Diagnosis of Sciatica
In the event of painful symptoms in the sciatic nerve, a consultation with a specialist doctor (neurosurgeon or orthopedist or a physical medicine and rehabilitation secislist) will be necessary first. Your medical history will be collected and a physical examination including posture analysis will be carried out to investigate whether you have an incorrect posture and clinically evaluate your symptoms. Normally a Doctor will prescribe exams such as:
- X-ray of the spine or MRI of the spine – to evaluate the integrity of bone structures, the conditions of the column (verticalization, arthrosis, spondylolysis, spondylolisthesis and intervertebral disc protrusions or herniation are amongst the things that are analysed) ;
- Electromyography – this is a diagnostic test used to evaluate nerves and muscles. It allows you to measure “conduction speed” and “Muscle function”. It has to be said that electromyography is a strictly functional exam, that is, it investigates the function of the nerve or muscle and allows us to quantify any damage on nerves.
Treatment of Sciatica
Treatment of Sciatica works in three precise phases: Acute phase, sub-acute phase, prevention of relapses.
Acute Fase: sciatica
At this stage the person cannot literally move, and staying in bed is the best condition, to avoid further irritating the nerve. In this phase, after a medical evaluation, anti-inflammatory and muscle relaxant drugs will be prescribed (generally injections are more effective), or a course of Cortisone. This Phase must be absolutely respected, no physiotherapy, osteopathic therapy, no type of massage, or heat should be applied, as there is a risk of increasing the pain.
This is the most delicate phase, in which the therapist has to treat the problem and if they do not follow the right steps, things risk taking a turn for the worse. This phase can last from a few days to a few weeks.
In this phase, the physiotherapy goal is to reduce pain and help return to a normal life.
Any pain-associated contractures and inflammatory processes of the nerve should be dealt with in this phase.
Vertebral manipulation (performed by highly specialized personnel) can be used prior to a functional evaluation that will provide indications on the correct direction of movements.
A series of tests can also be carried out to treat myofascial dysfunctions, and thickening of the fascia that limit movement. Physical therapies such as Tecartherapy, Laser, hyperthermia, or less modern but still valid therapies such as infrared or antalgic currents (tens, diadynamics ..) can help.
Prevention of relapses: sciatica
Generally, after the acute and sub-acute phase you will face a period of “Settling” where you will need to deal with two important aspects: you must re-evaluate and change your posture, and above all you must change your lifestyle. Performing a Postural Rehabilitation cycle is really important and it is the best investment you can make. You will need to work on the cause of your sciatic pain, and above all improve the anatomical relationships of the structures involved in this condition.