Backache – Sciatica: Ways to treat it

Back pain or lower back pain can manifest in two ways: as chronic back pain and can last for months or years and as acute back pain or lumbago.

The worst development of back pain is sciatica. Sciatica is pain that starts in the waist and ends in the foot at a different height each time and can reach the toes and the sole of the foot.

Sciatica is an urgent condition and should always be examined by a doctor. The risk in these cases is chronicity. If the condition remains untreated then the pain will become permanent, the loss of sensation will become complete anesthesia and the simple muscle dysfunction will develop into complete paralysis of the lower limb.

Symptoms

In terms of symptoms, acute back pain is manifested by an acute, usually sudden pain in the lower back, which reflects up to the buttocks while at the same time a reflex contraction of the lumbar muscles occurs and the patient unconsciously assumes a scoliotic (oblique) posture every time he stands up.

The pain is so strong in the beginning that it can immobilize the person for many hours in the place where it first appeared.

The cause most of the time is the lifting (lifting) of a weight in the wrong way. The person has the feeling that something has broken in his waist, he feels intense pain and gives up the weight he is holding by screaming from the pain.

Other times the seizure occurs 1 to 2 days after lifting the weight or after opening a drawer or after a long time of crouching and working at a low table or after turning the waist, etc. Usually, each patient has his own way of starting the seizure.

The crisis usually lasts for 4 to 5 days and gradually disappears.

Diagnosis

A non-urgent evaluation to control sciatica involves a physical examination and testing of the strength of the muscles, their reflexes and their senses to determine if the problem is caused by a compressed nerve. An X-ray, MRI or CT scan or electromyography (nerve conduction study) may also be needed.

Radiological examination is also necessary in cases where the symptoms persist. Because then it may not be the same known and old disease but something new such as for example a small vertebral fracture from osteoporosis that the patient has acquired but does not know. If the patient also has a fever or other general symptoms, then a hematological laboratory test will be helpful. Of course, all these examinations will be done naturally, since the patient feels a little better and can move without much pain.

Prevention

Prevention is achieved through:

• Use a hard mattress for sleep and during sleep the posture should be on the back or side.
• Proper postures and proper use of the body in daily activities. Those involved in sports to improve their technique.
• Encouraging activities such as swimming, walking, cycling, etc.
• If it is considered necessary to use special zones for intense activities, not for a long time.
• Daily exercise with special exercises, designed by the therapist and tailored individually to each patient.
• In case of persistent pain, consult a specialist who can identify the cause.

Treatment

From the beginning of the crisis until 15 to 20 days when he is standing, the patient should wear a belt with straps, which he can then use only when he is going to tire his waist, such as in long hours of standing or in a large travel by car.

In addition to the medications that will be used in the initial acute phase, from time to time the patient may often use an anti-inflammatory ointment which he will apply with a light massage to relax the back muscles.
Losing a few pounds, if any, helps in recovery. Kinesiotherapy and physiotherapy should be done by specialists. The best physical therapy for the spine is swimming. The more you swim in the pool or the sea, the stronger your waist and the better you feel.

Swimming will begin after the crisis is complete, in as warm a sea or pool as possible and at the beginning the patient uses a life-saving device (lifebuoy) for safety. Theoretically, if the person manages to protect his waist and does not have another crisis in the next two or three years, then he can be considered cured.

Chronic back pain usually does not end in surgery. In rare cases when it causes severe pain and is extremely persistent or when the patient has a profession in which the perfect function of his waist is necessary (such as an athlete), then he is referred to the Orthopedist for surgery.

Therapy

The therapy will depend on the final diagnosis and should be individualized to the needs of the individual.

The conservative method includes:

• Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling.
• Physiotherapy, which includes exercises aimed at strengthening the muscles and restoring range of motion.
• Physiotherapy with natural means
• Acupuncture

Sources

Kontzaelias DA, (2011). Physiotherapy in diseases of the musculoskeletal system, Publications: University Studio Press, Thessaloniki.