What is Sciatica? Sciatica is a constant pain that is felt along the sciatic nerve; it runs from the lower back down to the feet. It controls the muscles to the legs and provides feeling to the thighs, legs and bottoms of the feet. Sciatica occurs most often in people between the ages thirty through fifty. It usually is caused by repetitive use type of conditions, such as sitting for long periods of time, or normal wear and tear. It is rarely caused by an acute or traumatic event.

The pain from sciatica can be sometimes debilitating and it can get so bad it can be difficult for one to sit, walk or even sleep. Some people experience tingling, while for others it is just a dull pain. Occasionally it can be a burning type of feeling. Pain from the sciatic nerve is usually caused by the nerve being pinched or irritated in the lower back or lumbar spine. The nerve then gets inflamed and causes a variation of symptoms that can wreak havoc with one’s lifestyle.

The most conservative type of treatment for sciatica is the application of ice. I recommend to my patients to lay flat with two pillows under the knees and apply ice to the lower back on the side of involvement for fifteen minutes. This can be repeated up to every hour if necessary. It is important not to apply the ice for more than twenty minutes at a time because this can aggravate the condition. Applying ice to the source of the problem will decrease the inflammation of the nerve and subsequently decrease pain. Although this may be a temporary solution, it does offer some relief.

Manipulation of the spine to relieve the pressure on the nerve has been demonstrated in studies to be one of the most affective treatments for sciatic pain. Manipulation is the best place to start when someone has sciatic nerve pain. It is a non-invasive, drug-free treatment option. The goal of manipulation is to realign the spinal bones taking the pressure off the nerve. When the nerve pressure is alleviated one often finds great improvement with decreased pain and inflammation.

Other very effective, conservative option is a good exercise program. There are many exercises available, but these are the ones I have used in my clinical experience to be most effective. The first exercise is laying flat on your back with your knees bent. Squeeze or flex you buttocks pressing toward the ceiling. Hold this position for a count of ten and slowly return to the neutral position. Repeat this four times. Starting at the neutral position, bring each leg to your chest with both hands one at a time. Follow this by bringing both knees to the chest, bringing your head up again holding for a count of ten and returning slowly to the neutral position and do this four times. A third exercise is laying on your stomach and arching backwards with your elbows on the floor moving from a neutral position to a comfortable flexed position arching backwards as much as you can but stopping if back or leg pain worsens. The fourth exercise is on your hands and knees, pushing your back up toward the ceiling then pushing it to the floor, (this is often called the cat stretch). These exercises should be initiated slowly and if there is any pain or discomfort, to stop before you have pain. I would recommend doing these exercises two to three times a day.

There are many nutritional aspects to sciatic nerve pain you may not be aware. A diet that is pro-inflammatory i.e., one that is rich in meat, dairy and shellfish, will give more inflammation to all nerves. An anti-inflammatory diet consists of fruits, vegetables and fish. This is one of the most powerful ways to treat the symptoms of inflammation and stop pain.

The nutrients that I found to be most effective in treating sciatic nerve pain are turmeric, tulsi and rosemary. These powerful herbs have been studied and found to greatly decrease inflammation. Boswellia is an herb that is a specific anti-inflammatory. This is especially helpful for arthritic patients. Bromelein is a plant enzyme found in pineapples and has natural anti-inflammatory affects. I prefer to take this with papain as well, it is essential that you take it on an empty stomach to really get the benefits of the anti-inflammatory nature. Ginger is a powerful herb that offers pain relief. You can steep fresh ginger in boiling water and use it as a tea or make a juice out of it. Evening primrose oil, black currant oil, or borage oils contain the essential fatty acids Gammalinolenic acid. These omegas will greatly reduce the inflammatory process and take down the inflammation on the sciatic nerve.

There are many ergonomically beneficial positions that will improve sciatic nerve pain no matter the cause. It is an important part of your treatment to improve your posture and use your body correctly. Good posture allows the use of the body without strain on muscles, joints, ligaments, and internal organs. Good posture must be considered in all activities: sitting, standing, resting, working, playing and exercising. It is simply not a matter of “standing tall”.

