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Novo Nordisk Semaglutide – The Once a Week Anti-Diabetic Drug Has Been Approved For Type II Diabetes Treatment by FDA

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The new endorsement by the US Food and Drug Administration (FDA) to Novo Nordisk’s Semaglutide as once a week treatment for type 2 diabetes control was granted on October the 18th after the FDA advisory panel formed by 17 endocrinologist and Metabolic Drugs experts voted 16 in favor of its approval with one abstention.

After considering all the data and clinical trials conducted by the pharmaceutical company on more than 8000 adult patients with type II diabetes, including a two years long study of 3297 patient trials taking the drug for cardiovascular side effects. The FDA advisory panel found enough supporting evidence of the Semaglutide blood sugar lowering effect and its safety. The blood sugar lowering effect was measured by the record of the patients HbA1c or glycosylated hemoglobin, which is the gold-standard test for long-term sugar blood level measurement.

The HbA1c levels were 1.5 to 1.8% lower among the patients’ group receiving the drug compared with the others groups, who were either receiving a placebo or one of the competitors approved drugs. The 1.5 to 1.8% lower HbA1c on the patients treated with Novo Semaglutide was present even when compared with patients treated with Bydureon (exenatide) the AstraZeneca competing long-acting GLP-1 agonist extended release. Additionally, to the proven blood sugar lowering effect Semaglutide was directed associated with another beneficial effect on one clinical trial, the patient studied showed a 4.5- to 6.4-kg weight loss.

What is Semaglutide?

Semaglutide is a long-acting glucagon-like peptide-1 (GLP-1) receptor, agonist. It imitates the normal hormone secreted by the intestinal cells called Glucagon, which produces to increase insulin secretion by the pancreas’ cells in the presence of elevated blood glucose; delays gastric emptying, which decreases the blood sugar after food or meals ingestion; also, the glucagon-like peptide 1 reduces the physiological glucagon secretion.

Concisely, Semaglutide mechanism of action is similar to the naturally secreted body hormone glucagon. The drug acts on the same receptor for the hormone and produces similar response reducing the blood sugar level.

How is Semaglutide prescribed?

Semaglutide prescription is one per week subcutaneous injection of 0.5 or 1 mg an adjunct to diet and exercise to get or improve blood sugar control in adults with type 2 Diabetes

Semaglutide is safe for your heart

After several studies, there was not found any side effect for heart, arteries, or veins in patients receiving the Semaglutide during the two years clinical observation period. On the contrary, Semaglutide SUSTAIN-6 Top-line Data shows a cut on cardiovascular risk among those receiving it. Therefore, the FDA considered it cardiovascular safe, and with some protective or beneficial effects, additional observation and studies will continue as part of its post-marketing surveillance.

Semaglutide diabetic retinopathy controversy

The clinical trials showed an increased report of retinopathy cases among the patients receiving Semaglutide. After a careful revision of the data from those tests, the retinopathy was found as a confounding element. The revision panel found that the patient had developed the retinopathy before they were receiving the Semaglutide, and the condition might or might not be worsening by the drug. However, the FDA demands that a safety warning must be included on the drug label indicating the risk of developing or worsening retinopathy.

The ophthalmologist members of the revision commission agreed about the primary outcomes of safety concern were met. They said that the side effects were the same as expected for similar drugs and not worrisome. The data were insufficient to determine if there is an adverse retinopathy effect o not associated with the Semaglutide treatment.

Consequently, further studies and epidemiologic vigilance are needed to establish any possible association. Other ophthalmologist consulted about it indicated that having a warning on the label about periodical eye exam on the patient receiving the drug was not only a good idea but also the best possible recommendation for the patients’ best interest.

The approval for patient use of the Semaglutide is welcome by the medical community and the patient with type II diabetes. Type II diabetes patients can have a drug that works helping them reducing their blood sugar level with only one single weekly injection or a single dose per week. The single dose makes it easier to comply with the medical treatment. It proved to work and lowered the blood sugar levels when used simultaneously with diet and exercise. The additional weight loss effect improves further the blood sugar level control.

Type II diabetes patients require a yearly eye examination to discard diabetic retinopathy as the standard of care. Patient receiving semaglutide needs to be warned about a possible development or worsening of diabetic retinopathy and maintain the yearly or more frequent eye examination if they already had developed a retinopathy.

References
1. Novo Nordisk diabetes drug works; no heart risk-FDA review http://uk.reuters.com/article/us-novo-nordisk-diabetes-fda/novo-nordisk-diabetes-drug-works-no-heart-risk-fda-review-idUKKBN1CL1LZ
2. FDA gives Novo Nordisk top grades for its diabetes drug semaglutide, but retinopathy remains key https://endpts.com/fda-gives-novo-nordisk-top-grades-for-its-diabetes-drug-semaglutide-but-retinopathy-remains-key/
3. FDA Advisory Panel Endorses Semaglutide for Type 2 Diabetes, https://www.medscape.com/viewarticle/887279#vp_2
4. Now Novo Says Semaglutide Cuts CV Risk: SUSTAIN-6 Top-line Data https://www.medscape.com/viewarticle/862644
5. New SUSTAIN-6 Data Could Explain Retinopathy Worsening https://www.medscape.com/viewarticle/881413
6. Another Positive CV Outcomes Trial for Diabetes Drug: SUSTAIN-6 https://mail.google.com/mail/u/0/#inbox/15f24c6f68b589e9?compose=15f511f9970a2aef
7. Effect of Oral Semaglutide Compared With Placebo and Subcutaneous Semaglutide on Glycemic Control in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jama/article-abstract/2657376

Rogaine – Questions & Answers

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Hair loss can be a disturbing condition, which affects a person’s self-esteem and perception causing great distress and anxiety in the people who experience it. There are diverse reasons for hair loss, and their treatment depends on the causes of it. Rogaine has been helping people to regrow or stop their hair loss with medically proven results.

