There’s more to weight loss than fitting into your favorite jeans. A new study confirms that weight loss can significantly relieve back pain and sciatica in obese patients.

Low-back pain and sciatica are common among obese patients. Research shows that having a high BMI can slow your rate of recovery from low-back pain and increase your  risk of common causes of sciatica like lumbar disc degeneration. ^2-3 Decreased space between the spinal discs can lead to nerve impingement and sciatic pain.

This new study included 30 morbidly obese patients who had undergone bariatric surgery. ⁴ As patients lost weight, the space between the discs in the lumbar spine increased, easing pressure on irritated nerves. Patients also experienced a significant reduction in low-back pain and radiating leg pain.

For patients concerned with the potential costs and risk of surgery, non-invasive weight loss could be a viable option. A new literature review concluded that exercise and physical therapy can significantly reduce back pain in obese patients without the risks of surgery. ⁵   Weight loss has also been shown to relieve knee pain in obese patients.

A chiropractor can create a natural treatment plan for back pain that includes exercise, nutritional counseling, chiropractic adjustments, and more.

References

1. Djurasovic M, Bratcher KR, Glassman S, et a. The Effect of Obesity on Clinical Outcomes After Lumbar Fusion. Spine 2008; 33(16): 1789-1792.

2. Baumgarten K, Walter C, and Watson E. The Effect of Obesity on Orthopaedic Conditions. South Dakota State Medical Association. http://www.sdsma.org/documents/Carlson.pdf.

3.Samartzis D, Karppinen J, Chan D, et al. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: A population-based study. Arthritis and Rheumatism 2012; 64(5): 1488-1496.

4..Lidar Z, Behrbalk E, Regev GJ, et al. Intervertebral Disc Height Changes after Weight Reduction in Morbid Obese Patients, its Effect on Life Quality, Radicular and Low Back Pain. Spine 2012. doi: 10.1097/BRS.0b013e31825fab16.

5.. Atchison J and Vincent H. Obesity and low back pain: relationships and treatment

Pain Management 2012; 2(1): 79-86/(doi: 10.2217/pmt.11.64)

Researchers from China divided 90 sciatica patients into three groups receiving one of three treatments: warming acupuncture, tablets of a common drug called Nimesulide, or  injections of a plant-based alkaloid used as a natural anti-shock treatment. The researchers then measured patients initial pain thresholds. Acute and chronic pain tends to lower your overall pain threshold, or the level of pain you can tolerate. As expected, the sciatica patients had lower pain thresholds compared to 300 healthy participants tested. Over time though, as patients began to recover with treatment, their pain thresholds crept upwards. Patients in the acupuncture group experienced more significant improvements; their pain threshold increased by 1.65 mA compared to 0.5 mA for the drug and 0.72 mA for the injection group.

Researchers pointed out that acupuncture could release chemicals that alter neurotransmitters to block the transmission of pain. They also suggested that the burning moxa used in warming acupuncture could dilate capillaries in the affected area and improve circulation to strengthen the analgesic effects of acupuncture.  Though previous research has suggested that acupuncture can relieve back and neck pain, this study suggests it could also be beneficial for patients with sciatica.

Reference 

Chen M, Wang P, Cheng G, et al. The warming acupuncture for treatment of sciatica in 30 cases. Journal of Traditional Chinese Medicine 2009; 29 (1): 50-3.

Women with sciatica are more likely to have a slower recovery rate than men with the same condition. In a recent study, 28% of women had unsatisfactory outcomes after one year of treatment, compared to just 11% of men. Patients with unsatisfactory outcomes suffered from higher pain and disability levels as well as slower recovery rates compared to other patients.

The researchers tracked the progress of 283 patients with severe sciatica. The patients were treated with surgery, conservative care, or a combination of both. By the end of the study, 83% of patients had recovered, reflecting the generally positive prognosis of sciatica. But 17% of patients were still experiencing severe pain, and the majority of those patients were women. Gender differences in recovery rate were not affected by the type of treatment patients received.

Previous studies have shown that women are also more likely to have chronic pain and disability from other musculoskeletal conditions. Research suggests that there are various biological and social factors that could play a role in these gender differences. Smoking and obesity have also been linked to sciatica and chronic pain in women.

Since most of the women in the study did recovery after one year, it’s important to remember that being female doesn’t guarantee a poor recovery. Still it’s crucial to take steps to prevent chronic pain with early treatment, exercise, and improved posture.

Reference:

Peul W, Brand R, Thomeer R, and Koes B. Influence of gender and other prognostic factors on outcome of sciatica. Pain 2008;138: 180-191.

Sciatica is frequently the result of spinal conditions that lead to irritation of the sciatic nerve. The sciatic nerve is the largest nerve in the body, and runs from the lower back through the upper buttocks and down to the toes. Compression or irritation of the sciatica nerve can cause low-back pain with radiating pain in the back of the legs.

