out from it, both inward toward the spinal column and outward. Burst fractures are dangerous because they put your spinal cord at risk; bone fragments jutting into the spinal column could cause nerve impingement and even paralysis depending on the extent of impingement.

Burst fractures usually occur at the thoracolumbar junction due to trauma, such as a car accident or hard fall. Nerve impingement in this area often causes sharp, severe pain down the leg. The pain may wrap around to the groin region. Severe pain will also be experienced locally around the fracture.

Surgical Vs. Non-Surgical Treatment

Treatment for burst fractures is a topic of controversy. One thing is certain: Treatment is always needed, as this type of injury doesn't just heal on its own. Many, but not all, burst fractures require surgery. How to decide which fractures do and which don't require surgery is the subject of debate.

One main indicator for surgery is neurological deficit. If you have pain, weakness, numbness or loss of function along the nerve path, you have neurological symptoms. Injury to the thoracolumbar nerves can cause symptoms in the legs as well as loss of bladder and bowel control. If you don't have neurological symptoms, you may still require surgery.

The other treatment criterion to keep in mind is spinal stability. This has different definitions, but the most generally accepted definition of an unstable burst fracture is one that involves injury to the posterior portion of the vertebra and disc as well as the posterior ligament. Instability is generally considered grounds for surgery.

Spinal fusion is the surgery of choice for thoracolumbar fracture. Impinging bone fragments are removed and the unstable spinal segment is fused to prevent movement and nerve compression. After surgery, bracing and physical therapy are required. When surgery can be avoided, bracing for a period of 8-12 weeks followed by physical therapy is necessary.

The question of whether or not to receive surgery for burst fracture can be a hard one to answer. If you have no neurological symptoms but some instability, for example, which option is best? The review of the literature at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989512/ promotes the generally accepted opinion that, when instability is identified, early surgical treatment is best.

However, some in the medical field disagree with conventional wisdom. The definition of instability is vague, and a review of a number of control trials reveals that non-surgical treatment often has results on par with surgical treatment for burst fractures without neurological symptoms, with less financial expensive and risk of complications. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899715/ for an in-depth counterargument to surgery for unstable burst fractures.

Sometimes choosing what treatment to receive is hard, and this is the case with thoracolumbar burst fracture. While it is generally agreed that neurological symptoms indicate surgery, instability is questionable criteria for immediate invasive treatment. You will be best prepared to make a decision in your own case if you review the arguments for and against surgery and discuss your questions and concerns with your doctor.

How Simple Lumbar Stabilization Back Surgery Now May Eliminate Need For Painful Spinal Fusion Later

Thousands of Americans are suffering from back pain, and with the aging of the Baby Boomer generation, more are expected to start feeling the ache in years to come. There are any number of factors that can cause backaches, and there are even more ways that have been developed to treat it. But among these many techniques, two stand out most strongly: dynamic stabilization lumbar surgery and spinal fusion surgery.

Spinal fusion surgery has long been a reliable method of combating spinal injury. However, the technique has seen even further improvement over the years since it was first developed, and is now even more effective. Dynamic stabilization lumbar surgery is a newer method, developed largely to address lumbar problems before they get to the point of needing spinal fusion surgery, and making it far less likely that the patient would need to undergo the procedure a second time. However, since its development decades ago in Europe, dynamic stabilization lumbar surgery has gained a place as a treatment for lower back pain in its own right.

A Research Effort From Around The World

The development of dynamic stabilization lumbar surgery has been one of the first examples of global leadership within the medical community. Rather than the traditional European dominance of development, this technique is coming from top creative minds headquartered in medical travel destinations like Mexico. One Mexico surgeon, Dr. Juan Dipp, was responsible for creating the procedure associated with the Percudyn Dynamic Lumbar Stabilization System, one of the most used systems for dynamic stabilization.

What Is Dynamic Stabilization Lumbar Surgery?

Procedures like spinal fusion surgery are among the most challenging for any surgeon to perform. However, this area of medicine has attracted the doctors who are up to that challenge, and who love to constantly perfect their surgical technique. These are the doctors who have developed and perfected the dynamic stabilization system.

Originally viewed as s supplement to fusion surgery, dynamic stabilization now has many uses for helping alleviate lower back pain. The key to the procedure is the dynamic nature of the system, which allows it to move and accommodate the area surrounding it more easily. Before the dynamic stabilization, doctors commonly used metal rods to support the back. While effective support mechanisms, these rods were highly disruptive to the natural functioning of the spine.

In the spine, there is nothing quite as hard and rigid as metal; bone, though not exactly fragile, is much more pliable than hard steel. Where the rods had been installed, the spine began to show more wear. Surgeons began to notice a risk for further spinal injury as a result of the very devices which had been installed to help keep patients pain-free.

Using Dynamic Stabilization With Spinal Fusion Surgery

Dynamic stabilization lumbar surgery helps resolve back pain in three main ways. First, it is commonly used to assist with spinal fusion surgery. In spinal fusion surgery, a damaged portion of the patient's back must be fused together with bone grafts in order to facilitate healing. This is common where the spine has been crushed or where some form of degenerative condition has created a destabilization. The main advantage of spinal fusion surgery is that it will reduce stress on the area in the future; there will be less of an ability for that particular vertebra to bend, which will help ensure that it remains healthy. It is unlikely that the patient would see any particular lack of mobility in smaller spinal fusion surgery procedures, but if many vertebra are fused together, some difference may be noted.

The second common use of dynamic stabilization is to assist with healing after a spinal fusion surgery has been performed. This is what it was originally designed to do, replacing the metal rods that formerly helped the back recover after a surgery. In this case, the support helps the fused portion of the vertebra interact with the rest of the spinal column after the surgery. Very often, it is difficult for the fused and non-fused portions to reintegrate into the functioning spine. The dynamic stabilization offers gentle spreading of the forces across the area, reducing tension and allowing for smoother motion.

