Sciatica

by American Chiropractic Association

Sciatica describes persistent pain felt along the sciatic nerve, which runs from the lower back, down through the buttock, and into the lower leg. The sciatic nerve is the longest and widest nerve in the body, running from the lower back through the buttocks and down the back of each leg. It controls the muscles of the lower leg and provides sensation to the thighs, legs, and the soles of the feet.

Although sciatica is a relatively common form of lowback and leg pain, the true meaning of the term is often misunderstood. Sciatica is actually a set of symptoms—not a diagnosis for what is irritating the nerve root and causing the pain.

Sciatica occurs most frequently in people between the ages of 30 and 50 years old. Most often, it tends to develop as a result of general wear and tear on the structures of the lower spine, not as a result of injury.

What are the symptoms of sciatica?

The most common symptom associated with sciatica is pain that radiates along the path of the sciatic nerve, from the lower back and down one leg; however, symptoms can vary widely depending on where the sciatic nerve is affected. Some may experience a mild tingling, a dull ache, or even a burning sensation, typically on one side of the body.

Some patients also report:

• A pins-and-needles sensation, most often in the toes or foot

• Numbness or muscle weakness in the affected leg or foot

Pain from sciatica often begins slowly, gradually intensifying over time. In addition, the pain can worsen after prolonged sitting, sneezing, coughing, bending, or other sudden movements.

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Pain relievers

Recent research has demonstrated that some nonsteroidal anti-inflammatory drugs may actually slow the healing process by restricting the body’s natural healing mechanisms, so they should be used sparingly.

Joint manipulation

Recent research has shown us that, in some cases, joint manipulation can be helpful with pain reduction and more rapid recovery. Your doctor of chiropractic will determine if this procedure will be helpful in your case.

A Word about Prevention

In many cases, sports injuries can be prevented. Proper conditioning and warm-up and cool-down procedures, as well as appropriate safety equipment, can substantially reduce injuries. Understanding proper techniques can also go a long way toward preventing injuries.
Sufficient water intake is also an important preventive measure.

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Rest

Generally no more than 48 hours of rest and/or immobilization is needed, depending on the severity of the injury. In most cases, the sooner the person becomes active after an injury, the more rapid is the recovery. In fact, long-term immobilization can sometimes be harmful to recovery. Your doctor of chiropractic will guide this process, as too early a return to activity, choosing the wrong type of activity, or excessive activity can be detrimental.

Ice or heat
Ice or heat can be helpful with pain reduction and tissue healing.

Compression
Compression of the area may reduce the amount of swelling from the injury. Your doctor of chiropractic will determine if this will be beneficial in your case.

Elevation
Elevation of the injured arm or leg above the level of the heart is thought to be helpful in reducing swelling.

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Diagnosis and Treatment

Sports injuries are most often diagnosed from the history of the activity that brought on the pain, along with a physical examination. In some cases, x-rays are necessary to rule out a fracture. Magnetic resonance imaging (MRI) and diagnostic ultrasound are also used in finding soft-tissue injuries, like tendinitis and sprains.
Fractures require the application of some stabilizing device, such as a cast, after the bone is put back into position. Rarely, surgical intervention is required. There is a relatively standard treatment protocol for most of the other overuse types of injuries. This protocol involves the following:

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Stress Fractures

Some athletes may experience a stress fracture, also called a fatigue fracture. This type of fracture occurs when an abnormal amount of stress is placed on a normal bone. This might occur in a runner who rapidly increases the amount of mileage while training for a race. Stress fractures also occur in people who begin running as a form of exercise but overdo it from the start, rather than gradually progress to longer distances.
One final common injury is worth mentioning, and that is shin splints. This overuse injury is caused by microfractures on the front surface of the tibia (shin bone). This is most often seen in runners, although other athletes can also be affected.

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Tendinosis

In those who are training too much, overuse of a particular joint or joints in the body can result in pain and dysfunction. These injuries are called “overuse syndromes.” A common overuse injury is tendinosis, also called tendinitis. In this condition, the tendon becomes inflamed from repetitive use. In the shoulder, the rotator cuff (a complex of muscles that stabilizes and moves the shoulder) becomes inflamed, resulting in rotator cuff tendinitis. Tennis elbow is another form of tendinitis that occurs along the outside of the elbow, most commonly in tennis players. In golfer’s elbow, the tendons on the inside of the elbow are affected.

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Strains and Sprains

Although bones can sometimes be fractured with acute sports injuries, the most commonly injured structures are the muscles, tendons, and ligaments. Tendons attach muscles to bones, and ligaments attach one bone to another.
An acute twisting or overextension of a joint can lead to tears of muscles and tendons, called “strains,” and tears of ligaments result in “sprains.” These tears range from mild to severe. In mild injuries, just a few fibers are torn or stretched. Severe injuries, where there is a tear through the full thickness of the structure, are most often considered unstable injuries and frequently require surgical intervention. The intervertebral disc, a ligament between the vertebrae of the spine that works as a shock absorber, can also be torn, resulting in a disc bulge and/or herniation.
Ankle sprains most often involve tears of one or more of the ligaments along the outside of the ankle. Knee ligaments, including the larger external supportive ligaments and the smaller internal stabilizing ligaments, can also be torn. The cartilage on the back of the patella (knee-cap) can also become eroded from overuse, leading to a condition termed chondromalacia patella.