What is Rogaine?

Rogaine is topical Minoxidil; this means that the minoxidil comes either in a solution or a foam presentation to be applied to the regions of the scalp where thinning or balding is present.

Minoxidil is the active ingredient of Rogaine. It is a potent hypotensive drug when taking orally or it is injected into the body. It produces a marked dilatation of the arteries and arterioles (arterioles are smallest arteries inside the tissues or organs), which leads to decrease in the arterial pressure and increase of the blood flow without affecting the vein pressure. Minoxidil causes a direct vasodilator effect or dilatation of the arteries; this drug is prescribed orally only when the other antihypertensive drug combinations fail to control the arterial pressure.

When minoxidil is taken orally, it produces hair growth as a common side effect and makes hair thicker. Consequently, the hair growing properties of minoxidil are used to treat some cases of alopecia, which is the medical term for hair loss, with satisfactory outcome for many patients, who use it as topical medication on the scalp, without producing any systemic effect on other body tissues.

Does Rogaine work?

Yes, it works. Rogaine makes hair regrow, and reverse hair loss. After applying Rogaine topical solution or foam at either 2 or 5% on the scalp where there is thinning or balding. Rogaine starts acting at the hair follicle level (hair follicle is the part of your head’s skin (scalp), which produces or generates hairs). It increases the blood flow and activates some cells chemical factors secretions. The chemical factors are products made by the hair follicle cells, which can regenerate the skin lesion and stimulate the hair growth.

One of the primary elements secreted by the hair follicle is called the epithelial growth factor; it is responsible for increasing the keratin and collagen production and the ultimate hair development. Rogaine is believed to stimulate the hair follicle directly to increase production and secretion of the hair follicle epithelial growth factor and stimulate the hair regrowth directly.

Other local effects observed are the increase in cutaneous blood flow or the blood flow around the skin and tissues surrounding the hair follicle where the Rogaine is topically applied. The increased blood flow stimulates a resting hair follicle, and its cells repair themselves or induce hair follicle regeneration. Additionally, Rogaine can be applied for stronger and thicker hair on very thin, fragile or excessively delicate hair to make it stronger and more voluminous. Rogaine has been used for more than 30 years with a proven, observable medical effect on hair regrowth and a cosmetic baldness improvement. Rogaine as topical treatment has not any systemic absorption; it is considered nontoxic and safe to use. Rogaine has few side effects, and most of them are related to small skin irritation (usually localized to the scalp) on sensitive persons.

Does Rogaine work for a receding hairline?

Rogaine is approved for pattern baldness; it works on some types of receding hairlines. However, there are some receding hairlines which may or may not respond to Rogaine treatment particularly those diagnosed as Alopecia Universalis or Alopecia Totalis. Rogaine is not approved for frontal baldness.

Several clinical trials confirmed that after the topical application of Rogaine, it induces noticeable new hair growth in the treated areas. Most dermatologist will try Rogaine as the drug of choice for most non-infectious hair loss medical conditions. Rogaine as topical treatment has not any systemic absorption; it is considered nontoxic and safe to use

How long does it take for Rogaine to work?

Hair growth occurs typically in cycles of three phases. Most of the time some hair follicles are producing hair or in an actively growing period called “anagen phase” while others surrounding it are resting, and others are in actively shedding phase called “exogen phase.” This cycle occurs on each hair. Eventually, each hair will grow, rest, and be shed to prepare the way for a new hair cycle.

As a consequence, the results with minoxidil will not be sudden or immediate. Patients are required to understand that the hair grows at a speed of half to one inch per month or 0.5 to 2.5 cm monthly. Indeed, some growth might be noticed after a couple of months, but the real cosmetic results can appear after four to twelve months in men.

The topical lotion at 5% has a faster and better hair regrowth response than the 2% presentation on males if after 12 months of Rogaine treatment the patient does not show noticeable hair regrowth, the therapy failed for the patient, and it must be discontinued.

Does Rogaine work for women?

Yes, Rogaine not only works for women hair loss but also it makes the hair thicker and stronger. There is moderate evidence that Rogaine works as a treatment for female pattern hair loss. Women who were treated with topical minoxidil at 2 or 5% reported moderate to marked improvement. Women are advised only to use the 2% presentation, and they should notice a real cosmetic improvement after six to eight months of treatment.

Women who used the topical 5% concentration may have the side effect of facial hair growth, which is called hirsutisms. Consequently, they are encouraged to apply only the 2% presentation unless their doctors prescribe otherwise. If no result is seen in females after eight months, the Rogaine treatment is considered to have failed, and it must be discontinued.

Can women apply Rogaine for men?

Yes, women can apply Rogaine for men only if the presentation is at 2% concentration. The only real difference among Rogaine is its concentration presentations, which are at 2 or 5% and the vehicle or way of application, it comes either as a topical lotion or a topical foam. Women have to be cautious to never used a Rogaine with higher than 2% concentration to avoid the side effects, especially those of facial hair growth with can give a virile or male appearance.

