No Va Va Voom? Henry's back problem Explained

1 Henry's Problem >
2 Sciatica and Radiculopathies explained >
3 WJ Mixter: The Disc and Sciatica >
4 Recent research on Sciatica >
5 Treatment for Sciatica

Treatment for Sciatica

Severe Sciatica may require corticosteroid injections or even surgery, but most cases tend to be less severe and conservative treatment is usually very effective. The best available evidence suggests that patients with Sciatica should be advised to remain as active as possible. This is based on the fact that research shows no significant difference between bed rest and staying active, and that there is no evidence that staying active is harmful for either acute low back pain or sciatica. This may be why professional soccer players tend to recover from this type of injury in a very short period of time.

Pain-relieving medication is usually necessary for a prolapsed disc. The acute pain normally lasts for a few days and the patient should rest during this period. In most cases of a prolapsed lumbar disc, the symptoms can be relieved if the patient gets into a position of spinal extension. This can be achieved by lying on their front and gently propping the shoulders up on the elbows.

This puts the spine in the opposite position of extension – the opposite of the position in which the injury occurred - which encourages the prolapsed nucleus gel to recede into the disc. The outer layer of the disc will heal with scar tissue over a period of months, but the disc is vulnerable to re-injury and there will always be a weakness. For this reason, and to reduce the chances of a recurrence, the patient should follow the rehabilitation program set by a chartered physiotherapist. This will involve regaining the range of movement in the lumbar spine and strengthening the muscles which support the back.

Research has shown that specific exercises can be effective in relieving back pain and restoring normal function. These exercises are most effective for what is called 'mechanical low back pain', where the problem is caused by poor postural habits and the pain resulting from disc problems. Once the correct technique has been mastered these exercises are very easy to do. They are not too vigorous and they can be done by people of all ages.

The principle behind the exercises is that if certain specific muscles can be recruited or contracted, the spine will have much better support. This prevents postural faults which can predispose a person to back pain.

In order to understand how these exercises are effective it is necessary to have a brief introduction to how the back is supported by muscles. The first muscle we are concerned with is called Transversus Abdominus. This muscle arises from the middle of the tummy and goes right around the midriff, attaching itself to the spine.

The Transversus Abdominus muscle acts as a natural corset and provides stability for the lower back.

The second muscle involved in this exercise programme is the Multifidus. This muscle lies deep in the spine and attaches in between each vertebra. When it contracts it increases the stability of the spinal column.

If you can contract the Transversus Abdominus muscle, the Multifidus muscle is also contracted automatically. This improves spinal stability and can relieve back pain.

The most effective way to learn how to contract these muscles is to kneel on all fours. Once in position, relax and allow the stomach to sag down with gravity. To contract Transversus now, all you need to do is very gently pull in your tummy so that your belly button moves closer to your spine.

It is important not to contract too hard otherwise you will be using muscles other than the ones we are concerned with - don't contract your 'six pack' muscles. Also, don't confuse this exercise with breathing in and sucking your tummy in - you should be able to hold the contraction while continuing to breath and have a conversation.

It is difficult at first but once you have mastered the technique it should become second nature. The contraction should be held for 4 seconds and repeated 20 times. Then, as your technique improves, increase the contraction hold to 10 seconds. Eventually you should be able to hold the contraction indefinitely. Although it seems strange at first, once the muscles have been recruited, you will not have to concentrate on them and they will contract automatically - thus improving your posture and spinal stability.

Manual therapy in the form of spinal manipulation has also been shown to be effective in the treatment of disc related problems. The Arsenal medical team consists of four physiotherapists and an osteopath, and on returning to scoring action Thierry Henry was keen to praise their input. The striker said, "But with osteopathy I can put my back right and then I don't have the nerves blocked and I can run again. So I have to thank the medical staff, who do a great job."

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