Sciatica, Lumboischialgia: Therapy

Counseling/education

The patient should be educated about the symptoms and encouraged to actively participate. Caveat. The patient should not fall into a protective posture, but should continue to move actively!

General measures

  • Resumption of normal physical activities as soon as possible should be a primary goal of the affected person.
  • Nicotine restriction (abstaining from tobacco use).
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Review of permanent medication due topossible impact on the existing disease.

Conventional non-surgical therapy methods

  • Analgesics (painkillers), muscle relaxants (drugs that relax the muscles), and glucocorticoids, if necessary.
  • Infiltration therapy or therapeutic local anesthesia (TLA; injection of local anesthetics to nerves, muscles, or painful regions) with and without the addition of glucocorticoids or glucose (proliferation therapy) is a possible therapeutic option. Performing TLA under X-ray or CT assistance increases the success rate. Indications (areas of application) for TLA are:
    • Epidural infiltrations in mediolateral polrap, in spinal stenosis (narrowing of the spinal canal).
    • Transforaminal injection in lateral (lateral) disc prolapse (herniated disc).
    • Facet joint infiltration (FGI) – interventional radiological procedure for the treatment of painful facet joints; this involves an injection of locally active drugs in the immediate vicinity (periarticular) to the facet joints, as well as in the joint capsule (intraarticular).
    • Sacroiliac joint injection

Operative therapy

  • Surgical therapy is required in only 1-3% of all patients with degenerative spinal changes!

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Diet rich in:
      • Omega-3 fatty acids – fresh sea fish once or twice a week, i.e. fatty sea fish such as salmon, herring, mackerel.
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
  • Preparation of a fitness plan with appropriate sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

The following are recommended for uncomplicated back pain:

  • Heat applications (hot bath or red light applications).
  • Cold applications – gel or ice pack in the temperature range of ideally 10 to 15 degrees; several times a day for about 3 minutes to cool the painful area.
  • Massages
  • Shortwave treatment
  • Ultrasound applications
  • Remedial gymnastics or physiotherapy (compensation for individual deficits: eg, limited mobility; reduced muscle strength, etc.).

Psychotherapy

  • If necessary, psychotherapy or stress management
  • Behavioral therapy should result in improved function and pain relief.
  • Detailed information on psychosomatic medicine (including stress management) is available from us.

Complementary treatment methods

  • Chiropractic – Chiropractic method to release blockages in the spine.
  • The effectiveness of acupuncture in the treatment of back pain has not yet been clearly proven, but it can still be tried as an adjunctive measure.
  • Transcutaneous electrical nerve stimulation (TENS) – The effectiveness of this method in acute pain has not yet been adequately established. Case reports provide evidence for a good effect with TENS in lumbago.

Training

  • Back school or back exercises Back school is recommended for people who suffer from uncomplicated back pain for more than six weeks and for whom other therapeutic measures have not helped.