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Posted on 03-31-2015
DR. RICK'S 10 THINGS YOU SHOULD
KNOW WHEN TREATING SCIATICA
1) HAVE A PROPER DIAGNOSIS
Your physician or chiropractor should have a proper understanding of the mechanism that is causing the potential nerve pressure or
impingement. During treatment or prior to treatment, an xray or MRI may be necessary to fully diagnosis a condition. A complete history, orthopedic and neurological exam results, diagnostic exam results, response to treatment and/or medication and aggravating factors help your doctor confirm a diagnosis.
2) CONSULT AND RECEIVE TREATMENT BY AN EXPERIENCED CHIROPRACTOR WHO UTILIZES SPINAL DECOMPRESSION
Sciatica is a debilating condition and decisions
must be made through the course of treating patients. These decisions will be made more assertively and thoroughly with regard to proper medical referrals, the right prescription or diagnostic studies from an experienced chiropractor. Scientific research confirms that chiropractic manipulation is effective for sciatic conditions. There is also significant research proving the effectiveness of spinal decompression. An experienced chiropractor who is certified in spinal decompression and actively uses this technique will get excellent results. Spinal decompression is the most effective form of treatment for these types of conditions.
3) DO YOU NEED A PRESCRIPTION OR MEDICATION FOR BETTER RESULTS?
A chiropractor's initial responsibility, other then a proper medical referral when necessary, is PAIN RELIEF! Most cases of acute sciatica would benefit from an over the counter NSAID or possible prescription. Further prescriptions might include a muscle relaxer or pain reliever. An experienced chiropractor will know when to suggest the utilization of these prescriptions. In acute or chronic cases of sciatica, the right drug at the right time is imperative for quicker results. As I tell my patients, "My job is to get you on drugs when you need it and then get you off of it."
4) WHEN SHOULD I SEE RESULTS WITH TREATMENT?
In my office, I expect a patient to experience relief in the first four treatments. If pain relief isn't achieved in the first four treatments, then your chiropractor should re-evaluate the initial diagnosis, application of treatment or refer for a proper prescription to aid treatment. In my office, most patients can be released in 6-8 treatments. During the first four treatments, I expect my patient to come in and say, "Hey Doc, I'm feeling better!"
Effectively treating sciatica doesn't just take place in your doctor's office. In my office, you will constantly hear me consulting patients on the:
"5 Step Strategy Approach"
Meaning that you need to be consistent with the five steps in treating sciatica.
1) Effective treatment from an experienced chiropractor certified in spinal decompression. Be consistent with your appointments for two weeks
2) Use the proper medications appropriately
3) Use ice and heat how I teach you- ICE may be the most important therapy outside of treatment for sciatica and is rarely taught to patients properly
4) Be aware of what aggravates your condition and either stop it or do it differently. This may seem obvious. Being taught how to sleep, lift, sit, lie down or live differently during an acute sciatic exacerbation is often not acknowledged by most treating doctors. Through the course of treatment, patients are still going to work and sit long periods for work. If you have sciatica or a lowback condition you can understand the difficulty with sleeping as well. Patients need to be taught how to do these different in order to reduce the stress on the lumbar spine
5) The use of a proper support is often underutilized. Most people use supports to protect against the strain of lifting. A lumbar support is also very effective in reducing pressure on the lumbar spine during acute phases of sciatica. A reduction of pressure on the lumbar spine is essential for quicker results.
This may seem obvious to you but it isn't just the use of a drug or treatment that will get a patient results. Effectively and consistently managing sciatica is the responsibility of the doctor to teach the patient. Understanding how to approach these five steps is very important for good results.
5) USE ICE AND HEAT
The use of ice and heat is important- especially
the initial use of ice. I often tell patients that "ice is the best and cheapest medication". Ice helps to reduce inflammation and acts to numb the pain. You can't over ice during an acute sciatic problem and I recommend at least 6-8 times a day. Have your spouse get the ice pack for you when you wake up from the pain at 2AM. It will help get you back to sleep. If someone tells you to just ice for the first 48 hours then do not listen. Sciatica is a completely different condition and ice will be effective throughout treatment. Place the ice on the area that causes the most pain. If pain is occurring in the back of the leg or calf then place the ice there as well as the lower back. Moist heat is used to relax the muscles. Chronic cases of sciatica will benefit from the initial use of heat as well. Acute exacerbations should hold off on heat initially. A moist heat pack should be placed on the lower back or buttocks. I avoid recommending a patient to place a heat pack on nerve pain below the buttocks. Again, acute exacerbations should avoid the initial use of heat. An experienced chiropractor will teach you how to effectively use these tools
6) WHAT NEXT?
In order for an experienced chiropractor to effectively manage your condition, it is important for them to understand when a further level of medical intervention may be necessary. Initially, if an acceptable amount of pain relief isn't attained, then it may be necessary for consideration of an oral steroid or possible consultation for an epidural injection. Often, the need for these medical interventions isn't a failure in treatment. It is a responsible and effective step in managing a patient's condition. After receiving a desired effect from these medical interventions, treatment now becomes much more effective and that becomes a very happy patient. Your treating chiropractor needs to know when to make this decision. Epidurals and oral steroids aren't magic bullets but can be an effective protocol when initiated by an experienced chiropractor. Make sure your doctor explains your options to you.
7) ARE YOU USING PROPER SITTING ERGONOMICS?
Sitting is the biggest reason that people have regular lowback and neck pain. Sitting and bending forward places more stress on your spine then any other static position. MORE STRESS=MORE PAIN! If patients who sit for a living aren't taught proper sitting ergonomics then they will respond slower and need more treatment. Sitting ergonomics is an important skill taught in my office.
Exercise is not going to benefit an acute exacerbation of sciatica. However, exercise can be the most important tool outside a good chiropractor to manage sciatica long term(or any musculoskeletal condition). Exercise is important for flexibility, muscle strength and maintainance of consistent joint movement. If you do not exercise, you will lose the battle of chronic sciatica. In some cases of sciatica, you may need to change the type of post exercise you regularly perform. Once your condition is stable, a good physician should encourage you to exercise. I often tell patients, "If you like me and want to be in my office more then do not exercise!"
Understanding a patient's deviation of normal posture is critical to correcting a case of sciatica. Let's take an example of someone who walks slighly bent over(flexed). This postural norm causes more stress on the lumbar spine. If you are walking around with more stress on your lumbar spine then you will be prone to more exacerbations of your lowback condition.Your chiropractor needs to understand your postural deviation in order to treat your condition effectively. In addition, it's important for you to get educated on correct posture so that you can see your chiropractor less.
10) DO NOT WAIT TO GET TREATMENT AND FIND A CHIROPRACTOR WHO UNDERSTANDS HOW TO MANAGE THESE TYPES OF CONDITIONS
Most patients are stubborn and wait to long before initiating treatment. If you come in my office with a pain level of 8 out of 10 then expect 8 treatments. If you have a chronic condition then learn to initiate treatment when the pain is a 2. Get the picture! Managing sciatica is about avoiding it by making proper decisions. Following the steps listed here will help you to properly manage your condition.
No other physician is better at managing musculoskeletal conditions than an experienced chiropractor. Find a chiropractor who regularly treats these conditions. Not every doctor regularly treats acute and chronic sciatica conditions. Please visit my website and read the testimonials of other patients who have been successfully treated in my office.
If I can be of further service, please do not hesitate to call my office. It would be my pleasure to consult with you free of charge. During a consultation, I will flat out tell you if my office is the right facility for you to get the help you need.
Dr. Rick Goldfine
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