CONSERVATIVE TREATMENT OF SCIATICA

Conservative sciatica treatment typically involves non-surgical measures to alleviate pain and improve mobility. These treatments may include:

1. Pain medication: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce pain and inflammation associated with sciatica.

2. Physical/Manual therapy: A practitioner can provide exercises and stretches to help alleviate pain and improve strength and flexibility. This therapy may include myofascial release, massage, heat or cold therapy, and other techniques to reduce muscle tension and promote healing.

3. Osseous manipulation/mobilization (Chiropractic/Osteopathy): Both procedures help to relieve pressure on the sciatic nerve by improving joint mobility.

4. Acupuncture/Acupressure: These procedures involve inserting fine needles or applying pressure into specific points on the body to help reduce pain and inflammation associated with sciatica.

5. Epidural steroid injections: A healthcare provider may sometimes recommend an epidural steroid injection to help reduce inflammation and pain associated with sciatica. This could allow the patient to perform the recommended exercises and improve their sleeping patterns.

6. Lifestyle modifications: Making changes to your lifestyle, such as maintaining good posture, losing weight, and avoiding prolonged sitting or standing, may help to alleviate pain and prevent future episodes of sciatica.

Manual Therapy:

For optimal results in resolving sciatic pain caused by a disc herniation or non-discogenic pain, a conservative treatment process should focus on and include the following three components:

1. Joint function: Using joint manipulation/mobilization procedures.

2. Soft tissue integrity: Using myofascial release procedures.

3. Exercise: Focusing on three essential areas - mobility, strength, and balance.

Spinal Manipulation/Mobilization:

For patients suffering from back pain and sciatica caused by disc herniation, research has shown that spinal manipulation can be an effective element that should be incorporated within an overall treatment strategy for relieving pain, increasing the range of motion, and improving function (1,2,3,4).

Research has demonstrated that joint manipulation leads to an increase in the Pain-Pressure Threshold (PPT). (5) The PPT is defined as the minimum force applied that induces pain. This measure has proven useful in evaluating tenderness symptoms but not for diagnostic purposes.

The increase in tolerance could be attributed to changes in b-endorphin and serotonin levels, alterations in alpha motor neuron activity, or changes in the response of the autonomic nervous system (ANS). Currently, there is no definitive consensus on why joint manipulation increases the PPT. However, it is evident that patients experience significant pain reduction after joint manipulation. (6)

In addition to effectively increasing the Pain-Pressure Threshold, joint manipulation/mobilization has been found to have beneficial effects on both mechanical and neurophysiological components of the spine in cases of disc herniation. (3)

Joint Manipulation/Mobilization Physiology

The human body's ability to execute unlimited movements depends on good joint integrity. As practitioners, it is essential for us to comprehend the complex interrelationships between the structure and function of multiple joints. No joint operates in isolation. An injury in one joint often leads to biomechanical compensations in both adjacent and distant joints.

Research has shown us that when joints become immobile (as in injury or osteoarthritis), they then become subject to several physiological changes. (6)

These changes include a decrease in fluid content, consequently reducing the joint-fiber distance within the capsule surrounding the joint. This process leads to the development of increased cross-fiber linkages and the formation of adhesions in the synovial folds of the joints. These adhesions contribute to a decrease in the strength of collagenous tissue, potentially causing tissue failure even under reduced tissue loading. (7,8)

Joint manipulation has been shown to partially counteract many of these changes. (7,8)

Chiropractic Adjustments

Chiropractic adjustments are effective tools in addressing chronic back pain. Patients who receive chiropractic maintenance care involving regularly scheduled visits tend to fare better than those who only seek care during episodes of acute back pain.

MYOFASCIAL RELEASE

Myofascial release is a form of manual therapy that focuses on manipulating the fascia, the connective tissue that envelops and supports muscles, bones, and organs within the body. The objective of myofascial release is to alleviate tension and discomfort within the fascia, resulting in enhanced mobility, diminished pain, and improved overall functionality.

Our Facial System

Fascia as a Balanced Tensional Network

Fascia is commonly described as "an interconnected tensional network that adjusts its fiber arrangement and density in response to local tensional demands" (13). When fascial tension is well-balanced, it helps distribute force throughout the body and enables the storage and release of energy for propulsion. However, when fascial tension is imbalanced, biomechanical compensations occur, leading to dysfunction in extensive areas of the body.

Fascia's Significance in Neural Communication

Studies have demonstrated that the body's fascial network contains ten times the number of sensory nerve receptors compared to those innervating muscles. This indicates that there is a tenfold greater level of neuromuscular communication taking place through the fascia (10).

Various sensory receptors are involved, including myelinated proprioceptive endings (Golgi, Paccini, and Ruffini) and unmyelinated free nerve endings (9,10,11). In instances of sciatica, alterations in the functionality of this neurological network can have widespread neurological consequences.

Fascia - A Repository of Memory

To clarify the concept that "our fascia is the repository for our body's history" (12, 13), let's delve into the impact of injuries and physical forces on the body's architecture.