Treating Male Pattern Baldness

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This article will explain what causes the most common hair loss in men – Androgenetic Alopecia (or male pattern baldness). It is hair loss unrelated to the rare cases where the cause may be attributed to an unrelated medical condition or side effects to certain medication.

Androgenetic Alopecia commonly shows itself up by way of diffuse thinning from the hairline all the way back to the crown of the head. There is no common pattern – as in some people the hair loss may begin at the front and on others, the loss may be more prominent at the top.

The gradual (or sometimes quick) progression takes place until the worst case scenario where the entire front and top is devoid of hair, leading to baldness rated a 7 on the Norwood Scale, a chart showing different stages of hair loss in men.

Can male pattern baldness be treated?

Yes. But how well it can be treated may depend on the individual and, more importantly, how much the hair loss has progressed. The sooner it is diagnosed and treated the more likely it is that a full head of hair may be retained. It is our view that a general medical practitioner e.g. a physician is not always the best option when seeking advice about genetic hair loss, so it might be better to see a hair loss specialist seek out the correct diagnosis.

Correct diagnosis will ensure it is related to Androgenetic Alopecia. If it is not the case then a completely different treatment, or none at all, maybe the best option.

Provided it is determined that it is Androgenetic Alopecia the next best solution to seek is to see how aggressively it needs to be tackled.

What causes hair loss

Let’s begin with what is responsible.

An enzyme called 5-alpha-reductase converts testosterone in men into a hormone called dihydrotestosterone, an androgen, which gives men their male characteristics but can cause hair growth phase to shorten after it binds to hair follicles.

Given this, to tackle hair loss caused by DHT (dihydrotestosterone), it makes sense to either block its production or cause a reduction in its binding to follicles.

Propecia

These two require different treatments. To stop the production of DHT, Propecia, which contains 1mg Finasteride, has proven to successfully stop hair loss.

Finasteride, like Minoxidil, came about to be a viable hair loss treatment more by accident than design. While using Finasteride to treat men with an enlarged prostate, a side effect was increased hair growth. Eventually, it was trialed for hair loss.

1mg Finasteride is the active ingredient in Propecia and is widely considered to be the most effective way to stop DHT getting into the bloodstream and has been used many people and in many cases with effective results.

In many of the participants during the trial phase, the cessation of hair loss began to take hold only a few months in. Not only that but there was increased hair count and general thickness after it was continued for longer. The best results were seen around the two-year mark. It is believed the two-year mark possibly represents the point of optimal results.

One major drawback to Propecia is that it can cause nasty side effects in some of those taking it. The side effects are not minor. Decreased libido and other sexual dysfunction are a side effect experienced by some, and long-term adverse effects from taking it over many years aren’t known. These points can put people off from starting with Propecia.

Still, the number of of those suffering these side effects during the trial phase were relatively small in number. The trial also showed participants who discontinued taking it saw side effects dissipate.

A second solution would be to actually to use something that triggers hair growth (regrowth).

Anyone whose hair loss has progressed considerably and showing visible thinning or baldness would also likely need to add something that triggers or stimulates hair to regrow.

This is where Minoxidil comes in. Minoxidil is the active ingredient in Rogaine, a hair loss product designed to regrow hair in men. It was the first hair loss product given clearance by the Food and Drug Administration (FDA) as a viable treatment for hair loss. To get a better understanding of this product, please see our article on Rogaine Questions & Answers.

PropeciaRogaine
Finasteride 1mgMinoxidil 5%
Stops hair loss
May grow hair
Regrows hair
Thickens thinning hair
Decreased libido
Erectyle dysfunction
Testicular pains
Depression
Itchy scalp

Rare: Increased heart rate
Headache
Chest pains

Real world performance of Propecia and Rogaine

We must stress, not everyone derives the same level of results from either Propecia or Rogaine.

It appears from considerable anecdotal research, that Propecia possibly does a better job in its function of slowing and stopping hair loss than rogaine does at regrowing hair.

While some people react very positively to Rogaine others complain of seeing either frustratingly slow regrowth or experience barely visible progress at all, causing some of them to quit.

There is a natural tendency for people to see Rogaine as the go-to product because of its known capability to induce regrowth of hair, while others are quite rightly apprehensive about Propecia because of the documented side effects, though, in truth, Propecia, or any other product known to inhibit DHT, would be the ideal place to begin. If the root cause of the problem is not tackled, then regrowth of hair will only provide a temporary solution.

The extra thickness and density of Rogaine that could initially lead to greater hair count and thickness versus not using it at all will eventually subside as the loss will outweigh any regrowth over time, so any good hair loss regimen should ideally consist of something that will stop hair loss as well as something that will trigger hair growth.

Side effects of Rogaine

Side effects from Rogaine are generally very mild and not that common. Getting an itchy scalp is quite common but nothing to worry about. But few also experience worse side effects, such as faster heart rate and chest pains. In the event of chest pains or irregular heartbeats following Rogaine application, it is recommended to stop and consult a doctor.

Although it is Recommended rogaine is stopped following these more severe side effects, many tend to continue with it as generally the side effects subside within days or weeks. This is a matter for the user of what course of action to take, though it is recommended to stop it.

