herniated disc in neck - Diagnosing Sciatica Is A Complex Procedure
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Diagnosing Sciatica Is A Complex Procedure

What are the causes behind the pain of sciatica? Sciatica is usually associated with compression of the sciatic nerve due to a slipped or a herniated disc. A degenerative disc disease is a condition that is brought about by the ageing process. The sciatic nerve is sometimes pinched by the piriformis muscle that is located deep in the buttocks. Sciatic pain can also be caused by conditions that are not related with disc. Bad postures can also lead to pseudo sciatica, a pain that is similar to sciatica.


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What are the symptoms of pain referred from the back? An aching in the buttocks that is difficult to pinpoint. The slump test may reproduce buttock pain which is eased when the neck is relaxed back (extended).

Sciatica Symptoms Acute low back pain. Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness.

There may be muscle spasm in the lower back. Tenderness in the lower back when pressing in. Pain on the straight leg raise test which is not apparent when just stretching the hamstring only.

* X-Rays * Magnetic Resonance Imaging (MRI) * Computed Tomography (CT) Scan. * Electromyography - passing an electric current through a nerve to record the electrical waves associated with the activity of skeletal muscles. * Myelography - X-rays done after injecting a contrast medium into the space between vertebrae.

Areas of the lumbar spine may be tender and have poor mobility. Tight gluteal muscles and other muscles of the buttocks. What can I do? See a Physical Therapist who can identify the problems in the lower spine.

What can a Physical Therapist professional do? Manipulate and mobilize the segments of the lumbar spine. This is a good way of assessing whether the lumbar spine is a cause of buttock pain. If it is then symptoms will be relieved.

Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and this results in the relaxation of ligaments in preparation for childbirth. In most cases the causes of sacroiliitis are mechanical, however there may be other medical inflammatory conditions present such as Ankylosing Spondylitis as well as others which will need attention.

What are the similar or related injuries and conditions? Ankylosing Spondylitis Myofascial pain Low back pain Coping with Sciatica

Pain is usually relieved by lying down, often on one side. Pain is often better in the morning after a nights rest. Scoliosis or an S shaped or bent spine as seen from behind is often present with the patient bending away from the side of pain.

But since the most effective treatment for the two conditions varies signficantly, it is important to determine the correct diagnosis if at all possible. In most cases there is an easy way to distinguish between sciatica and piriformis syndrome.

As mentioned earlier, the symptoms of true sciatica are very similar to piriformis syndrome. Both cause pain, tingling, burning, "electrical shock" sensations, and/or numbness down the leg, often all the way to the foot. In addition, both sciatica and piriformis syndrome tend to be at least partially related to biomechanical functional problems in the joints of the back and pelvis and they may even be present simultaneously in the same person, so it an be difficult to tell them apart.

What other injuries are related or similar? Piriformis syndrome Sciatica Sacroiliac joint pain. The Sacroiliac joint Is? The Sacroiliac Joints are located at the bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum and the ilia.

Apply heat or a hot bath may help to relieve muscle spasm. Use a heat retainer or back brace can provide support in the early stages. See a sports injury specialist or doctor.

A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has 'slipped' out of place. Intervertibral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.

A large amount of confusion and misunderstanding exists concerning the conditions sciatica and piriformis syndrome. There are some who insist that the two conditions are actually the same thing, but even though they can have symptoms that are very much alike, the underlying causes differ.

Apply electrical stimulation in the form of a Tens machine or Interferential. Apply ultrasound treatment. Operate on a slipped disk if neurological signs (nerve related symptoms) continue or worsen.

Use electrotherapy equipment to treat affected tissues. If indicated and safe to do, level the pelvis via manipulation. Articulate sacroiliac joint and restore normal function.

The tissue can be navigated in the three planes of movement and dimension. The Frontal, sagital, and transverse planes are functional movement planes of potentials (x,y,z) that are usually inhibited because of asymmetries in the tissue and structure. The tissue in a similar manner has three primary planes of potential, it can lengthen, rotate, and flatten (x,y,z).

Ilia rotation - this assesses weather the ilia is rotated on one side creating imbalance. What can a Physical Therapist or GP do? Use diagnostic tests to discover the cause of the problem.

Rolfing Ten Series session three completes what was initiated in the first-hour, defining the body in three-dimensional space (x,y,z). This session should allow the inhibited tissue in the sleeve to ease, and enable the work to transition to a deeper layer in the fourth session.

Eliminate medical diseases such as Ankylosing Spondylitis.. Treat the cause as well as the symptoms. Prescribe anti-inflammatory medication (e.g. ibuprofen) and rest.

Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica. Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.

Symptoms include: Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.

There are torsional or twisting forces applied to the pelvic girdle when the lower limbs are moved. These limbs act like long levers and without the sacroiliac joints and the pubic symphysis (at the front of the pelvis) which allow movement, the pelvis would very likely be subject to a fracture.

Sciatica refers to irritation of the sciatic (often mis-spelled as syatic or psyatic) nerve, that arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation, or "true" sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region. Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve comression and inflammation, may extend down the entire leg to the ankle and foot.

A Pain deep in the cheeks of your bottom can be referred from the lower back. There does not necessarily have to be pain in the lower back as well for pain to be referred into the buttocks.

The intervertebral discs are filled with a soft liquid in the middle called nucleus pullouts and when a disc prolapses this liquid squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.

It is important to distinguish between sciatica and piriformis syndrome, because the treatment for the conditions varies, and getting the diagnosis right typically leads to more effective treatment.

Use sports massage techniques to relax tight muscles. Gently apply mobilization techniques to the spine. Use traction or advise on the use of and Inversion Table.

Begin an exercise programme that will stretch and strengthen the muscles supporting the lumbar spine. Stretch the gluteal muscles and hip rotator muscles.

Strengthen the core stabilizing muscles of the spine.

Terry O'Brien

http://www.BackTrouble.co.UK

Specific assessment tests: The Stork test - to assess weather the sacroiliac joint is moving correctly. Leg length difference measurements - both straight leg and bent leg assessments.

Begin extension exercises as soon as pain allows. What can a Physical Therapist or GP do? Determine the cause of the sciatic pain. Prescribe anti-inflammatory medication e.g. ibuprofen or muscle relaxants.

Diagnosing sciatica is a complex procedure. Since the pain can be indicative of other conditions as well, it is also necessary to rule out more serious conditions like infection or cancer. Sciatic is a progressive disease that can immobilize the patient to a great extent. Sciatica alternative remedies like exercises, yoga and acupuncture can be very effective to stem the progress of a highly developmental condition. On the first signs of pain in the lower back an examination by a specialist is highly recommended.

The second maneuver is done in two parts. First, from the sitting position one bends the leg and pulls the knee on the painful side towards the same-side shoulder. In all but the most severe cases, there is usually no major increase in pain in this position. The second part of the maneuver is to pull the knee toward the opposite side shoulder. An increase in the sciatica-like symptoms is a strong indication of piriformis syndrome.

 
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Sciatica treatment A Short Rest in bed if necessary in a position that is comfortable. A doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen. Should always be taken under the direction of a doctor and do not if the patient has asthma.

In some cases, piriformis syndrome may cause true sciatic nerve irritation, as the sciatic nerve may run underneath or even through the middle of the piriformis, so contraction of the piriformis may produce sufficient compression of the sciatic nerve to produce actual nerve symptoms. This is one of the main sources of confusion when it comes to distinguishing true sciatica from piriformis syndrome.

The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.

Two simple maneuvers will distinguish sciatica from piriformis syndrome in the majority of cases (when the problem is one versus the other and not both conditions at the same time). First, in a seated position, if one straightens the leg on the painful side (so that the leg is parallel to the floor), and the sciatica symptoms increase, this is usually a sign of true sciatic nerve irritation.

Symptoms such as a disability in walking suggest nerve root compression. In cases symptoms that are severe enough to consider a surgical intervention the physical examination is mostly followed by other investigative procedures. To confirm any doubts the physician might ask for, the doctor might perform any or all of the following tests:

The main goals in the third-hour are to address structural relationships that limit the lateral line, Z dimension, and address associated rotations/counter rotations in the arms, legs, and torso. Develop a more balanced relationship between the shoulder girdle and thorax enabling it to move freely on ribcage and in lateral line by addressing the structures that shift the body anterior and posterior.

John Barton, Certified Rolfer & Rolfing-Fort WorthDallas-Austin-Arlington Denton-Texas-Oklahoma rolfmovement.com, certifiedrolfing.com, budokamp.com, certifiedrolfing.com, certifiedrolfing.com/Contact, certifiedrolfing.com/Rolfing, certifiedrolfing.com/FAQS, certifiedrolfing.com/Articles, certifiedrolfing.com/John,

About the author:

Richard provides articles and information about herbal remedies on his site at http://remedyguidance.com

A physical examination and the medical history of the patient are very important for diagnosing sciatica. The doctor needs to eliminate normal back pain or lumbago before proceeding for sciatic nerve treatment. There is always a possibility that a difference in lengths of the two legs may cause pain in the lower back.

