How to treat sciatica

Written by Na Hong Wei
Orthopedics
Updated on September 21, 2024
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Sciatica typically has two treatment methods. One is non-surgical treatment, which is currently the first and most commonly used approach. The first step is general treatment, meaning that once symptoms of sciatica occur, one should rest on a hard board bed. Second, one can combine this with some heat applications to the lumbar area, physical therapy, and acupuncture; all of these are options. The third is traction therapy, which is very effective for discogenic sciatica, as it can reduce the pressure on the intervertebral disc, thereby increasing the volume of the spinal canal and enlarging the area of the intervertebral foramen, thus reducing stimulation to the nerve. Fourth, one can consider undergoing sacral canal injections, or using papain or collagenase for chemical dissolution of the nucleus pulposus, which usually can also achieve a good effect. The fifth point is that when symptoms are reduced, one should start exercising the lumbar and back muscles to increase their strength and enhance the stability of the lumbar spine, thereby ensuring the stability of the intervertebral disc. It should be mentioned that massage and manipulation are quite effective for herniation of the disc nucleus pulposus, but if there is already obvious osteophyte formation, narrowing of the intervertebral space, or disorder of the facet joints, or even lumbar spinal stenosis, then massage and manipulation are not recommended. If the aforementioned treatments prove ineffective, the condition does not relieve or even worsens, or if there is central herniation of the lumbar disc, or if the patient shows significant cauda equina nerve stimulation symptoms, then surgical treatment is required.

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General Surgery
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How to treat sciatica?

Patients with sciatic nerve pain must rest in bed, especially those whose pain is caused by nerve compression. They must pay close attention to keeping warm and resting regularly, and use heat application on the waist and buttocks. For medicinal treatment, the drugs are mainly divided into Western medicine and traditional Chinese medicine. Western medicine primarily uses non-steroidal anti-inflammatory drugs and neurotrophic drugs. Traditional Chinese medicine mainly uses drugs that invigorate the blood to promote the repair of nerve edema and surrounding tissue swelling. Treatment can also include acupuncture and physical therapy, particularly ultrashort wave therapy and direct current iontophoresis during the acute phase, combined with acupuncture, which can effectively promote the alleviation of sciatic nerve pain.

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Written by Guan Jing Tao
Orthopedics
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Is it useful to take calcium supplements for sciatica?

Generally speaking, supplementing calcium has very limited effects on sciatica. Sciatica is typically caused by compression at the location where the nerves deviate, or by herniated lumbar discs, leading to compression of the sciatic nerve. This means that different compression sites require different treatment methods. For sciatica, if it is caused by a herniated lumbar disc compressing the nerve, minimally invasive surgery can be performed when necessary to remove the protruding disc tissue. If the sciatic nerve is compressed near the buttocks or the piriformis, surgery may be required to remove part of the tissue to relieve or loosen the compressed sciatic nerve. In terms of medication, oral nutritional supplements for nerves, anti-inflammatory and blood-activating drugs can be used to improve the condition of the compressed sciatic nerve. This can further alleviate corresponding symptoms such as pain and sensory abnormalities, while the role of calcium supplementation is very limited or ineffective. (The use of medication should be under the guidance of a professional doctor.)

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Written by Guan Yu Hua
Orthopedic Surgery
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Can sciatica patients walk?

Sciatica can be managed with activities like walking, brisk walking, or jogging. It is best to walk or even walk backwards. It is important to avoid sitting for long periods, bending over, or carrying heavy objects. When the spine is bent, it can increase the pressure on the intervertebral discs, potentially worsening the nucleus pulposus, rupturing the annulus fibrosus, and causing a series of symptoms related to nerve root compression. This compression can cause local swelling, which can press on the nerves to varying degrees. It is recommended to strictly rest on a hard bed, and generally, with about ten days to two weeks of warming up the lower back, recovery is usually achievable. Gradual relief and disappearance of symptoms can occur, and it is advisable to avoid sitting for long periods, bending, or carrying heavy loads. Moderate walking is suitable.

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Written by Lv Yao
Orthopedics
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Which department should I go to for sciatica?

When experiencing sciatic nerve pain, we first need to analyze the cause of such pain symptoms, such as a herniated disc compressing the nerve root leading to sciatica. In this case, we recommend visiting an orthopedic or spinal surgery department. If there is no disc herniation or nerve root compression, consideration should be given to whether the pain is caused by piriformis syndrome, in which case a visit to the pain management department is suggested.

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What to check for sciatica

Sciatica is divided into primary sciatica and secondary sciatica. Secondary sciatica is very common and is mainly due to diseases of the spinal canal, including herniated lumbar discs, lumbar spinal stenosis, or spinal tumors compressing the spinal cord and nerve roots. Another condition is piriformis syndrome, where the sciatic nerve exits; if there is narrowing here, it can also cause sciatica. Therefore, clinically, one starts with secondary sciatica, conducting either a lumbar spine CT scan or an MRI, which can basically clarify the location causing the compression. Another type is called primary sciatica, which is caused by inflammation of the sciatic nerve, and is an internal medicine disease, not an orthopedic disease. This requires an electromyography (EMG). After completing the EMG, the diagnosis can generally be made based on the injured muscle or the muscle with abnormal electromotor conduction. Thus, the routine examinations for sciatica are X-rays, CT, MRI, and the non-routine examination is the EMG.