Other Treatments besides Propecia & Rogaine

These are both proven treatments to tackle hair loss, but are there other cheaper or safer options? To be fair, Rogaine is fairly affordable today at around $30 a month and there are even cheaper generic options available, such as Kirkland’s 5% strength Minoxidil, which works out to an only few dollars for a month’s supply when bought in larger quantity.

With Propecia, there is the cheaper generic version in the form of generic Finasteride available, although it is suggested a great deal of care taken when buying generic Finasteride online. Generic Finasteride often comes from overseas, where regulatory practices aren’t likely to be as stringent as those in developed countries such as the USA or UK.

Aside from Propecia and Rogaine, there aren’t many hair loss treatments available that would be considered as either proven or have any considerable level of efficacy behind them.

There is one vague study suggesting Saw Palmetto may have a weak form of DHT inhibiting qualities after it helped to increase the hair count in a small number of the participants. It functions similarly to Propecia, although of the natural variety. However, it is not really proven to any great measure as further studies haven’t been conducted.

There are also various hair loss products containing Minoxidil 5% and since they have this proven ingredient, judging by what seems to be genuine customer feedback, have proved to be successful in many cases.

These treatments usually a concoction of Minoxidil 5% and various other ingredients that may or may not actually help. These extra ingredients usually are said to act as a means to combat DHT, so you are getting both the minoxidil to trigger growth and the anti-DHT properties, in one. Examples of products are Lipogaine and Provillus.

But when it comes to proven alternative treatments then laser comb is one which actually has been backed by FDA. In trials, it has shown to increase the hair count in participants and thicken the diameter of the hair shaft, albeit not as nearly convincingly as Finasteride and Minoxidil. And going by a lot of anecdotal evidence, it appears to be a very much hit and miss, with many actually saying it didn’t help them any.

All in all, it may be best for anyone aiming to tackle male pattern baldness to have an all-encompassing regimen, consisting of a DHT inhibitor, something that stops DHT binding from to follicles, and something that stimulates growth, and if they can afford to, maybe even a laser comb.

Sources:
Merck.com
Rogaine.com
Food and Drug Administration

Are You Getting Enough Calcium?

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Does a glass of milk really do a body good? When it comes to the conversation about calcium, absolutely. While your body naturally produces the mineral calcium, it doesn’t produce enough on its own and therefore requires you to intake dietary calcium to make up the difference.

What exactly does calcium do?

Calcium plays an important role in many critical body functions including:

  • Reinforcing structure and density of bones and teeth
  • Helping nerve cells communicate and send signals back to the brain
  • Aiding muscle contraction
  • Supporting the flow of blood through the body’s blood vessels
  • Stimulating release of vital hormones and enzymes

When you are not intaking enough calcium, your body actually starts to pull it out of your bones resulting in loss of bone density, also known as osteoporosis. Overtime, serious calcium deficiency can result in increased risk for bone fractures, convulsions, abnormal heart rhythms, and numbness or tingling in the fingers.

A 2014 analysis  of U.S. Census and National Health and Nutrition Examination Survey data found that over 50% of the U.S. adult population over 50 years of age had osteoporosis and low bone mass. Postmenopausal women especially experience greater bone loss and less calcium absorption due to biochemical changes in their bodies, like a reduced production of estrogen, which is believed to help the body more readily absorb calcium.

What does this mean for older adults? Low bone mass increases risk for bone fracture, diminishes overall strength, and increases risk for experiencing a fall. Ultimately, potential for mobility issues, which require aids like wheelchairs, quad canes, or walkers, grows as older adults experience bone loss and crippling injuries like hip fractures.

It’s not just older adults who aren’t getting enough calcium either, but evidence suggests that on average, many kids and younger adults don’t intake the daily recommended amount of calcium.

What are the recommendations for calcium intake?

The Office of Dietary Supplements under the National Institutes of Health shares a helpful breakdown of recommended daily values of calcium in milligrams by age:

  • Children 4 to 8 years of age should intake 1,000mg of calcium a day
  • Children 9 to 18 years of age should intake 1,300mg of calcium a day
  • Adults 19 – 50 (and men 51 to 70 years of age) should intake 1,000mg a day
  • Adult women 51 to 70 years of age should intake 1,200mg a day
  • And all adults over 71 should intake 1,200 mg a day

For special cases like infants to 3 year olds, smaller doses of 200 to 260mg of calcium a day are recommended. And for pregnant and breastfeeding women, 1,000 to 1,300mg of calcium a day is recommended depending on age.

How much calcium are you consuming a day?

Dairy foods, like milk, yogurt, and cheese are a common go-to source for calcium, while additional non-dairy foods like kale, broccoli, collard greens and fish with soft bones, like sardines and salmon, provide appreciable amounts of calcium too.

You may notice in the grocery store how some foods are “fortified” with calcium as well, like orange juice, cereals, breads, even tofu. It’s important to look at nutritional labels when prioritizing your calcium consumption.

Many adults take calcium supplements which are comprised of calcium carbonate or citrate. Their effectiveness can vary depending on how much you consume at a time, your level of stomach acid, and whether you eat food with the supplement. Recent research has indicated possible adverse effects from taking calcium supplements however.

The Journal of the American Heart Association reported in October 2016 that taking calcium in the form of supplements may increase the risk of plaque buildup on artery walls, potentially harming the heart and vascular system. A growing body of research reinforces the association of taking calcium supplements and developing cardiovascular disease, however, further studies are needed to substantiate the exact links of why and how this is happening.