They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting. However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.

Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning. Aching to one side of your lower back when driving long distances.

The Certified Rolfing Ten Series has the ability to reduce pain and release tension in the connective and myofascial tissue of the body associated with TMJ, CTS, RLS, Fibromyalgia, Sciatica, Fascitis, Bunions, Scoliosis, and Cerebral Palsy. Fascial asymmetries can cause foot, leg, knee, hip, back, shoulder, neck, arm, hand, and head pain; integration therapy is necessary. Orthopedic, Chiropractic, Physical, and Massage Therapist recognize Rolfing and Rolf Movement as premium pain management utilizing Structural, Functional, and Postural Integration.

This is a great opportunity to detail work up each vertebrae addressing side bends with rotations, and drift's of the thorax. The position of the vertebrae dictate's the direction of the drift. The ribs are directly affected by the asymmetry in the spine. The ribs are directly affected and acted upon by the position of the segments above and below one another. Make sure to work the x,y,z planes in the tissue of the IT band lateral line and continue to horizontalize the pelvis.

Differentiate the arms from the scapula and address inspiration/expiration issues and horizontals by resolving the structures that are associated with the primary tilt contributors. The thorax to pelvis relationship of freeing eleventh and twelfth ribs, Q.L. and thoraco lumbar fascia down to L4 must all be addressed in the third-hour. Tractioning on the clients arm while it is extended above their head in sideline exposes the spatial relationships of these segments. Work to further normalize side bends with rotations in the spine and the effect that it has on the ribs.

Piriformis syndrome, also known as "pseudo-sciatica" (meaning "false sciatica"), is actually referral pain and other symptoms (tingling, numbness, etc.) caused by tightness and knots of contraction in the piriformis muscle, which runs from the upper femur bone to the edge of the sacrum, the triangular pelvic bone that is below the lumbar spine. The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica.

Physical examinations include the following procedures. * The patient may be asked to lie down, face upward and the affected leg is then raised to various heights. * The doctor may also ask the patient to rotate the hip joint. Pain caused by these movements can often help in pinpointing the location of the pain and assessing the hip muscles. * Testing the strength of bending backward of the ankles and toes can also indicate the position where the nerve is likely to be pinched. * Another test used by many doctors is the reflex of your ankles.

After the acute painful phase Restore pain free movement to the back through mobilization and stretching techniques. Ensure posture and correct lifting techniques are learned and maintained.

In most cases, medical history is able to identify patients that are likely to have a herniated disc. Sciatic pain is superficial and localized. It also gives a feeling of numbness or tingling. It aggravates when pressure is applied between discs.

Depending on where the sciatic nerve is pinched will determine where you feel the pain which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged.

Address the interosseous membrane of low leg by addressing the x,y,z planes in the tissue and the tibia fibular relationship. Seated back work in flexion and extension, and push reach with pelvic triangle awareness. The back work at MDH should lengthen front and back proportionately. The client should be seated on rami with cued direction of awareness, rolling forward into flexion (yield) and extending up (push). Pelvic lift, general neck work and lift at the sub occipitals to end.

Sciatica is a pain that starts in the back and radiates down one of the legs. It is quite a common complaint and is sciatica is caused by pressure on the sciatic nerve which runs down into the leg. The medical term is acute nerve root compression. The cause of pressure can be varied from a Slipped (Prolapsed) disk to muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths and infections.

Deep tissue sports massage techniques can be applied to the lower back and buttocks to release muscle tension, particularly in chronic conditions. Acupuncture or dry needling can also help reduce chronic tension in muscles.

These joints can often get stuck or in some cases one half of the pelvis can glide forwards or backwards, which is often referred to as a twisted pelvis. When this occurs it often irritates the Iliolumbar ligament which results in Inflammation. This is usually indicated by tenderness around the bony lumps which you can feel if you place your thumbs either side of your lower back.

Sports massage will help relieve any soft tissue tension in the area. Use injection therapy. Advise Ice and cold therapy to reduce inflammation.

Pain is often triggered by a minor movement such bending over to pick something up. Pain may be worse by sitting, lifting, coughing or sneezing.

About the Author:

Dr. George Best is in private practice in San Antonio, Texas. For more information, check out Dr. Best's free e-book and online video course to assist in understanding and treating sciatica and piriformis syndrome, including in-depth instruction on sciatica exercises at http://www.SciaticaSelfCare.com .


 
 
     
 
 





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