Parsteiner Blog

Posts Tagged ‘Sciatic Nerve’

Have you ever suddenly noticed that you are tensing your muscles unnecessarily due to Sciatic nerve pain?

Take a good look around you when you are taking a walk in the park or just sitting on a bench. If you look carefully, some people move their bodies very rigidly, others are more loose and natural in their movements.

Stiff people will tend to get stiffer with age, but why? Just because of the way they move throughout the day. This is their daily exercise routine. If they don’t give certain joints and muscles a greater range of movement, the movements they are able to do now will be even more limited in the future. They are straining some muscles almost all the time and leaving others practically unused. They are tense because of stress due to daily problems or pain.

Your mind actually limits your movements long before your body does because of fear. Fear that a certain movement cannot be done because you may experience pain again. But if you learn to think through the process, overcome that fear and believe it can be done, the pain you may feel will be lessened because you won’t be tensing your muscles unnecessarily.

Dr Feldenkrais taught many people to use every part of their bodies to the extent that they were designed, relaxing unneeded muscles while others are doing their job. He came up with ways to relax when sleeping so the body feels refreshed on waking up. He taught people to get the most out of life and enjoy their bodily movements, their daily activities and their relaxation.

The whole healing process starts in the minds of the people who are suffering from Sciatica nerve pain. The Feldenkrais Method of Somatic Education is more a way of thinking than actual exercises. It shows you that you can do more for yourself than you think to relieve your pain and suffering.

Close to 200,000 hip replacement surgeries are performed
each year in the United States. Over 90% are successful
with no hip replacement complications during or after surgery. But as with all surgeries, the risk of complications is always a possibility. However, complications are infrequent and often reversible.

The older the person is the higher the risk of complications.
A person over 80 years old has a 20% chance of developing at
least one complication after hip replacement surgery.

Hip replacement complications during surgery

Nerve damage

The sciatic nerve is at risk of being accidentally surgically
cut due to its close proximity to the capsule of the hip joint. This same nerve may also become
over-stretched during hip manipulation during surgery.

Depending on the extent of the nerve damage, temporary or
permanent damage may result. There may be loss of muscle power
and feeling in parts of the leg. It may take up to 6 months
or more for recovery. Most patients have some numbness
around their incision site which may be permanent.

Vascular damage

The damage involves direct trauma to the blood vessels in
the area of the surgery. The damaged blood vessel can be
repaired by a vascular surgeon if it is caught in time.

Femur fracture

Force is applied during the surgical procedure. This can
result in a femoral shaft fracture, especially in older or
osteoporotic patients. Again, the problem is addressed during
surgery, but may lead to extended rehabilitation. The surgeon
may place weight bearing restrictions while you are walking.

Leg length discrepancy

In some cases, it may be difficult to get the exact same
leg lengths. The result is usually a longer leg on the
surgical hip. It may be unavoidable and deliberate in order
to improve muscle function or stabilize the hip. If there
is more than a quarter of an inch difference, a shoe lift
may be necessary.

In some patients, both legs are the exact same length
but they think their surgery leg “feels” longer. In most
cases this “feeling” goes away as the patient adjusts
to their new hip.

Rarely does shortening of the leg occur. If the
leg is significantly shortened after surgery, it may
have dislocated.

Anesthetic complications

Complications can occur, and in rare cases even death.
Your anesthesiologist will explain the risks involved
prior to your surgery.

Hip replacement complications after surgery

Blood clots (DVT-deep vein thrombosis)

This is one of the most common complications after
hip replacement. The most common area is in the
calf. Increased leg pain is usually the most obvious
symptom. Redness around the area of the clots may also
occur. It’s a minor problem if the clots stay in the leg.
But if they dislodge, they can reach the lungs (pulmonary
embolism) and can possibly result in death (very rarely).

If your surgeon suspects blood clots, he will immediately
order an ultrasound to confirm or rule out clots. Most
surgeons will order bed rest until the test results come
back positive or negative for blood clots. He will prescribe
a blood thinner. Compression boots and ankle/leg exercises
help reduce the chance of blood clots.

Infection

Infection can occur during surgery or develop afterwards.
It is one of the most serious risks to the joint replacement.
If the infection settles deep into the joint and surrounding
tissues, the new joint often has to be removed until the
infection clears with treatment. If the patient develops
an infection elsewhere in the body (bladder, teeth, chest),
it must be controlled to prevent the possibility of it
spreading through the blood to the new joint.

If you have rheumatoid arthritis or diabetes, or have
been taking cortisone for a long time, you are more prone
to infection in the weeks following your surgery.

Infection can occur many years after the surgery. Bacteria
can travel through the bloodstream from an infection in
other parts of your body (bladder infection, infected wound,
kidney infection). Oral antibiotics may need to be taken before
and after routine dental work years after your hip replacement
operation.

