Can a Chiropractor help with Sciatica?

Physical therapy is one of the modalities used to treat sciatica. If there is an unexpected issue, which has not been discussed earlier, we would go ahead and discuss it with the patient’s relative and treat it accordingly from there. If there is something which can wait, and is not detrimental to the patient, and relatives are not able to make decision on it, we may leave it for a later date to be discussed with the patient after the surgery. If the patient needs to use stairs, patients are trained by the physical therapist before they are let go home. If the patient develops problems like chest pain, breathing problems, sudden neurological deterioration, or any other emergency they should call 911, or go to the emergency room directly. Patients who develop worsening pain at the surgery site, discharge from the wound, fever; they should call in the office. Some patients are not good candidates for minimal invasive spine surgery and doing such a surgery in such patients may lead to non-resolved solution of the symptoms or worsening. If the patient needs an adjustable bed, they are informed about that.

When patient has back pain or has a surgery in which enough bone is removed to destabilize the spine, in these cases patient may need a fusion surgery to stabilize the spine, as well as to alleviate the symptoms. In such cases a brace is arranged in immediate post-operative period. Most of the patients with spine surgery do not need a brace. Most of the patients do not need surgery and can be treated with conservative means. How soon after the surgery can I start physical therapy? A decision to go into physical therapy will depend on the surgery as well their recovery. Sciatica is usually self limiting in 90% of patients and only needs treatment in the form of medication and physical therapy and occasionally cortisone injection. Patients may need treatment in the form of medications or injections to relieve the pain, so as to spend this period of four to six weeks, till then the relief is evident.

Patients are usually followed at two weeks, six weeks, three months, six months, and a year after surgery. Are there any warning symptoms? Warning symptoms of lumbar disc disease include worsening pain, tingling and numbness, development of weakness, or worsening of weakness, involvement of bowel or bladder in the form of incontinence of urine or stools, presence of fever, unintentional weight loss. Patients who develop neurological deficit in the form of weakness or involvement of bowel or bladder may have irreversible damage if the surgery is delayed enough. Most common spinal stenosis is at lumbar level and it, when narrowed, can compress nerves, causing pain going down the legs, with or without tingling, numbness, weakness, or involvement of bowel or bladder. Cervical decompressive surgery is removal of pressure that is on the spinal column or the spinal cord in the neck region. These patients may need surgical management to relieve their pain due to the pressure over the nerve roots.

When the patients do not respond to conservative measures, or if they have worsening neurological deficit, or worse pain, they may need surgery. Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. Occasionally in about 10% of the patients, there will be no relief, worsening or recurrence of sciatica pain despite all treatment modalities over four to six weeks. How long will the surgery take? Patients with low demand work and desk job, can be back to work as soon as three to six weeks after the surgery depending on patient pain control as well as recovery. If the sciatica pain is under control or mild then doing workout which should include stretching as well as strengthening muscles especially of the back may be helpful in decreasing the pain and recovering from sciatica.

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