why SWD and IFT in sciatica?

[alophysio]

Hi.

I will try to explain but I do not have access to my resources at the moment...

First of all, it is probably not the compression of the nerve that is causing symptoms. Studies have shown that people with compression of a nerve on MRI can be completely symptom free. Rather, it is thought that the noxious chemicals from the disc sensitise the nerves to pressure and therefore pain results.

A good review of the disc is given for free by Urban and Roberts 2003 -

Urban JP and Roberts S (2003) Degeneration of the Intervertebral Disc. Arthritis Research and Therapy 5: 120-131

Next, I would be hesitant to blame the SIJ for the compression of the nerve causing sciatica. However, I do believe that dysfunction of the SIJ will lead to factors that will lead to sciatica and the perpetuation of pain.

Explaining how to treat the SIJ is really not possible to do on a forum. I understand that it is difficult to purchase the books - perhaps you can get your employer to purchase it or get the hospital library to buy them. I would recommend "The Pelvic Girdle - 3rd Edition" by Diane Lee.

A key idea from the book is the "Intergrated Model of Function". You can get the chapter on this from Diane Lee's website - www.dianelee.ca - for free as a download...

The integrated model of function looks at:
1. Form Closure - how do the joints work - This involves assessment of the L/S, SIJ and Hips.

2. Force Closure - how do the local and global muscles work? Are the joints adequately supported during movement? Are the muscles able to stabilise the joints during motion?

3. Motor Control - How does the body/brain co-ordinate the muscles and joints? Your joints might be fine and intact. Your muscles might be strong and uninjured. But if the muscles don't co-ordinate their action, dysfunction can result.

4. Emotions - This area is more about how the body is affected by the brain. Less about "hands-on" in this area!

Plan your professional development along these lines - that is, work out if you know how to assess and treat along these lines. Work out where you are deficient and aim your development there.

For instance, my strength is in my form and force closure as well as emotions (I really am a "joint-man" at heart!). My weakness *was* motor control. So I have been working hard at learning and understanding motor control better so I can help my patients.

Lastly, please don't get caught up with finding the "pain-producing structure". People often try to find what is causing the pain and try to fix it to fix the problem. A better question to ask is "why did this structure breakdown in the first place?".

That way, you are looking for why the L4/5 disc is severely degenerated when the others look fine. Yes it may have a big bulge there compressing the nerves but what is the patient doing to stress that L4/5 disc in the first place? Adressing that reason is often better than trying to get an overworked disc to settle down (which most do within 6 weeks anyway!).

So although the pain may be coming from the back or SIJ, or wherever, we should treat the reason why it broke-down...

I hope that helps.

Now about your electrotherapy for sciatica.
1. Are you suggesting that preservation of the nerve/prevention of degeneration occurs if you use electrotherapy? Any References?

2. How quickly do your patients improve with Electrotherapy? Is it long lasting? Does it take longer than 6 weeks? Can you get them better with 3 treatments within 7-10 days?

I ask qu2 because i haven't been able to in the past and i was wondering if other people do it regularly - if so, I am more than happy to try

THanks