The bottom line is that incorporating more calcium into your diet is an absolute must. And don’t forget your Vitamin D! Vitamin D increase calcium absorption and ensures young people reach peak strength and bone density by the time they are 30. Exercise and resistance training at any age stimulates the body to produce calcium and build up bone density too, so stay active!

5 Things You Should Avoid to Prevent Back Pain

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Back pain can be uncomfortable, annoying, and downright debilitating at times, and yet, it seems to be an everyday part of life. That simply doesn’t have to be the case. Avoiding these 5 things could help you successfully prevent back pain for good:

Inactivity

Rest, taking it easy, putting your feet up, binging Netflix . . . all of these ideas seem obvious for taking it easy on your back, especially if you have stiff or sore muscles, right? Wrong. Back pain is only exacerbated by inactivity because it diminishes blood flow to key tissues – blood flow which aids healing and carries vital nutrients to muscles, bones, tendons,
and ligaments.

Inactivity also shortens muscle length and makes muscles and joints stiffer and less limber, so when you do finally get around to exercising, stretching, or taking part in some physical activity, they’re more likely to strain and feel sore later. The American College of Physicians actually lists exercise and physical activity as a remedy for lower back pain in their updated 2017 clinical guidelines

Bad Posture

In addition to inactivity, working on a computer all day also promotes bad posture, which can lead to back pain. Slumping, slouching, rounding the shoulders, craning the neck, and hunching the back – all these body positions place added stress on internal joints and the spine, making
muscles strain and work harder to stabilize your body.

Forward Head Syndrome, or the condition where your neck and head lean forward past your shoulders, is typically applied to people who spend hours and hours each day staring down at a computer screen or other mobile device. Studies have shown that for every inch your head cranes past your shoulders, you’re applying 10 extra pounds of force down on your body from the pull of gravity. This pull tugs directly on your neck and back muscles, leading to inflammation and chronic pain down the line.

Awkward Movements

No, we’re not talking embarrassing dance moves, but awkward movements which twist and turn your body in ways it really shouldn’t. A good example of this is trying to pick up an item you dropped behind your bedroom dresser. You stoop and swivel your shoulder, crane your neck and extend your arm farther than it should really stretch, grasping for a tiny object you can’t even see. You feel a yank, pop, or pull and all of a sudden your neck and back muscles are crying for help.

Awkward body movements and positions like this can lead to muscle spasming, inflammation, pinched nerves, and lasting achiness. Humans are so inclined to think the easiest route for something is over-extending themselves, when truly taking the time to use proper form or finding an assist with a tool or handy device could save much pain and trouble down the line.

Bad Lifting Technique

Lifting heavy loads with improper form and technique is the ultimate recipe for back pain, especially lower back pain. Millions of people see their doctor each year for complaints about some type of back pain, but those who work in physical labor jobs like airport baggage handlers, movers, warehouse workers, and even nurses who are required to lift and move patients, have it the hardest. Wearing a lower back brace can help provide compression, support, and stabilization for someone doing heavy lifting each day, but nothing beats proper form and technique.

The Occupational Health and Safety Administration (OSHA) shares proper
lifting techniques and guidelines for workplace lifting including using machines, tools, and
devices when possible to add leverage or to do the lifting for you. They also recommend companies implement good lifting environments like having workers lift from their ‘power zone’ (mid-thigh to mid-chest) area and not straight off of the ground.

Skipping Warm-ups & Stretching

Going from 0 to 60 might be fun in a fast-moving sports car, but when it comes to working out, launching into a full-on session without warming up can take its toll. Dynamic warm-ups are active movements that help your muscles warm up by boosting your heart rate, increasing blood circulation, and stretching and loosening stiff joints and connective tissues. A dynamic warm-up before a game, weight lifting circuit, or workout may include plyometric jump squats, a brisk walk, burpees, or jumping jacks.

Stretching after a workout or training session also plays an important role in preventing sore back muscles. Your muscles are most pliable after you complete physical activity. Engaging in static stretching helps re-lengthen muscles, boost blood flow to flush out toxins and lactic acid, and reorganize jumbled muscle fibers to aid with healing and tissue repair.

Preventing back pain is possible and has a lot to do with what you avoid doing as much as what you choose to do. Avoiding inactivity, bad posture, heavy lifting, and more will play a significant role in keeping you active and pain-free.

How to Ease Foot Pain in 5 Steps

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Is foot pain disrupting your day to day activity? Or even worse, preventing you from staying active and exercising? The danger of foot pain is that it often goes undiagnosed but can have the greatest impact on lifestyle, affecting mobility and activity levels. With your health potentially on the line, don’t leave your foot pain unchecked. Check out these help tips and ideas:

Common Causes of Foot Pain

If your foot pain doesn’t resolve itself with rest or ice and heat therapy, it may be time to see a doctor or podiatrist for an expert evaluation. Your foot pain may be caused by:

Plantar Fasciitis – when the plantar fascia band of tissue that runs along the bottom of the foot from the heel to the toes becomes inflamed or incurs tiny tears, it can cause pain when walking or standing.

Ingrown Toenail – typically afflicting the big toe, an ingrown toenail occurs when the sides of the toenail are curved inward and grown into the skin instead of away from it. Ingrown toenails can result in painful inflammation, tenderness, and even infection.