Sciatica is often a result of disc herniation. Spinal discs are soft cushions between the vertebra of the spine. Disc herniation is the process in which an injury or spinal degeneration causes the disc to move outside of its normal boundary. This bulging disc pinches the sciatica nerve triggering pain.

Although disc herniation is a common source sciatic pain, several other mechanisms can cause pain. In a recent study, researchers used new, state-of-the-art imaging techniques to illustrate sources of sciatic pain other than disc herniation.

Additional causes of sciatica:

Tumors and cysts: Various tumors and cysts can compress nerves in the lumbar spine region, causing pain.

Injury:  Fractures of the pelvis or sacroiliac joint can lead to lesions that place pressure on the nerves in the lumbar spinal plexus, or the group of nerves in the lumbar spine /low-back region. A hamstring injury can also lead to inflammation of the tendons and compress the adjacent sciatica nerve.

Infection: Though less common, infections can lead to abscesses, causing sciatic pain. These infections can occur in association with post-surgical complications, inflammation of the sacroiliac joint, gastro-intestinal pathologies like Crohn’s disease or infections in the pelvis region.

Gynecological pathologies:

Gynecological conditions like ovarian cysts, ectopic endometriosis, or pregnancy

can lead to sciatic pain, typically on the right side. Patients with sciatica due to ectopic endometriosis are typically in their reproductive years and have periodic flare-ups of sciatica known as cyclic sciatica.

Other causes

Piriformis syndrome occurs when the sciatic nerve is compressed due to disorders or injury of the piriformis muscle. (This is a large muscle in the gluteal region.) Patients with piriformis syndrome experience pain in their buttocks with prolonged sitting.

Additional causes of sciatica include pelvic, gynecological, and urological cancers. Rather than severe radiating pain, these patients experience weakness or swelling.

Understanding the origin of your pain can assist doctors in providing effective sciatica treatment. A doctor of chiropractic can identify the source of your sciatica to provide effective treatment. Learn more about the  causes of sciatica here.

Reference

Ailianou A, Fitsiori A, Syrogiannopoulo A, et al. Review of the principal extra spinal pathologies cause of sciatica and new approach by MRI. The British Journal of Radiology 2012. E-published ahead of print. doi: 10.1259/bjr/84443179.

References:

Cohen S, White R, Kurihara C, Larkin T, Chang A, et al. Epidural Steroids, Etanercept, or Saline in Subacute Sciatica A Multicenter, Randomized Trial. Annals of Internal Medicine 2012; 156(8): 551-559.

Phend, Crystal. Shot Delivers Scant Relief for Back Pain. Medpage Today. April 17,2012. Accessed April 23,2012. http://www.medpagetoday.com/PainManagement/
PainManagement/32212.

Pittman, Genevra. Spinal injections may not aid lower back pain. Reuters Health. April 16, 2012. Accessed April 23,2012. http://www.reuters.com/article/2012/04/16/us-spinal-injections-idUSBRE83F17P20120416.

When a patient discovers they have sciatica due to lumbar disc herniation, one of the first questions they have to answer is whether or not they wish to undergo surgery. Numerous studies have explored that question, and a 2010 review of the literature on sciatica treatment brings us closer to an answer.

The study revealed there is inconsistent evidence on whether surgery is more beneficial than conservative care. In the review, researchers evaluated several studies comparing surgery to prolonged conservative treatment for sciatica due to lumbar disc herniation.  They discovered that many of the leading studies were subject to bias towards surgery­­­–a bias which may have tainted the results.

Only two of the leading studies were considered to have low bias. One found that surgery provided faster relief of leg pain, but that differences between surgery and conservative care diminished after 1-2 years. At the annual follow-ups, both groups of patients had substantially improved. Another study confirmed that there were no major differences between conservative care and surgery in the long-term.

Despite that one study suggested that surgery may provide faster relief, the initial benefit may be out weighed by the costs and risks of surgery, researchers said.

They concluded that more research is needed to understand which patients may benefit more from surgery and which will benefit more from conservative care. Since both may be equally effective in the long term, for now, it’s up to patients to decide whether surgery is worth the additional cost and risk.

Jacobs, WC, M. van Tulder, M Arts, SM Rubinstein, et al.” Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review.” European Spine Journal 2011; 20(4): 513-22.

The efficacy of drugs for sciatica treatment has been called into question in a recent  literature review. Although there are consistent guidelines for prescribing medication for low-back pain, “this is not the case for sciatica.” To address this lack of clear guidelines, researchers analyzed the results of current literature on pharmaceutical treatment of sciatica.¹

After evaluating 23 studies, researchers concluded that there is no clear evidence demonstrating “favourable effects of NSAIDs², corticosteroids, antidepressants, or opioid analgesics in the immediate term [relief of pain] even compared with placebo.” That means that in many studies, drugs were no more effective than a placebo in relieving pain. Several drugs also did not significantly impact leg pain, one of the primary symptoms of sciatica. Though some NSAIDs and an anticonvulsant called gabapentin did reduce overall pain in the short term, the long-term effective  were unclear.

