Posts tagged sciatica
Ankylosing Spondylitis Treatment by Physiotherapy
Ankylosing spondylitis belongs to a group of disorders called the spondyloarthropathies, a group which also includes psoriatic arthritis, reactive arthritis and arthritis related to inflammatory bowel disease. All these conditions are linked by the genetics of a gene on white blood cells called HLA B27 and by the presence of enthesitis, inflammation at the points where ligaments and tendons insert into bone. This can lead to fibrosis at these sites and then bone formation, causing joint fusion (ankylosis) in some cases.
The commonest spondyloarthropathy is Ankylosing spondylitis, which occurs as a reflection of the occurrence of the HLA B27 gene in the population. The gene occurs much less commonly near the equator and much more commonly in northern latitudes, and this is also the pattern with the development of AS. White race people are more commonly affected with around 0.1 to 1.0 percent overall, varying with latitude. Only 1 or 2 people of a hundred with the HLA B27 gene actually develop AS, but if they have a close relative who has the condition the likelihood rises to 15 to 20%.
Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.
Low back pain is the major diagnostic alternative but AS patients are generally younger and the inflammatory process leads to different symptoms:
Morning back stiffness lasting half an hour and often longer Back pain improved with exercise Back pain worsened with rest Night pain later on in the night Other joints may be affected Fatigue is common Active inflammatory disease can cause systemic affects such as unwellness, weight loss or fever
On examination the physiotherapist can find a stiff lumbar spine with reduced movements from normal, postural abnormality such as a flat lumbar spine and an increased thoracic kyphosis. In later stages neck movements may also be involved and chest expansion will be reduced from normal. In the third of patients who get peripheral involvement, enthesitis develops in areas subject to mechanical stresses, the most common being the insertion of the plantar ligament in the foot and the insertion of the tendo Achilles to the heel. These areas will be palpated by the physio to help confirm the spread of the disease, helping to focus the treatment plan later on.
The physiotherapist initially notes the postural changes which have occurred in an AS patient such as any spinal deformities, round shoulders, bent knees or an increased cervico-thoracic curve and poking chin posture. The physio will record ranges of movement of the spine and include the neck, thorax and lumbar ranges, also assessing any peripheral joints which may be affected. Any entheses which are reported as painful are palpated to confirm the presence of an inflammatory process, and if the AS is very active then the physiotherapist might also find effusions in the joints, perhaps with a feeling of unwellness, night sweats and poor rest.
Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.
The Treatment of Sciatica by Physiotherapists
Sciatica results from a structure impinging on a lumbar nerve root, causing compression and/or inflammation enough to cause neurological changes in the skin, reflexes and muscles served by the affected nerve. Not a common syndrome, it is estimated that 3-5% of the population suffer this kind of problem at some time. It affects men and women equally with men most susceptible in their forties and women in their fifties. Up to a quarter have symptoms which last more than six weeks and referral to physiotherapists for acute management is routine.
Disc prolapse can result in the internal nuclear material being extruded past the outer disc wall, physically compressing the nerve root which runs nearby. The nuclear material is also chemically irritating to the nerve structure and these irritants make the nerve and nearby structures swell, partly blocking the local circulation and the nerve's message transmission. Disc prolapse is typically the cause of proper sciatica but the size of the prolapse is not closely related to the amount of pain the person suffers.
The great forces which we impose on the low back mean the lumbar intervertebral discs suffer structural changes and prolapses. Many activities involve a significant level of leverage, such as flexing over, performing movements in an upright position and lifting with the arms away from the body. This greatly magnifies the forces on the discs and due to their fluid mechanics they suffer 3-5 times the loads on the skeleton. This can cause the disc walls to degenerate, giving weak areas and predisposing to prolapse at some time.
The onset of lumbosacral radiculopathy is often sudden with low back pain and any back pain may disappear at the start of the leg pain. Worsening factors are sneezing, coughing and sitting with lying down or standing up common easing factors. Sciatic pain typically occurs in the buttock, back or side of the leg and calf and into the foot. If the disc prolapse is higher up (prolapses at disc levels L1 to L3 are 5% of the total) the pain may be in the front of the thigh no further than the knee. A patient may have an isolated area of pain and still have a prolapse.