In the resting position, it is beneficial to lay flat on your back with two pillows under your knees or lay on your side with a pillow between your knees. Avoid positions like sleeping flat with no pillow, on your stomach or lying on your stomach with one knee bent up. This will cause a ’swayback’ condition. Some simple things, such as getting up and down from bed, to get into bed it is preferred that you sit on the side of the bed bring both arms to one side, lower your side to the bed keeping your knees bent at forty five degrees, then pull your feet into bed. Remain on one side or roll on the back. Getting up from the bed it is best to roll on your side push with the hands to the sitting position keeping knees bent and swinging legs over the edge of the bed. When sitting, avoid a chair that is too high, as this will increase swayback. When sitting, the knees should be higher than the hips as this will flatten the lumbar curvature. Avoid slouching on a chair with feet on an ottoman because this can strain the lower back. When traveling in a car the seat should be close to the steering wheel and use a small pillow for proper lumbar support. When standing, I recommend placing one foot on a stool or shelf and after a short time switch to the other foot this will flatten the lumbar curve and ease the pressure off the lumbar spine. When lifting, avoid bending at the waist. Bend the knees and carry the object close to the body. When bending, bend at the knees and push your buttocks out rather then flexing at the waist.

My final tip on stopping sciatic nerve pain is to drink plenty of H2O. A dehydrated body is one that will be more difficult to heal. It is important to drink at least six to eight glasses of water per day to keep the body well hydrated and to flush toxins built up from resulting muscle spasms of the pain and inflammation. Water will also keep the disc well hydrated. Between your spinal bones are intervetebral discs that dry out as we age the more we can keep them hydrated, the less arthritis will occur in the spine. This is also the cause of us getting shorter as we age is each little disc between the vertebrae dry out, or desiccate, then subsequent height loss will occur.

If you follow these simple steps for stopping sciatic nerve pain, you will go a long way preventing any discomfort in the future and avoid any harmful drug side effects or painful surgical intervention. Remember, an ounce of prevention is worth a pound of cure.

Discover the waysto stopping sciatic nerve discomfort. Through years of clinical treatments, Dr. Gendron has helped thousands of patients prevent and relief the discomfort of sciatica. Visit his blog, www.doctorgendron.com now, to find natural solutions and stop the discomfort.

Osteoarthritis (OA) is the commonest joint degeneration condition in the world, resulting in huge amounts of pain and suffering, work loss, expense and disability. Ageing of western developed populations, soon to be followed by some developing countries such as China, will place an increasing burden on medical services as the occurrence of OA rises steadily with age. There will be an increasing need to provide medical and physiotherapy treatment for OA over the next 50 years and for many thousands of people this will involve joint replacement.

Medical interventions can be rated on a scale which calculates the improvement in quality of life which results and here hip replacement comes out top of all treatments. The 1960s saw its development into a standard treatment for hip arthritis but the 21st century has seen the technique evolve into a complex and predictable approach to many hip conditions, with excellent fifteen year plus results. Once conservative treatments have been exhausted due to a worsening joint then joint replacement becomes the standard choice.

Total hip replacement involves removal of the arthritic joint surfaces and their replacement with metal and plastic components. The top of the femur, the ball of the hip joint, is removed and the socket is reamed out to make it bigger to accept the new part. Cement is pressurized into the bony areas and a steel alloy femoral component with a ball and stem is inserted down the femur and a plastic cup of ultra high density polyethylene into the socket. The metal-plastic interface allows very low friction and wear, ensuring a long life for the joint.

On return from operation the physiotherapist will check the patient’s operative record, medical observations and assess the patient. Initial physio treatment consists of checking respiratory status and the muscle power and feeling in the legs to exclude nerve injury. Exercises are given to restore normal movement although an epidural can cause loss of movement in the legs and delay progress. The physiotherapist will then mobilise the patient with an assistant, taking care of the hip precautions, stand them up and walk them a short distance with elbow crutches or a frame.

Toes, ankles, quadriceps, hip flexion and buttock exercises continue to restore normal muscle activity to the legs and maintain the circulation. Routine painkillers should be taken as this helps patients get up and about and once safe they can get up three times a day or more with a helper to walk, toilet and wash. Usual precautions are taken and when sat out the chair must be the correct height and normally patients do not put their feet up whilst sitting.