Hip dislocation

The first six weeks after hip replacement is the
most vulnerable time for your new hip. During this period,
muscle tension is the only thing holding the metal ball in the
socket. If the metal ball slips out of the socket, it’s
dislocated. As the hip muscles regain their strength and
scar tissue forms around the ball, the risk of hip dislocation
diminishes.

Traditional hip replacement requires that certain precautions
be taken and some positions/movements are restricted, at least
for the first 6 weeks. Your surgeon and physical therapist
will instruct you in your hip precautions. Basically, the
precautions are:

do not turn your toes inward do not cross you legs do not bend your hip more than 60-90 degrees (when sitting, your knee should not be level with your hip, it should be lower)

If dislocation occurs, call an ambulance to get you
to the hospital. Your surgeon will pop the hip back into
place. If it happens frequently, a hip brace worn for several
months will prevent further dislocations. Hip replacement
using the anterior approach eliminates the need for hip precautions or restrictions of positions/movements.

Those people who are overweight or have weak muscles
are more prone to dislocation. Avoid heavy exercise that
puts too much stress on your new hip (running, playing
basketball, tennis, heavy lifting). Instead, participate
in activities such as walking, swimming, stationary bike.

Trochanteric problems

Your greater trochanter, a large boney part of your femur, is
located below and to the outside of the ball of your hip joint.
Many of your large hip muscles anchor on the trochanter, so
it’s essential for normal hip function.

During lateral approach surgery, the trochanter is detached
to access the hip joint. It’s then reattached. If the
trochanter does not heal back on the femur bone, it remains
as a separate piece. This may result in pain, weakness, and
loss of hip function.

Bowel complications

Constipation frequently occurs for the first week or so
after surgery. This can be caused by medication, immobility,
loss of appetite, not drinking enough fluids. Stool softeners
or enemas may be needed.

Urinary problems

A catheter may be inserted during surgery. Your doctor will
order its removal as soon as is practical, as catheters pose
an increased risk of urinary infection.

Hematoma formation

During surgery, the main areas of bleeding are controlled
by cauterization. But some oozing of blood and fluids still
occurs, so a drain is attached from the wound to the outside
of the body. If the drain does not work as planned, a
collection of blood and fluids forms in the hip area. This
can cause pain, pressure, and possible infection. Your
surgeon may take you back to surgery to drain the hematoma.

Loosening of the prosthesis

The harder your bones are, the longer your hip replacement
will last. Hard bones create a stronger bond. People with
rheumatoid arthritis and osteoporosis are more at risk.

Running and heavy impact activities can also loosen the
bond of the implant. Keep your weight down, as this will put
more stress on the hip joint. Every pound you gain adds three
pounds of force on your hip.

Choose a surgeon who has performed many hip replacements.
Talk to some of his previous patients to see how they are
doing after their hip replacement. Not all surgeons are alike.
I have seen a few hip revisions that were necessary only because
the initial hip replacement was done poorly by the original
surgeon.

Pressure sores

In the immediate days after your hip replacement, you may be
spending quite a bit more time in bed. Spending a long period of
time in one position can lead to pressure sores. Your heels,
especially on your surgery leg, are very susceptible. A pillow
or towel roll under your calves will float your heels and
relieve pressure. The elderly are especially prone to pressure
sores because their skin is softer and they do not move around
as well. A close eye should be kept on their heels and tailbone
area, and should be regularly repositioned in bed with pillows.

Blood transfusion complications

All blood intended for use in transfusions is screened for
Hepatitis B virus, Hepatitis C virus, syphilis, Human T Cell
Leukemia virus, and the AIDS virus. But infections still occur.
Hemolytic Transfusion Reaction occurs due to incompatibility
with the donors blood type. The most common cause of Hemolytic
Transfusion Reaction is clerical error (mislabelled specimen or
improperly identifying the patient receiving the blood).

If you plan to use your own blood for possible
transfusion, let your doctor know ahead of time so arrangements
can be made. Your blood can only be stored for 35 days.
Collection should begin at least 10-14 days before your surgery.
The final collection occurs not later than 5 working days
before the surgery date. Your blood will be screened as well.

About hip revision surgery

Most people who undergo hip replacement surgery will
never need to replace their artificial joint. But because
more and more people are having hip replacements at a younger
age, the wearing away of the joint surface can create problems.
After 15-20 years of wear and tear, replacement (revision surgery)
of the artificial joint is becoming more common. Revision surgery
does not have as good an outcome as the initial surgery.

Consider all the hip replacement complications before you
decide on surgery. This is not a complete list of risks, as
there may be some rare complications not mentioned here.

I’m sure you are familiar with it. You wake up in the morning, go to get out of bed BUT are stopped in your tracks by the pain and stiffness in your lower back or sciatic nerve. It can then take a few minutes or much longer to straighten up and become more mobile again… Why is your back so stiff and painful in the morning?