When used in either of these ways, stabilization can be very helpful in preventing future complications. There is none of the stress and strain that might be expected from a metallic rod, making it much easier for the patient to function short term and long term.

Dynamic Stabilization on Its Own

Lumbar stabilization has a unique ability to simulate the posterior tension band. Located at the furthest back portion of the spine, the band often must be removed during procedures. Without the band, the spine may destabilize and require spinal fusion surgery to treat in the future. A stabilizing device can help prevent that problem, saving the patient from requiring a potentially painful and complex surgery in the future.

Scoliosis Spine Treatment: A Scoliosis Forum Dedicated to Finding a Better Way

The treatment of Idiopathic Adolescent Scoliosis has always been controversial and ranging from those whom recommend radical multi-level spinal fusion surgery in very young patients to those whom don't feel any treatment is required at all. Part of the confusion and varied treatment recommendations has been the lack of available research data and of course the very nature of treating a condition with an unknown cause.

Hippocrates, the father of medicine, famously (and infamously in some cases) proclaimed, "First, do no harm" which essentially translates into recommending treatment from a least invasive to most invasive manner. Good and generally heeded advice, but it still leaves quite a bit of grey area in terms of discussion of does spinal fusion surgical intervention really benefit the scoliosis patient?
The results of long-term "quality of life" studies on Scoliosis patients would suggest that patients are better off receiving absolutely no treatment than choosing surgical intervention. A long-term follow us study at the University of Iowa concluded, "Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns." (1) Whereas an approximately 17 year follow up of surgically treated patients found, "40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons" and "The psychological health status is significantly impaired."(2)

How could this happen in the age of "evidence based medicine"? How can we drive remote control cars on the surface of Mars, but can't find a non-surgical way to treat an age old condition like scoliosis of the spine? I purpose that it is due in large part to a lack of open dialog and a safe place to discuss the problems plaguing the current treatment system and the sharing of ideas that could lead us into the future. Until recently scoliosis treatment forums have been dominated by pre and post surgical treated patients with general lip service and a single chat room given to anyone searching for a non-surgical scoliosis treatment solution. A non surgical forum created to provide the over-whelming majority of scoliosis patients whom won't choose surgical intervention as a treatment choice, a place to learn, converse, and share ideas is certainly needed. A place for patients, parents, and scoliosis doctors whom dream of a better way to treat scoliosis to come together and discuss different alternative options and new ideas for treating scoliosis without the constant assault from surgical advocates claiming surgery is the only way.

Dr Brian T Dovorany

1. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67. Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV.
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.

2. Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8 Quality of Life and Back Pain: Outcome 16.7 Years After Harrington Instrumentation Spine 2002 Jul 1;27 (13):1456-63 Gotze et al, Dept. of O Surg, Hamm,Germany

Spinal Decompression Therapy - A Back Pain Relief From Degenerative Disc Disease

Degenerative disc disease is the progressive deterioration of the spinal discs and arthritic changes that occurs due to wear and tear with aging. Not actually a disease, it is a condition in which pain is caused from a damaged disc. In clinical terms, it is called spondylosis. The pain caused by a degenerated disc is termed by doctors as discogenic pain. The condition can take place throughout the spine, but most often, it occurs in the discs in the lumbar region (lower back) and cervical region (neck).

In a study, it is found that low back pain increases with increasing degree of disc degeneration. Degenerative disc disease is more likely to be developed as an individual gets older. Intervertebral discs become more vulnerable to degeneration and become more distinct as the lower spinal column gets straighter. Those individuals with a straighter vertebral column are at greater risk of low back pain and more severe symptoms than individuals with normal intervertebral slope.

A spinal disc is composed of a tough outer shell with a soft center inside. The discs are located between your spinal vertebrae to support spinal bones and cushion your movements. As a person age, the discs flatten out and spread sideways. The outer shell can become brittle or crack and the soft center can leak or bulge, pressing on nearby nerves or joints which can cause pain.

Degeneration in intervertebral disc is a part of normal aging and is associated with additional risk factors such as heredity, obesity, excessive weight, and smoking. When we are born, the disc is about 80% water. As we age, the disc dries out and loses flexibility to absorb shocks. Daily activities and sports activities can damage the disc. By the age of 60, most people have some degree of degenerative disc disease.

Degenerative disc disease is common and it can be present in people with no symptoms. In some people, they may feel symptoms such as low back pain which is more painful when sitting and when doing certain activities like bending, lifting, and twisting. They actually feel better when walking or running rather than prolonged sitting or standing, and if they shift positions frequently.

For people with degenerative disc disease, they usually manage the pain by minimizing stress on the disc through proper ergonomics and posture, exercise, and engaging in rehabilitation program. It is usually in the best interest of most patients to treat the pain using conservative treatment rather than surgery.

Spinal Decompression is the only nonsurgical treatment that is capable of reducing the symptoms of degenerative disc disease by treating the cause of disc degeneration, the chronic disc compression that contributes to loss of fluid.

Decompression therapy is a new form of treatment for back pain associated with disc problems. Research confirms that decompression is an effective treatment for degenerative disc disease. It reduces pressure on the disc and nerves and rehydrates the disc by drawing in fluids and nutrients.

Many lives have improved with spinal decompression since it was introduced. With just a course of the treatment, majority of the patients experienced complete relief and remained pain-free. Added with exercise program, appropriate spinal balancing, and spinal education, you'll see that no other treatment can provide such benefit than spinal decompression.