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Sports Injuries

Participation in sports or exercise is an important step in maintaining your health. Exercise strengthens your heart, bones, and joints and reduces stress, among many other benefits. Unfortunately, injuries during participation in sports are all too common. Often, these injuries occur in someone who is just taking up sports as a form of activity, doesn’t use proper safety equipment, or becomes overzealous about the exercise regimen.
The more commonly injured areas of the body are the ankles, knees, shoulders, elbows, and spine. Remember that you should discuss any exercise program with your doctor of chiropractic before undertaking such activities.

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What Are Good Ergonomics?

According to the United States Department of Health and Human Services, ergonomics is the science of fitting workplace conditions and job demands to employee apabilities. An ergonomic assessment of the workplace critically appraises the physical work environment—followed by changes based on the assessment.

Ergonomic principles are then used to make the workplace compatible with the employee, improving the employee’s safety and productivity. In other words, the easier it is to do a job, the more productive and happy the worker will be.

When considering the impact of proper ergonomics on workplace safety, three basic principles are especially important:

1- When lifting, the largest muscles in the area should perform the task. The larger the muscle or muscle group used for lifting, the lower the stress placed on smaller, more vulnerable muscles.

2- During any work activities, people should be able to comfortably assume a number of different postures and not remain in one position for an extended time. Muscles will fatigue and be more prone to injury when assuming a particular posture, especially a poor one (e.g., partially bent forward at the waist).

3- When performing tasks, it is important to keep the joints either in their neutral posture or approximately halfway into the range of motion. Working with your joints at the extremes of their ranges of motion for prolonged periods places abnormal stresses on them and can cause repetitive stress injuries.

When working at a desk, try these suggestions for greater comfort:

1- Choose a desk that is the proper height. All things on your desk should be within easy reach.

2- Your feet should be touching the floor, with the legs and body forming an angle of 90 to 110 degrees.

3- Keep your body straight with the head and neck upright and looking forward, not to the side. Do not hunch over or slouch.

4- Adjust the height of your monitor. Look forward with your head in a neutral position. Your eyes should be at the same height as the top of the monitor. Leaning your head forward can lead to headaches and neck pain.

5- When typing, keep your wrists straight, your shoulders perpendicular to the floor, and your forearms parallel to the floor.

6- When reading at your desk, use a bookstand or a paper holder to keep your eyes in the same neutral position you use to read documents on your computer monitor.

7- When talking on the phone, use a headset, when possible, especially if you talk on the phone for prolonged periods. Holding the phone between your shoulder and cheek will only lead to neck pain and headaches.

8- Stand up and stretch your legs with a short walk about every 20 to 30 minutes.

9- Take micro-breaks often, stretching your neck, arms and wrists, back, and legs. Simple stretches include neck rotations, fist clenches, arm dangles, and shoulder shrugs.

10- If your eyes concentrate on a particular object for long periods, relax your eye muscles by shifting your focus from objects that are close to you to objects that are farther away. This helps reduce eye strain.

When lifting, follow these simple suggestions:

When lifting from the floor, keep your back straight and lift with the legs. Do not bend over at the waist and lift with the muscles of the low back. Your body is more easily injured in this position.

Keep the object being lifted close to your body.

Keep your elbows flexed.

Keep your head up and your neck straight as you lift.

When working with a computer mouse, try the following:

Don’t move the mouse with just your wrist. Use your entire arm and shoulder.

Don’t rest your arm on the edge of the desk while manipulating the mouse.

Hold the mouse loosely.

Keep your wrist relaxed. Don’t hold it up or down; instead, hold it in a neutral (straight) position. Move away from the mouse several times per hour and move your wrists, arms, and shoulders around.

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Workplace Ergonomics

by American Chiropractic Association

Workplace injuries, a common cause of time off, cost employers and employees billions of dollars every year. Some of the more common workplace injuries are carpal tunnel syndrome (a nerve entrapment at the wrist seen in computer users), low-back pain, tendinitis, bursitis, and neck pain or headaches.

What Causes Workplace Injuries?

Many workplace injuries are called repetitive stress injuries or cumulative-trauma disorders. These injuries occur when abnormal stresses are repeatedly placed on normal joints by poor posture or poor joint position during the performance of a task.

Many of these stresses are caused by poor workstation design and/or repetitive task performance. In addition, poor posture at the workstation can also be detrimental. For example, prolonged use of a computer or a mouse, particularly when the work area is not designed well, can lead to carpal tunnel syndrome and/or neck and arm pain.

Many modern product manufacturers are designing their products ergonomically, mixing form with function. Such products blend in easily with the worker’s actions while on the job and make tasks safer and easier to perform.

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