Bunion or Bone Spur – unwanted bone growth, usually on the outside of the
big toe or pinky toe, develops from wearing narrow shoes over a long period of time, from general overuse and stress of the inner and outer foot joints, or even from arthritis of the foot.

Hammer Toe – often found on the second, third, and fourth toes, hammer toe is simply the permanent bending of the toe at the top joint, leaving the end of the toe facing down. Sometimes it can rub on footwear and become irritated with blisters, corns, or calluses.

Steps to Ease Foot Pain

Foot pain relief does not necessarily need to include medicinal avenues or invasive treatments.

Check out these natural and accessible foot pain remedies:

1) Foot Care

This one might sound simple, but few actually care for their feet quite like they should. Washing and drying feet thoroughly each day (don’t forget in between the toes!) is vital to removing unwanted contaminants and bacteria. Moisturizing daily as well helps to nourish skin, prevent
calluses from developing, and keep skin from drying out and cracking.

Regular foot massages can help break up scar tissue and even aid muscle repair in the feet after a long day at work or after a workout.

2) Exercise

Long, limber foot muscles and ligaments are less likely to strain or become injured with movement. Routine stretching and exercise boosts blood flow to the feet, stretches important muscle groups in the feet and legs, and strengthens connective tissues – even the tiny tendons in your toes. This can prevent conditions like Achilles tendinitis, plantar fasciitis, and
hammertoe as well as soothe pain associated with inflamed joints, or arthritis.

3) Wear Good Shoes

Investing in a solid pair of shoes is critical to aiding and preventing future foot pain. For athletes, shoes which fit and support your arch type and stabilize your ankle motion play a critical role in promoting good body mechanics. For seniors, shoes which fit well, but aren’t too snug, and have a smooth bottom to allow for safe, easy mobility are a must. For women, ditch the high heels. When you can, avoid heels as they narrow the forefoot, throw off hip stability, and can cause painful foot conditions like bunions, bone spurs, and arch pain.

4) Brace and Splint

Existing foot problems can make walking and exercising difficult, but like with some injuries, bracing, wrapping, splinting or wearing orthotic insoles can help. For example, an arch support which slides over the foot like a sleeve and sits in the arch can provide arch support to someone with flat feet. A plantar fasciitis wrap can provide compression to an inflamed and painful foot, or the best bunion splints can stabilize the big toe joint and prevent the bony growth from rubbing against footwear.

5) Cross Training

For athletes and avid gym members who are pained to miss out on routine training because of foot pain, cross training may be a viable alternative. Largely referred to as the learning of an additional role or sport to enhance performance in the original, cross training can also be employed during recovery from a lower extremity injury. Runners suffering from painful plantar fasciitis or metatarsalgia may benefit from body weight exercises, walking on a treadmill, or riding stationary bicycles.

With one quarter of all your body’s bones in them, your feet make up some of the most important components of your body. Ignoring foot pain now can lead to much bigger health problems down the line. Consult a doctor and find routes for treatment and pain relief that are accessible, practical, and effective.

Ice Therapy – How Does It Work?

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You sprain your ankle or pull your back – what’s the most common
recommendation you’ll get from a friend or family remember? “Put some ice
on it,” right? You might be curious how ice therapy works exactly and if it
is really beneficial for treating acute injuries.

Part of the ‘RICE’ treatment – rest, ice, compression, and elevation – ice
therapy might include applying an ice pack or other cold compress,
receiving ice massage, or soaking an injured body part in an ice bath.

There are best practices when it comes to applying ice packs to avoid ice burn and further injury, but when administered correctly, ice can be a powerful tool to relieve acute pain and swelling.

How Does Ice Reduce Pain?

The cold sensation of an ice pack applied to the skin for 10 to 20 minutes actually has a somewhat analgesic effect. It slows the conductivity of sensitive nerve impulses around the injured area which are sending pain signals back to the brain, essentially providing a numbing effect and preventing nerve-spasming.

How Does Ice Reduce Swelling?

Ice therapy generates a cold shock to the area of application which makes the veins in the tissue constrict, reducing blood circulation and therefore inflammation of the injured area. This can also prevent tissue damage.

After the ice is removed, blood flows back in carrying oxygen and nutrients vital to tissue repair and wound healing.

How Should Ice Be Applied?

A handful of misconceptions about ice therapy may actually cause more harm than benefit when it comes to aiding a painful injury. Ice and ice packs should never be applied directly to skin, but rather some sort of barrier like clothing, a towel, or a soft cover over the ice pack should be used in conjunction with the cold therapy.

Ice packs should not be left on an injured area for more than 10 to 20 minutes at a time, and should be reapplied up to three times a day. Only after swelling has subsided 48 to 72 hours later should heat therapy be considered.

Ice massage may also be a cold therapy alternative that soothes sore back muscles and provides pain relief typically to the lumbar spine region. Ice massage involves taking an extra large ice cube and moving it around the lower back area in a circular motion for no more than 5 minutes at a time.

Because ice massage involves constantly moving the ice and only doing it
for a limited amount of minutes, you avoid ice burn even though you are
applying the ice directly to the skin. Your body can handle ice massage up
to five times a day.

