why SWD and IFT in sciatica?

[sharmaphysio]

hi guys,
normally we give SWD and IFT in sciatica.my question is y so?
ok fine SWD is a deep heating modality,then y deep heating only,and also y swd only?
when sciatica is a radiating pain why ift is more often used then tens?

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[monak84]

Hi,
Can anybody please explain how SWD or IFT would treat the root cause of sciatica..?
I guess its just gonna give u temporary relief..n not treat the cause...instead manipulations would help..

[alophysio]

have a read of the posts above...

[monkey]

Hi Alo,
May I first take exception at your offensive statement against a monkey in your first reply to this, but then I do agree with a lot of what you are saying, but with some exceptions.
My feeling is that as far as sciatica and back pain are concerned pain is everything, get rid of the pain and you get rid of the problem. As you mentioned there are plenty of people walking around with large disc prolapses, severe degenerative change and stiff facet joints that are not effecting them in any way. We also scan plenty of people who have severe sciatica and no changes what so ever on the MRI film (OK to use this abbreviation?).
My impression is that the pain is often due to a sensitized nerve root which may be due to both mechanical and chemical irritation. Manual techniques often aggravate those sciaticas which are "chemical" in origin and these respond best to pure pain control. Are the effects of manipulation purely mechanical? There are schools of thought that suggest manipulations greatest effect is pain modulation.
What I would suggest is do anything that you can to get rid of the pain to allow the person to return to activity. This can be anything from manipulation, medication, advice (yes, just talking sometimes helps best), exercises, acupuncture and if you live in the dark ages use electrotherapy. Usually a combination tailored to the individual works best (treat the person not the condition), and that surely is what the initial assessment is all about.

[alophysio]

Hi Monkey,

Sorry, i didn't know that there actually were people called "monkey" working as physiotherapists - so i retract my statement about monkeys

Secondly, I agree with what you have written - and just so that you know that i have a balanced and fair perspective, i will let you know that there was a recent study that showed that LASER with MT/x was better than MT alone or x alone or something like that (don't have reference on me - on a different computer at the moment).

My main point is that as physiotherapists, our perception in the community is that all we do is massage and put people on machines. Every week, i have lots of new patients asking if what i just did for their treatment was 'physiotherapy' because many other physios that they had seen in the past just gave them some heat, massage and put on I/F (and some home exercises).

THe main point of the assessment IS to provide a provisional diagnosis and then provide appropriate treatment based on your assessment. And in some cases, all you can do is put someone on a machine for pain relief. HOWEVER, in my experience, this is the exception rather than the rule. Most people will try to put up with their pain for a little while so it is not often that you have someone fall in your doorway just from the pain (which has happened to me recently - i helped him across the road to see the GP because there was nothing i could do for him).

In some ways i am happy for the physios in my area to keep doing the same thing because i will then have a clear point-of-difference which will give me a competitive advantage however for the profession of physiotherapy, i would much rather a more sophisticated, multimodal, personally modifed, holistic approach to treatment.

I kid you not, people actually say that physios just work on the muscles, chiros work on your spine and joints. We are not very good at marketing ourselves!

[monkey]

Thanks Alo,
I think we are actually using similar approaches, my intention was just to remind people that it is possible to develop genuine sciatica without any compression or even narrowing of the nerve root canal.

[alophysio]

Hi monkey - i had a reread of my posts - i didn't see a monkey reference in there but i might have missed it - i did however see the reference to chemical stimulation on my 1.05.2006 post - scary that this thread has been going on for so long! haha - indeed i believe that chemical sensitisation is usually the main cause of the sciatica.

[monkey]

Hi Alo, 06-04-2006 you referred to a monkey treating back pain. But I will forgive you, how were you to know that there is a monkey working with Back Pain.

[alophysio]

Haha

Sorry my friend. I completely missed it! I did say however that a monkey can help with their symptoms... i just didn't realise that monkeys had developed such good manual therapy skills and improved knowledge of the anatomy and physiology of the spine-perhaps a journal article in Nature is in order??

I ask for forgiveness and pray that you take it easy on me should we ever meet - i heard that monkeys have 5 times the arm strength of humans...your poor patients!

Thanks for your humour

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