Treatment
The therapy of S1 syndrome is usually based on a multimodal treatment principle, i.e. a combination of several therapeutic options. Often the S1 syndrome is based on a herniated disc. This is usually treated conservatively.
The focus of this therapy is first and foremost, of course, pain relief. For this purpose, in addition to the administration of painkillers, procedures such as acupuncture, massages, heat applications or minimally invasive procedures such as periradicular therapy (see below) are used. However, just as important as acute pain relief is the strengthening of the back muscles to stabilize and relieve the spine and to prevent recurring complaints.
Physiotherapy as well as movement and behavioral training are particularly suitable for this. It is important to note that rest or bed rest is more likely to aggravate the complaints than to improve them. In more serious cases, surgery may be necessary to expose the affected vertebral segment and remove the constricting structures, such as disc tissue or bony parts, or to replace the entire disc.
However, a herniated disc rarely requires surgery. Surgery is urgently indicated if paralysis occurs or a narrowing of the neuroforamina is the cause of the symptoms. Therefore, it is recommended to start with physiotherapy and exercise therapy already at the beginning of back problems in order to counteract a worsening of the symptoms and a chronification.
Especially if a herniated disc is the cause of S1 syndrome, exercises of the back muscles can help to alleviate the complaints. It is advisable to strengthen the back muscles in a targeted manner in order to prevent a bad posture caused by pain with chronification of the symptoms. In addition to exercises, a pain therapy should be carried out.
Possible exercises for S1 syndrome are arm support with arm and leg lifting, forearm support (Plank-exercise) and rowing. Abdominal exercises such as sit-ups can help to stabilize the trunk. It is important to start the workout cautiously and gradually increase at a slow pace.
If you train too fast with too much effort, you can damage your back. You should be especially careful when training with weights. Furthermore, yoga exercises, such as the cat, dog and cobra, are very good for stretching the back.
Recommended are exercises that the patient can also do alone at home after detailed instructions from the doctor or therapist. Finally, it is good to mobilize the spine in all directions of movement and to hold the positions for at least 30s. However, one should not go beyond the point of pain, but always only move to the position where one does not yet feel any pain.The movements include an approach of shoulders and knees (a flexion), bending the back into a “hollow back” (an extension), a sideways tilt and rotation with simultaneous flexion.
The latter is achieved by turning the pelvis sideways while lying on your back with your knees drawn up. Periradicular therapy is the introduction of a drug directly at the affected nerve root. For this purpose, imaging (MRT/CT) is first performed in order to be able to accurately assess the affected vertebral body and nerve root on the one hand, and to plan the puncture guide on the other.
Then, with the help of a target laser, the thin injection needle is brought as close as possible to the nerve root and the medication is injected. Usually a combination of a locally effective anesthetic and a steroid, e.g. cortisone, is used for this purpose. These have a pain-relieving effect on the one hand and a decongestant and anti-inflammatory effect on the other, thus counteracting the irritation of the nerve root.
