Sciatica & slipped disc

Bed rest lengthens the course. Short walks, frequent changes of position and normal everyday movements within the bearable range are today the basis of the treatment.

Over weeks to months the escaped core retreats by itself — the bigger the prolapse, the more so. So treatment starts without an operation, unless warning signs are present.

New weakness in the leg, numbness in the saddle area, disturbance of bladder or bowel: to the emergency department at once, not the next day. That is rare — but every hour counts.

Taken regularly in the first days they make movement possible — and movement is the actual treatment. A drug for nerve pain often works less here than expected.

Lying on the back with the lower legs on a chair noticeably relieves the nerve root. Meant as a break between movements, not as a programme for the day.

In the first six weeks without warning signs a picture almost never changes the treatment — but it shows wear that also occurs in people without complaints, and it unsettles. It becomes necessary with warning signs and before a procedure.

Painkillers bridge the time the body needs to break down the disc herniation itself — weeks to months, and in most people the herniation disappears again on imaging. Surgery takes the leg pain away faster; after a year the outcome is similar either way. Immediate surgery applies only with weakness or bladder problems.

In about nine out of ten disc herniations the complaints improve within six to twelve weeks without surgery — the prolapsed core dries out and is broken down by the body, visible on MRI over three to six months. Surgery is done for paralysis, bladder disturbance, or when the pain stays just as strong after six to eight weeks. Bed rest beyond two days measurably lengthens the course.

Turn onto your side, draw up the knees, let the legs slide over the edge and push up with the lower arm. Avoids exactly the movement that hurts most in the morning.

That is what tells the trapped nerve from ordinary low back pain: it runs over buttock and back of the thigh into calf, foot or toes — usually as a narrow band, not spread out.

Every rise of pressure in the belly shoots into the leg. That is a very reliable pointer that the root itself is involved.

A numb area on the top of the foot, weakness standing on tiptoe or on the heel: where exactly says which root is involved. Increasing weakness matters more than the pain.

Numbness in the saddle area, no longer feeling or no longer being able to pass water, loss of bowel control, weakness in both legs. That belongs in hospital at once and not in an appointment next week.

No value explains the pain itself. This one looks for the rare but important exception: an inflammation or infection behind the complaints.

Together with the CRP the hint of an inflammation of the spine — with fever, constant pain at night or after an infection both belong measured.

Belongs to the same warning signs. With ordinary disc pain all these values are normal — and that is the useful information.

Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.

Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.

The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.

In some countries high-dose B12 is injected against nerve pain; the studies are small and the results inconsistent. A proven deficiency is a different matter and belongs replaced.

A deficiency causes diffuse back and leg pain that resembles sciatica but does not follow the nerve’s path. That difference is the question to answer first.

Cortisone injected at the nerve root eases the leg pain measurably in the first weeks; after three months the difference from sham treatment has gone. It is a bridge, not a cure — and most disc problems recede in that time anyway.

In pregnancy ligaments and pelvis loosen, and the growing belly shifts the balance. Sciatica-like pain then often comes not from the disc but from the pelvic ring — and is treated differently.

Every extra kilo raises the pressure on the lower discs. With excess weight losing 5–10 % reduces recurrence in studies — that works over months, not in the acute phase.

Straining at stool noticeably raises pressure in the disc space. In the acute phase — and on painkillers that slow the gut — fibre and fluid are worth more in practice than they sound.

Bed rest worsens the course — one of the clearest findings there is.

Warmth makes possible the movement that is the actual treatment.

Targeted exercises work on the cause; the choice depends on the level involved.

Lies on the bladder meridian, which follows exactly the line of the pain.

Listed values: 10 · 16 · 17 · 18 · 19 · 20 · 174 · 666 · 690 · 727 · 787 · 880 · 1550 Hz

Listed values: 20 · 120 · 727 · 787 · 880 · 10000 Hz