Physiotherapists routinely teach and correct patients’ gait after hip replacement to improve joint movement, muscle strength and a normal walking pattern. On getting a patient up initially the physio will teach the “step to gait”, instructing the patient to place the crutches forward at first, place the operated leg between the crutches then following it by stepping to it with the unoperated leg. This technique is steady but slow and used when safety is key, and the next progression is to a “step through gait” where the unoperated leg then moves through past the operated leg into a more normal gait. The most advanced gait sees the operated leg and the crutches moving together at the same time and gait approaching normal.

Six weeks or so after the operation the patient will have a good gait, have reasonable muscle power and be able to do most functional activities such as a walk, climb stairs and ride in a car. They may then move on to a stick if stability or balance is difficult or the person is very old. Patients can now return to normal activities but need to maintain the hip precautions:

* Avoid hip flexion over 90 degrees by not sitting down in low seating, not sitting down or standing up too quickly, not bending over to the floor quickly and not crouching.

* Standing on the operated leg and rotating the body is risky.

* Don’t flex the hip suddenly or above 90 degrees, such as by sitting in a low chair, sitting down too fast, crouching or leaning forward quickly to the feet.

* Inform a doctor if an infection develops in an area such as the teeth, bladder or chest, as these can track to a new joint.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

The ability to position the fingers and thumb in precise postures is vital for the highly coordinated use of the hand and the wrist has a significant role to play in this function. The shoulder blade and the shoulder perform the gross positioning of the arm, the elbow places the hand at varying distances from the body, the forearm dictates the angle of the wrist and the wrist performs the final positioning of the hand. The closer to the hand the body parts come the more precise and fine the movement becomes.

The wrist bones are a grouping of eight small bones called the carpal bones and which are arranged in two rows between the metacarpals and the ulna and radius of the forearm. From the end row of carpal bones the metacarpals run down the hand to the junction with the phalanges at the knuckles, making a mobile central hand area. Running virtually parallel to each other and being long and narrow the metacarpals can alter their positioning, either becoming flattened to support something large or rotated round to cup the palm for increased grasping ability.

The neat, close group of carpal bones allows the wrist to perform a conical range of movement facing forwards, with a full 360 degree rotation possible. The bones can move as a group or to some degree individually to permit fine control of the thumb, fingers and hand. The rows are somewhat irregular but on average there are two bones in line with each metacarpal between it and the forearm. This pattern creates a series of joints in line with each other and permits a great variety of individual movements to translate into precise and varied positioning.

The thumb is the most manoeuvrable and astonishing part of the human hand. We possess an “opposable thumb” which is absent from apes and allows us to achieve the high levels of precision movements we require. On the outside of the hand the thumb’s metacarpal is not flat in the same plane as the others in the palm but is turned inwards, giving it the function of crossing the palm to allow the thumb to meet the ends of the fingers in gripping. Much of the specialised thumb movement comes from the junction of its carpal and metacarpal bones.

The carpal bones typically move in small motions which are reflected throughout the wrist, in other words they often move all together to accomplish a movement. There are small amounts of motion between all the carpal bones as the hand is moved, and with the ability of the metacarpals to rotate in regard to each other, this allows a cupping posture of the hand. Cupping the hand moulds the palm so that objects can be gripped and brings the fingers round to an appropriate angle to hold something. If the metacarpals lose the small accessory movements which occur between them this can affect the use of the wrist and so the ability of the hand.

Wrist function can be adversely affected by heavy work with the hands such as grasping and pulling heavy objects, pulling ropes and using vibrating machinery. When the hand is grasping something firmly the longitudinal forces this generates are very great as the carpal bones are compressed between the metacarpals and the forearm bones. This can cause a reduction in the essential accessory movements of the carpal bones. Forced extension of the wrist may wedge one of the carpal bones, the lunate, slightly forwards which causes pain and disability.

A fall on the outstretched hand (FOOSH) is the most typical reason for the wrist to be extended forcibly and a Colles fracture is a common result where the break is located in the last inch of the radius and ulna near the wrist. Older women are most likely to suffer from this fracture and although most attention is concentrated on the fracture there is often a significant soft tissue injury of the wrist bones as well. The fracture will heal in five or six weeks but pain, weakness and functional difficulty may persist for much longer, related to some extent to the loss of individual movements between the carpal bones.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in London visit his website.