Ice baths, or cold water immersion, are popular with athletes and runners after an exhausting performance because they cover more surface area of the body with cold thus restricting blood vessels, inflammation, and reducing metabolic activity on a greater number of muscle groups. When you exit an ice bath, the underlying tissues begin to warm up and blood flow back to the area increases quickly, flushing out metabolic debris and speeding up tissue repair. Experts recommend ice bathing in water between 50 and 59 degrees Fahrenheit and soaking for no more than 10 or 20 minutes at a time.

What Are Common Types of Ice Packs?

Most drug stores and big box stores carry ‘reusable’ ice packs which can be frozen, used, and refrozen. Typically comprised of a synthetic gel material in a flexible or hard plastic casing, reusable ice packs are inexpensive and effective. Alternately, one-time use, or disposable, ice packs may be room temperature to start and become cold through a chemical reaction of the compounds inside them when shaken or broken. Great for having on hand when playing sports, disposable ice packs are convenient, but considerably more expensive and not as eco-friendly.

Experiencing a leg injury and don’t have a reusable ice pack for knee or ankle pain handy? There are plenty of common household items you can use for ice therapy to treat a painful injury like an ankle sprain. Grab a bag of frozen vegetables out of the freezer, freeze a wet towel or sponge, or even fill a resealable baggy with dish detergent and freeze it to make your
own faux gel pack.

Ice therapy can be a beneficial instrument in the injury and post-athletic play toolkit. By following expert best practices and committing to routine treatment with ice packs, ice massage, or cold baths, speeding up your body’s healing capabilities may be just an ice cube away.

Brain ‘Wonder Drug’ May Save Dementia Patients

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Dementia Alzheimer's Disease

Mention Alzheimer’s disease, Parkinson’s disease, and prion disease and many experts will tell you that these are health conditions that have kept researchers scratching their heads in search of effective treatment without success.

About five years ago, there was excitement when a test drug proved that it could reverse brain cells degeneration in rats with prion disease.

Prion disease is characterized by many misfolded proteins and the disease affects humans in nearly the same way. While the drug proved helpful in the rats, it turned out to be toxic to humans with cases of toxicity to the pancreas being reported. Needless to say the clinical trials of the drug were stopped.

New excitement

There is renewed excitement after scientists in the UK announced that they have found drugs that can prevent or arrest Alzheimer’s and Parkinson’s disease among other neurodegenerative disorders such as prion disease and the dreaded ‘mad cow disease’ (CJD)

The news about this were published in the respected Brain – A Journal of Neurology of April 19 2017 (online version)

These drugs are not entirely new. They have been in use for the management of other medical conditions and the research results suggest that they could be repurposed to fight the brain disorders. The first drug trazodone hydrochloride has been in use as an antidepressant and anxiolytic medication. The other dibenzoylmethane (DBM) has been mainly been intended for use in cancer (prostate and bowel) treatment.

A recent report by the PubMed Health noted that the two drugs were effective in:

  • Memory restoration
  • Reducing neurodegeneration signs and symptoms. This includes brain shrinkage which is a typical feature in these conditions.
  • Reduced associated paralysis
  • Not showing toxicity effects in the doses used

According to this source, the trial of trazodone on human beings could start almost immediately because issues about its safety have already been settled in its use for the emotional disorders mentioned above. Probably the focus would now be on the effective and safe doses of the medication for the purpose of the neurodegenerative disorders.

Although there is optimism about trazodone, marketing it for neurodegenerative disorders might take a while. It will involve the many stages it needs to go through in human clinical trials before it is approved for that purpose. The fact that such clinical trials have not even began suggests that it take time before it hits the market. The reality is that, such trials may not even go beyond the initial steps depending on initial findings.

For dibenzoylmethane (DBM), the journey to the market as a drug for neurodegenerative disorder is much longer and uncertain since it is still under review as a cancer drug.

One of the leading authors of the study, Professor Giovanna Malluci urged that clinical trials should commence to find out whether the same results would be achieved on human trials. She however, cautioned the public and other stakeholders against rushing to use the drugs until the studies offer reliable findings (on human subjects)

Why are scientists and the medical fraternity excited about this?

Neurodegeneration disorders present a challenging medical and social situation. Consider these:

  • The disorders affect both aspects of the central nervous system – the brain and the spinal cord.
  • Neural tissue in these areas is gradually lost
  • The disorders insidiously destroys decision making ability and coordination
  • The damaged nervous tissue and cells cannot be regenerated easily and so the damage is usually irreversible.

The future

Many experts agree that the study was well-conducted and inspires hope. Dr. Doug Brown of the Alzheimer’s Society in the UK said that the results of the research had potential and the time between the release of the findings and the drug’s availability in pharmacies can be greatly reduced (for trazodone).

Dr. David Dexter (Parkinson’s UK) said that a replication of the findings in human beings would be a ‘major step forward’ in the treatment of the degenerative neurological disorders.
According to Professor Malluci, efforts should now be focused on finding out whether using trazodone can help in arresting or slowing down the progression of the brain and spinal cord cells disorders. Either of these outcomes would be a major step in making the disorders easier to live with.

References
Mark Halliday, Helois Radford, Karlijn A. M. Zents, Collin Molloy, Julie A. Moreno, Nicholas C. Verity, Ewan Smith, Catharine A. Ortori, David A. Barrett, Martin Bushell, Giovanna R. Mallucci; Repurposed drugs targeting eIF2α-P-mediated translational repression prevent neurodegeneration in mice. Brain 2017 awx074. doi: 10.1093/brain/awx074

Do Sciatica Exercises Work?

