FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

Rx FOR WIFE'S SCIATICA: BETTER CAR SEAT, MANIPULATIVE TREATMENT

Question: My wife has developed sciatica, and has done all of the "standard" medical treatments-pain medication (ibuprofen and Relafen), therapeutic massage and physical therapy. While the medication helps temporarily, nothing has given her long-lasting relief. She drives about 25 minutes to work on a congested highway and feels that the constant "brake tapping" with her left foot contributes to the pain. She bought some padded cushions for the car that seem to help a bit. I'm wondering if there's any osteopathic treatment that her M.D. might not know about, or if there are other treatments she should try?

The sciatic nerve is the largest nerve in the body-it is a bundle of nerve fibers that is about as big in diameter as your thumb. It is formed from smaller nerves that leave the spinal cord in the low back region and join together near the spine to form the sciatic nerve. This nerve then passes across the inside of the pelvis, courses across the buttock, passes near the hip, and then leads down the leg.

Irritation or injury to any part of the sciatic nerve can produce pain that is correctly labeled "sciatica." Sciatica is usually low-back pain that also involves the buttock and leg. Its intensity may range from mildly annoying to completely disabling. In addition to pain in this region, there may be loss of sensation or loss of muscle use in the leg.

Almost 40 percent of us will have sciatica some time during our lives. These episodes may have many causes. The sciatic nerve can be injured while giving birth to a child, or it can be damaged when the pelvis or hip is broken. Most episodes of sciatica, however, occur for less easily identifiable causes. A common culprit is a ruptured or bulging intervertebral disk in the low back.

X-rays, CT scans and MRI studies are often done to find the source of sciatica. Sometimes these studies clearly identify the underlying problem, and this knowledge then enables your doctor to specify appropriate treatment. As examples, surgery may be necessary for a severe ruptured disk or for a broken hip. Most of the time, however, these studies only show minor age-related changes that aren't the real cause of the sciatica. Most individuals with sciatica will have resolution of their symptoms within one month without special treatment. There are a large number of other sufferers, however, whose symptoms are more severe or more persistent. This group of individuals warrants treatment for their sciatica. Manipulative treatment done by an osteopathic physician or a chiropractor has been shown to reduce the healing time. Your wife hasn't had this type of therapy and would probably benefit from it. Additional physical therapy, particularly therapeutic exercise, is also of great benefit.

Driving always creates strain in the low back. This occurs because of the need to work the accelerator and brake (and clutch for some of us) with the feet while being positioned to see the road and to use the arms to steer. The back muscles must constantly adjust the posture as the vehicle subtly bounces and sways. Extra cushioning to help maintain a proper posture minimizes, but doesn't eliminate, this type of back strain. This problem is worse in vehicles that have seats close to the floor just as sitting on the floor in the living room is less comfortable than sitting up on a chair. I'd suggest that your wife consider borrowing a vehicle with a taller and more supportive seat and trying a course of manipulative treatment.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.