Myths about the Sciatica treatment
Sciatica pain or sciatica nerve rediculopathy is the condition related to radiating pain due to impingement or irritating sciatica nerve. Sciatica is pain going down the leg from the lower back commonly. This pain may go down the lower back, outside, or front of the leg.
Onset of sciatica is often sudden following activities like heavy weight lifting, sudden jerking movement all though gradual onset also seen in some cases.
The pain is often described as shooting and radiating by patients. It is noteworthy that symptoms are unilateral i.e only on one side of the body got affected. Lower back pain is sometimes also associated with it.
If kept untreated weakness or numbness may occur in various parts of the affected leg and foot.
There are common myths associated with sciatica nerve here are few
1) sciatica will get better by its own
Physical therapists know that the sciatica problem is long standing if not treated in time and if left untreated for 2-3 yeas may lead to muscles wasting in worsh condition may lead to disability.
Our physical therapy profession is related to pain management and giving hope and empathy to our patients but we should not be giving false hopes.There are a subset of patients with radicular pain/ sciatica who may not get complete relief.So let's not give our patients false hopes and optimism rather provide accurate prognostic advice which should be evidence based. This will help you also to prove yourself honest in front of your patients, as patient with radicular pain will never make 100% recovery, because it is a myth.
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2) Movement will relieve the pain
It is a common saying that motion is lotion but it is not true in cases of redicular pains.Never advise this to your patients.
Sciatica Patients are already in worse Pain and frustration so a good physiotherapists should not advise movements which may lead to more pain and frustration to them, so with such patients go with rest is best approach.
Relaxation Exercises/ therapy will provide more healing to sciatica patients. This will also provide optimal conditions to heal or recovery.
Hence telling patients not to rest is a myth.
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3) Best exercises for sciatica are there
In the Era of internet before reaching to doctor patient have already taken 100s of advises from Google search. Patients searching for the pain relief exercises on the websites but reality is that there is no fullproof exercise treatment available for Sciatica pain.
The concept of best exercise for sciatica is a myth.
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4) Surgery is never required for sciatica
The common first line of treatment for radicular pain is conservative management like medicine, physiotherapy elctrotherapy, accupressure or acupunture etc.
This may sound strange and inappropriate as therapist, but we should draw a clear line between conservative treatment and non conservative treatment.As we know that all patients not required surgery, but a small numbers of patients might need surgical intervention more than they need physiotherapy.
After proper diagnosis and intervention if we find
1. progressive neurological deficits
2. lack of response to conservative care
3. persistent symptoms
Please don't hesitate to take surgical opinion or ensure referral of such patients.
If the patient is not improving even without these symptoms, Please refer such patients as it may unnecessarily prolonged the sufferings from conservative treatment.
5) Misdiagnoses as Piriformis syndrome
It is commonly heard that your piriformis is trapping your sciatic nerve or you have a tight piriformis.
Some doctors may tell you that your glutes are too heavy and it’s putting pressure on the nerve. The piriformis syndrome also misdiagnoses as deep gluteal syndrome.
In my opinion it is a wage term for pain in the posterior side of hip as it is not associated with fix structure so used vastly and has gain popularity in doctors.
Above that there are no strict diagnostic criteria for Piriformis Syndrome or deep gluteal syndrome present.
Most regular features include unilateral hip pain, pain with prolonged sitting, increases mechano-sensitivity and pain on palpation over the greater sciatic notch but these are also classic Symptoms of a lumbar nerve root pathology. Does that mean that every diagnosis of piriformis syndrome is a myth? I will write separate discussion on this also.
It is possible that something in the deep gluteal space could pressurizing the sciatic nerve, but probably not to the extent that it has been diagnosed.