Well, contrary to popular belief, it is more than likely NOT due to the bed / mattress you are sleeping on! That’s right, I believe this is a myth well worth busting, as it may save you a fortune by avoiding the unnecessary replacement of your current bed.

There are also those that may say you are stiff and painful first thing in the morning due to the fact you have moved relatively little for the previous few hours. Although I would agree that there is an element of truth in this last statement, once again I do not believe it is likely to be the main cause.

So why is your back so stiff and painful in the morning?

More often than not, it is not due to the bed itself, but rather the position you are sleeping in or what you have been doing the few hours before retiring to bed, it is the former which I am going to be discussing in this article.

So what is the best position for me to sleep in then?

The best position for you to adopt would primarily depend upon what is the cause of your low back / sciatic pain. However, as a rule of thumb, the most comfortable position to sleep in is usually side lying (either side) with your bottom leg fairly straight and your top leg supported by a couple of pillows, so that this top leg is more or less parallel with the bed.

By sleeping in this position, keeping the bottom leg straight is encouraging your lower back to be in a neutral position. Yet with the top leg being supported by pillows, it is preventing it from dropping ‘across & down’ and twisting your low back and stretching your sciatic nerve in the process.

Some people tend to lie on their side, but forget to support the top leg. This just has a twisting stress upon the lower back which is maintained for several hours while you are sleeping. Therefore it should come as no surprise that your low back or sciatic nerve may feel stiff and painful first thing when you wake up.

As I alluded to above, there are other positions which could be more beneficial, but this depends upon the cause of your pain, but side lying with pillows supporting your top leg is usually a good comfortable position to get in no matter what your diagnosis.

It is also important to realise that it may not necessarily be your sleeping position which is the problem, but rather the things you are doing to your low back before going to bed. If you try different sleeping positions, including the one given here and yet you are still having difficulty sleeping, it is likely what you are doing before going to bed which is your problem. This will need to be assessed before thinking of replacing your bed.

Sciatica is a simple term used to describe pain which passes down the back of the leg as a result of irritation of the sciatic nerve. It is not a diagnostic term at all. The reason for me highlighting this point, is because any exercises for sciatica you wish to perform will be dictated by the cause of the sciatica itself. Unfortunately there are no general ‘sciatica exercises’ as such.

The sciatic nerve is formed from 5 nerve roots which leave the lower back from the lumbar spine and sacrum. As it does this, the sciatic nerve passes through the buttock region and down the back of the leg to the back of the knee. As it passes below the knee, it is officially no longer referred to as the sciatic nerve. However, pain which is felt anywhere down the back of the leg, to as far as the toes, is typically termed sciatica (assuming it is an irritated sciatic nerve which is causing the pain).

Getting back to the title of this article “Exercises for Sciatica Problems”, as I mentioned above, this will all depend upon the true cause of the problem itself.

Three common causes of sciatica are:

1) Disc Prolapse.

This is not as bad as it may initially seem. This problem arises typically when there are too many flexion based forces across the lower back and therefore the discs of the lumbar spine begin to bulge. This bulge then presses on the sciatic nerve and subsequently pain is often felt. If this is the cause of your sciatic pain, as a rule of thumb extension based exercises would be the main principle of your treatment. This may involve lying on your stomach, with or without a pillow underneath, little and often throughout the day. You would then increasing the degree of extension as your pain improves.

2) Facet Joint Compression.

This tends to occur when the joints of the lumbar vertebrae begin to pinch on the sciatic nerve and irritate it. In this circumstance, the opposite to the above exercise is given, where a more flexion based exercise regime would be indicated. For example lying on your back and gently hugging your knees to your chest or maybe kneeling on all fours and gently sitting back on to your heels. Once again, these should be performed little and often throughout the day and progressed as your pain improves.

3) Tight Muscles.

Two of the main culprits when it comes to tight muscles would be the Piriformis and Hamstring muscles (although it is not exclusive to these two). The sciatic nerve passes through or underneath the Piriformis muscle as well as through the Hamstrings. Therefore, if either of these muscles are tight, they can aggravate the sciatic nerve which therefore leads to pain.The aim of treatment here would be to stretch out the tight muscles, in order to relieve some of the pressure from the sciatic nerve.

Any stretch for either the Piriformis of Hamstring muscles should be a gentle one to start with. Only when you feel comfortable with it should you think about progressing to more aggressive stretches.

As I mentioned above, sciatica can be a result of many different causes, and it is the cause of your Sciatica which dictates the exercises needed to be performed, not the sciatica itself.

Just to elaborate a little further before I finish, muscle imbalance is without doubt one of the biggest problems with regards to low back pain and sciatica. This is where either tight or weak muscles combine to place inappropriate stresses across structures, such as the sciatic nerve, which results in pain.

The aim of treatment in these circumstances is to stretch and strengthen the appropriate muscles. Although in this article I have only discussed movement or stretching exercises, it is likely there is weakness as well as tightness present. In such circumstances, it is important strengthening exercises are also performed.