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Sciatica is miserable to go through.  For many people, it is debilitating to the point where they can’t stand, sit, walk, or even sleep without drugging themselves into unconsciousness, and sometimes even that doesn’t work.  So it is no wonder that sciatica sufferers are willing to do just about anything to get rid of the pain and typically don’t ask a lot of questions of their doctors.  They just want the pain to go away.

The dirty little secret about sciatica treatment is that although there are many treatments for sciatica that work to varying degrees for different people, none of the treatments can really be considered a long-term “cure”.  Now a lot of doctors will tell you that the treatment they are proposing is a cure, but the reality is that the underlying causes of sciatica require lifetime management - there simply is no cure that is going to take care of the problem once and for all.

For example, one of the more popular treatments for sciatica is epidural steroid injection (or ESI for short).  ESI does relieve sciatica for some people, but the effect is temporary.  Most cases of true sciatic nerve irritation (not to be confused with pseudo sciatica  from a muscular problem called piriformis syndrome) are due to one or more lower lumbar spine disc herniations and the associated inflammation which place pressure on nerves that form part of the sciatc nerve.  ESIs are used to reduce inflammation, and this often reduces pressure on the nerves, alleviating the sciatica symptoms.  But ESIs do nothing to actually repair the damaged disc, and there is some indication that excessive use of ESI may actually cause weakenng of the disc tissue and make it more susceptible to further damage.  While ESIs can be a very useful treatment measure for short-term sciatica relief, they can lull patients into a false sense of security.  Because the symptoms may go away completely following ESI, a person may think he or she is healed and may resume activities that can re-aggravate the disc injury and possibly even make it worse.  Unfortunately, many doctors do not adequately communicate to patients that a lack of symptoms does not equate to being healed. 

Another popular treatment for sciatica is physical therapy.  Early on in the treatment process, physical therapy usually consists of “passive therapies”, which are things done to the patient to alleviate pain, such as electrical stimulation, ultrasound, massage, etc..  Assuming there is some symptom improvement, most physical therapy will eventually transition to “active therapy”, which is activities done by the patient to recondition and stabilize their condition - in other words, exercise.  Exercise is a valuable form of sciatica treatment, but there is a big problem with the way it is often used.  In many cases, the patient goes to physical therapy and exercises on a regular basis for 6 to 8 weeks, and perhaps longer.  At some point the patient is considered to have reached maximum improvement and is released from treatment.  While a small percentage of people continue to do their physical therapy exercises on their own, most do not.  After just a few weeks of not doing the exercises, most of the benefits of the original therapy program are lost.  This leaves the patient feeling alright, but in a very vulnerable condition.  It is very common for re-injuries to occur and for the sciatica to return at this point. 

As with ESIs and physical therapy, the other treatments for sciatica suffer from the same lack of long-term effects.  Medication can only be used for so long before the user becomes habituated to it and it no longer works, not to mention the high risk of side-effects of medication when taken daily for long periods of time.  Chiropractic, acupuncture, and massage may bring excellent short-term relief, but again just because symptoms are gone, it doesn’t mean the condition is actually healed.  Spinal decompression is a new form of traction that gets very good results in many cases where nothing else has worked and it appears to help damaged discs heal to an extent, but maintenance treatment is still required in most cases.

But what about surgery?  Surely disc surgery solves the problem once and for all, doesn’t it?  Well, obviously if you go so far as to remove a damaged disc completely, that disc will not cause any nerve compression again, but you hve to look beyond that.  Complete disc removal (discectomy) may be performed with or without spinal fusion (most commonly done with some type of metal screws, plates, and/or cages to attach the spinal bones above and below the removed disc to each other).  Even if the disc is removed without doing a fusion, eventually fusion does occur just by virtue of the bones growing together naturally.  When there is an area of fusion in the spine, the motion that would have occurred at that level of the spine gets transferred to the adjacent areas, creating additional mechanical stress on discs above and/or below the fused level.  This often results in future disc injuries and a return of symptoms.  Add to this the problem that post-sugical scar tissue an sometimes begin to create nerve compression and result in sciatica and back pain too, I don’t think you can legitimately call surgery a long-term cure in most cases.  In fact, one of the leading risk factors for needing spinal surgery in the future is having had spinal surgery in the past!  This is not to say that one should never consider surgery as a treatment option.  Surgery is sometimes the only treatment that has the potential to help at all, and it definitely should be done if there is an imminent risk of permanent neurological damage (signs of which include severe leg weakness, loss of bowel and bladder control, and loss of sensation in the groin and inner thighs).  But all too often, people rush into surgery because they are desperate for pain relief and thinking that surgery is a permanent fix, only to be very disappointed later on. 

As I stated at the beginning of this post, sciatica requires lifetime management.  Ultimately, the most effective way to help discs heal and to prevent re-injury and a return of sciatica is to combine an ongoing preventive exercise regimen with awareness and vigilance  to avoid the most commonly-damaging positions and activities that cause disc injuries and sciatica.  Daily or almost daily sciatica exercises, maintaining safe bending and lifting habits, and working with good posture and ergonomics are all necessary to avoiding sciatica long-term - even if you’ve already had some other form of treatment and are currently feeling fine.  No matter how good you feel right now, if you’ve had a disc-related episode of sciatica, all it takes is one wrong move, and you’re back in trouble all over again. 

If you’ve already been given exercises and recommendations for preventing sciatica, just incorporate those things into your daily life.  If you aren’t sure what you should and should not be doing, you need to learn.  You can have a few visits with a physical therapist, medical doctor, or chiropractor who specializes in back and sciatica rehab to get one on one instruction, or there are various resources you can purchase for your use at home.  For online video and text-based information and instruction, I have a site dedicated to sciatica exercises and self-treatment for both short and long-term sciatica management.  Another good online resource is Stop Sciatica Now, which is a downloadable e-book by a Feldenkrais practitioner (Feldenkrais is a gentle movement-based therapy).  Another good online video/audio program can be found on SecretsToAPainFreeBack.com  - which competes with my site mentioned above, but it’s a good system and I definitely recommend it.  An inexpensive, but very useful and user-friendly book is The Sciatica Relief Handbook.  However you come to your preferred sciatica management routine, the most important thing to remember is to be consistent and stick with it for life.

 Stay tuned to my natural remedies blog, and specifically the sciatica category for future updates!

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