A thorough history performed by the physio will uncover any red flags, an indication of a possibly serious underlying medical condition responsible for the pain. Loss of weight or appetite, severe pain at night, a history of cancer, unwellness or fever, bowel or bladder control difficulties, young or older patients, all these things ring warning bells and the physio will refer the patient on to a medical specialist for evaluation. The location, nature and response to activities and postures of the pain will be noted by the physiotherapist.
The physiotherapist begins with postural observation of the patient which can show an inability to stand up or a thoracic shift to one side. Spinal movements are performed and the pattern of movement limitation noted, with a full neurological examination of the lower limbs. The physio is looking for deficits in muscle power, reflexes or feeling which are related to the specific nerve root involved. The straight leg raise may be performed to check the stretch reaction of the spinal nerve.
The McKenzie technique works on pain centralisation, the tendency for pain to move towards the back from the legs, suggesting a disc problem, and many physios use this technique. Pain in the front of the thigh and over the knee can be referred from the hip joint, so the physiotherapist will assess the lower limb joints to check the diagnosis. A thorough examination informs the physiotherapist of the likely diagnosis and how they might treat the syndrome, or that the patient needs to be referred to a medical practitioner for a consultation and investigation.
Treatments for sciatica due to disc prolapse are many and physiotherapists can choose to use mobilisations and manipulations, lumbar stabilising exercises, the McKenzie treatment path, soft tissue mobilisations such as massage and myofascial release, using analgesics, education about the condition, advice on resting and the best position to relieve extreme sciatica pain. Sciatica naturally settles in time in the vast majority of cases and physios would encourage patients to establish an exercise regime over the long term.
New Method of Relief for Lower Back Pain
Chronic, nagging lower back pain causes lost hours at work, brings about sleepless nights, and even creates disability for four out of every five adults in America. Chances are, you've experienced or will experience lower back pain during your lifetime.
The occurrence of chronic lower back pain often begins after a spinal injury such as a strained muscle, sprained ligament or herniated disc. Once the initial damage has been repaired, one would expect the pain to vanish as well. However, health experts have found that such episodes can sometimes trigger an alteration in the nerve cells that transmit signals. The resulting hypersensitivity persists, even after the initial trauma has been healed.
When this occurs, the chronic lower back pain transforms into a disease that is much more than a symptom of underlying spinal damage. Hypersensitivity can continue to create bouts of pain, even when there is no havoc that factored the twinge. For this reason, it's important for people who have suffered lower back trauma to maintain an ongoing rehabilitation program, to avoid any future painful episodes.
An effective, non-surgical treatment method that can bring relief to those suffering with lower back pain is PNT, or percutaneous neuromodulation therapy. PNT brings relief by applying electrical stimulation to deep tissues within the posterior portion of the body.
The PNT procedure for relieving chronic lower back pain has recently received an FDA clearance. You can have this minimally-invasive procedure in a regular medical clinic.
There are particular requirements for those hoping to take advantage of PNT treatments:
* Be at risk of developing long-term, intractable pain.
* Existing pain should radiate from the lower back into your buttocks, legs and feet.
* You should not be taking ample pain-relief medications, including physical therapy or chiropractic manipulation.
* A desire to take a less insidious approach before resorting into a surgical operation is required.
When your doctor performs PNT, she or he will use several needle electrodes that are designed to reach the nerve pathways that may be impacting the pain. Specialists believe that this type of charged stimulation will aid in restraining the central nervous system that relentlessly ushers in pain.
Expect the PNT session to last for about thirty minutes. You'll be asked to lie face down on the table. Once you're in a comfortable position, up to ten PNT electrodes will be applied to specific locations on your lower buttock area. At each point, a fine-gauge filament electrode will reach to a depth of three centimeters. With these electrodes in place, the doctor will adjust the stimulation to distribute the most therapeutic benefits to the patient.
Patients who undergo PNT treatment for lower back pain must complete three or four sessions before evaluating the effectiveness of the procedure. Some patients report experiencing a certain level of relief after a single PNT session, while others require subsequent sessions. The most suitable frequency of PNT treatment for lower back pain will vary with each individual.
Following your percutaneous nueromodulation therapy, you may find improvements such as increased physical activity, reduced need for pain medication, better quality of sleep, more pain control and lower levels of disability.
If you suffer with lower back pain, you don't have to be a slave to the condition. Effective treatment options are available, including PNT sessions, which can provide the relief you need to get back on your feet.