Each injury or physical force experienced leads to changes in the body's structure through a process of mechanical compensation. These compensations stem from mechanical forces that trigger transcriptional (RNA) changes within the body, resulting in alterations to our fascial architecture (12).

Such changes may lead to biomechanical imbalances, adhesion formation (fibrosis), tissue thickening, and reduced mobility. This is truly remarkable! It demonstrates how mechanical forces initiate the transcription process of creating an RNA copy of a gene sequence (12) to produce corresponding proteins, all based on the body's physical history.

The Motion-Specific Release Approach

The Motion Specific Release (MSR) approach is commonly employed in treating cases of sciatica. However, the specific procedures used will vary significantly for each patient, based on their history and physical examination findings. MSR is a comprehensive "Treatment System" that integrates the advantages of various therapeutic perspectives, with its primary focus on resolving musculoskeletal conditions. MSR adheres to the EPIC paradigm (Evidence-based, People-centered, Interdisciplinary, and Collaborative) in its approach.

Eliminate Your Sciatic Nerve Pain

In this video, Dr. Abelson demonstrates some of the Motion Specific Release (MSR) procedures we use to release the Sciatic Nerve. Symptoms of sciatica can be caused by disc herniation, foraminal stenosis, spinal stenosis, or entrapment of the sciatic nerve. Fortunately, most cases of Sciatica do NOT require Surgery, as long as no red flags are present.

RECOMMENDED REFERENCE BOOKS

Functional Atlas of the Human Fascial System - Carla Stecco https://amzn.to/3TE1EqP Functional Anatomy: Anatomy, Kinesiology, and Palpation https://amzn.to/3f49Xgn

The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns and

Anatomy Trains: Myofascial Meridians for Manual Therapists https://amzn.to/3SCkhtZ

Joint mobilization/manipulation extremity and spinal techniques https://amzn.to/3DxqCCs

CONCLUSION - PART 3

In conclusion, conservative therapy that combines joint mobilization, myofascial release procedures, and exercise often yields the best outcomes for addressing sciatica. There is significant research supporting manual therapy (conservative care) in reducing pain, enhancing mobility, and improving overall function.

In part four, we will discuss "Exercise & Activities of Daily Living".

Sciatica Part 1 – What Are You Dealing With

Sciatica Part 2 – Causes & Diagnosis

Sciatica Part 3 – Treatment - Logic & Recommendations

Sciatica Part 4 – Exercise & Activities of Daily Living

DR. BRIAN ABELSON DC.

Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred, personalized care.

As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.

REFERENCES - PART 3

1. Snelling NJ. Spinal manipulation in patients with disc herniation: a critical review of risk and benefit. Int J Osteopath Med 2006;9:77–84.

2. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131–137.

3. Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004;27:197–210.

4. Lisi AJ, Holmes EJ, Ammendolia C. High-velocity low-amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature. J Manipulative Physiol Ther 2005;28:429–442.

5. Akeson WH, Amiel D, Abel JF, et al. (1987). Effects of immobilization on joints. , 219, pp. 28-37.

6. Woo SL, Matthews JV, Akeson WH, et al. (1975). Connective tissue response to immobility: correlative study of biomechanical and biochemical measurements of normal and immobilized rabbit knees. , 18(3), pp. 257-264.

7. Coronado RA, Gay CW, Bialosky JE, et al. (2012). Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. , 22(5), pp. 752-767.

8. Degenhardt BF, Darmani NA, Johnson JC, et al. (2007). Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. , 107(9), pp. 387-400.

9. Mitchell JH, and Schmidt RF. (1977). Cardiovascular reflex control by afferent fibers from skeletal muscle receptors. In: Shepherd JT, et al, eds, Handbook of physiology, Section 2, Vol. III, Part 2. Bethesda: American Physiological Society, pp. 623-658.

10. Schleip R. (2003). Fascial plasticity— a new neurobiological explanation. Part 1. J Bodyw Mov Ther, 7(1), pp. 11-19.

11. Van der Wal J. (2009). The architecture of the connective tissue in the musculoskeletal system: An often-overlooked functional parameter as to proprioception in the locomotor apparatus. In: Huijing PA, et al, eds. Fascia research II: Basic science and implications for conventional and complementary health care. Munich: Elsevier GmbH.

12. Chen C, and Ingber D. (2007). Tensegrity and mechanoregulation: from skeleton to cytoskeleton. In: Findley T, and Schleip R, eds. Fascia research. Oxford: Elsevier, pp. 20-32.

13. Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. Fascia research II. Basic science and implications for conventional and complementary health care. München: Urban and Fischer.

14. McGill, S.M. Ultimate back fitness and performance, Backfitpro Inc., Waterloo, Canada, 2004. ISBN 0-9736018-0-4. Fourth edition 2009.

15. McGill, S.M. Low back disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Second Edition, 2007.

16. Lori A, Boyajian-O’ Neill, et al. Diagnosis and management of piriformis syndrome:an osteopathic approach. J Am Osteopath Assoc Nov 2008;108(11):657-664

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