For long-lasting relief of sciatica pain, chiropractic care combined exercise may ultimately prove more effective by addressing the root cause of sciatic pain instead of simply easing symptoms.

Reference:

1. Rafael Zambelli Pinto, Chris G Maher, Manuela L Ferreira, Paulo H Ferreira, Mark Hancock, Vinicius C Oliveira, Andrew J McLachlan, Bart Koes.”Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis.” British Medical Journal. 2012, February; 344:e497 doi: 10.1136/bmj.e497.

2. NSAID stands for nonsteroidal anti-inflammator drug; they are typically common pain medication like ibuprofen or asprin.

In the study, researchers analyzed records  from the Utah Population Database, which includes data dating back to early settlers. Using familial genealogy of 1264 patients, researchers were able to track the presence of lumbar disc disease over several generations. They found that having a close relative quadrupled your risk for lumbar disc disease. But if you’re parents didn’t have lumbar disc disease, you’re not off the hook: even having a distant cousin can elevate your risk.

Genetics isn’t the only cause of sciatica; mechanical stress on the spine, occupational loading, aging, and even smoking has been linked to sciatica. Learning whether you have a genetic risk of lumbar disc disease can help you take additional steps to prevent or minimize sciatic nerve pain.

References

Patel, Alpesh. William Ryan Spiker. Michael Daubs, Darrel Brodke, and Lisa A. Cannon-Albright. “Evidence for an Inherited Predisposition to Lumbar Disc Disease.” The Journal of Bone and Joint Surgery. February 2011; 29(3): doi

165 patients with moderate and severe sciatica pain participated in several supervised physical therapy sessions for three months. Immediately following a session, 85% of patients experienced reduced leg pain through a process known as centralization. Centralization occurs when radiating leg pain retreats to the spine, where the pain originates. Centralization is generally associated with a good prognosis in patients with sciatica, and researchers wanted to determine whether certain patients were more prone to centralization after physical therapy sessions.

The fact that the majority of patients experienced centralization means that physical therapy can reduce pain in sciatica patients, regardless of what type of disc lesion caused their pain. After three months of treatment, all patients saw a reduction in leg pain and were better able to perform normal activities. Patients who had immediate centralization experienced the most improvements, but even those who did not experience immediate relief after a session had improved symptoms in the long run. For all patients, these benefits persisted at the 1 year follow-up.

This study confirms how the appropriate physical therapy can reduce radiating leg pain immediately for most patients, and provide substantial long-term benefits.

 Reference

Albert, Hanne, Eva Hauge, and Claus Manniche. Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?. European Spine Journal. 2011, August; DOI 10.1007/s00586-011-2018-9.

Albert, Hanne and Claus Manniche. The efficacy of systematic active conservative treatment for patients with severe sciatica.: A single-blind randomized clinical controlled trial. Spine; 2011, April; doi: 10.1097/BRS.0b013e31821ace7f.

The orthopedic medicine department of a hospital in Norway determined to examine the effectiveness of chiropractic treatment for patients with severe sciatic pain.  They studied 44 workers who had developed sciatica at work.  The patients in this study experienced pain that was severe enough that it required hospitalization.

In the study, the hospital chiropractor performed a full examination of each patient and then proceeded with joint adjustment techniques.  Ice treatment was applied after the adjustment, since there was soft-tissue soreness experienced by the patients.

These patients were treated daily during their hospital stay, followed by 3 days a week for the first 2 weeks while in the clinic.  Some patients also received follow-up treatment once or twice a week for some time.  Norwegian public health regulations will only allow refunding for 14 treatments, so the total number of treatments rarely exceeded this.

At the end of these chiropractic treatments, a full 91% of the patients (a total of 40) had returned to full-time work within an average of 21 days.  Two patients returned to 80% of their previous work load, and the last patient at 50%.

This study points out the effectiveness of seeing your chiropractor for work-related sciatica.  Norwegian public health records show that the average patient with sciatica – and not under the care of a chiropractor – is disabled for 72 days.  In this study, patients who received the care of a chiropractor returned to work in just 21 days.   That is a 70% reduction!

The bottom line is this:  if you are experiencing pain from some type of work-related sciatica, see your chiropractor.  Much can be done to reduce the pain in a far more timely manner than ever before.  You can be back to your normal hours and capacity in a shorter period of time.  And the best part is – that debilitating pain is gone from your life!

Stover BD, Turner JA, Franklin G, et al. Factors associated with early opioid prescription among workers with low back injuries. Journal of Pain 2006;7(10):718-25.

Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.

Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.