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Sciatica ExercisesSciatica is a condition that can grossly affect a person’s quality of life (QOL). Depending on what is causing the problem, almost 90% of cases will improve without the need for surgery. 50% of patients will recover within six weeks. Exercises play an important role in the efforts of alleviating pain without resorting to surgery.

Sciatica Exercises can be done at home or in a health institution. In both situations the guidelines of a physical therapist are a must so that you do them right and safely. Surgical intervention is the last resort when every other measure has failed. But do these exercises work? What types of sciatica exercises are employed?

Types of sciatica exercises

A physical therapist will most likely design an exercise program that fits an individual’s circumstances. Common sciatica exercises can include:

  • Knee to chest stretch
  • Sciatica mobilization stretch
  • Back extension
  • Pilates
  • Standing hamstring stretch
  • Aerobics
  • Lying deep gluteal stretch
  • Trigger point massage. Strictly speaking this is not a form of exercise but it involves pressure that helps to release piriformis muscle impinged sciatic nerve
  • Yoga. This may combine exercises and meditation

A physical therapist may also prescribe other types of exercises for general back health.

What research has established about sciatica exercises

One of the risk factors for sciatica is a sedentary lifestyle. This means back and other muscles in the body become weak and lax. Exercises are known to strengthen muscles and so when done correctly; they can strengthen the spine muscles which in turn reduce the risks of factors that promote chances of sciatica.

A combination of muscle strengthening exercises and high intensity exercise programs can help you to achieve this.

Yoga

Yoga involves ancient forms of exercises that strengthens specific muscles and improve balance and flexibility. According to the Yoga Journal, specific yoga exercises and poses can help you to loosen up tight muscles and reduce back pain (including sciatica pain).

This works well if the proper exercise sequence is followed. Working with a yoga instructor in the initial stages is important until the exercises, poses and sequence has been mastered. The journal further specifies that the lotus pose and reclining big toe pose are the best for sciatica management.

The International Journal of Yoga of January 2015 published a study that found that Iyengar yoga can be an effective practice that can help to reduce back pain. Study subjects who did these yoga exercises for sixteen weeks had a 64% improvement rate.

Pilates and sciatica

A study published in the Maturitas – The European Menopause Journal of December 2015 found that women aged over 65 who went through a six week program improved their chronic back pain among other balance related benefits. While this study may not have been specifically targeted at sciatica patients, it suggests that sciatica as a cause of back pain may also benefit from Pilates.

Tentative study results repeatedly indicate that exercises are beneficial for sciatica pain. However, there is a general consensus that there is need for more research involving many sciatica patients so that more conclusive results can be achieved.  While exercises are beneficial not only for the back and sciatica but the whole body and overall health, it is important to do them correctly to avoid more health problems including an exacerbation of sciatica pain.

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Understanding Sciatica

Understanding Sciatica – An Overview

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What is sciatica?

The word sciatica comes from sciatic which refers to the largest nerve in the body that runs from the lower back at the level of the lumbar vertebra 3. It is about 2cm wide. It starts from the lumbosacral plexus and goes down to exit the pelvis through the greater sciatic foramen.

The sciatic nerve branches into two to supply each of the limbs. Some of the areas the nerve offer motor functions include:

  • Posterior compartment of the thigh muscles that include biceps femoris
  • Calf muscles through the tibial nerve
  • Inner and outer sides of the leg through the fibular nerve

The sensory functions of the nerve are indirect through its end-point branches.

The area that the sciatic nerve supplies is where symptoms occur when the nerve has issues.

One of the commonest problems that can occur with this nerve is sciatica. This term is used in reference to a collection of symptoms that affect the leg and does not refer to a specific diagnosis.

A more technical name for sciatica is radiculopathy

In most cases, sciatica does not affect both branches running down the legs but only one side. The pain can be severe and activity limiting but in most cases it resolves on its own after a few weeks. When the symptoms are severe, medical or surgical intervention may be necessary.

Symptoms of sciatica

The symptoms relate to the path the nerve takes. Common ones include:

  • Lower back pains
  • Pain that radiates down the hip, buttock and down the leg
  • Tingling or numbness of the affected limb
  • Leg weakness and in severe cases, walking is difficult or impossible

The nature of the pain varies. For some people it feels like an electric shock while for others it can be mild and dull. Common actions that may exacerbate sciatica pain include:

  • Sitting for long
  • Standing for long
  • Coughing
  • Sneezing
  • Sleeping

Severe types of sciatica can cause disturbance in the bladder and bowel habits. This can either be retention or incontinence. When this happens, it is considered a surgical emergency that must be managed without any delay.

How do you differentiate sciatica from other types of back pain?

According to the American chiropractic association – ACA, at any one time, there are 31 million Americans suffering from some type of back pain. Obviously not all these people have sciatica.

The main difference that separate sciatica from other causes of back pain is the associated properties of the pain. The pain in sciatica runs down the leg to the foot while that of common back pain does not.

Sciatica also usually occurs suddenly without any apparent cause while with other types of back pain; there may be a history of straining or overextending the back.

What causes sciatica?

Sciatica symptoms may follow an injury to the spine, an infection or a malignant process. The commonest cause is a slipped disc which is also referred to as prolapsed or herniated disc. This condition occurs when for some reason the tough tissue between the vertebral bones is damaged and subsequently presses on the sciatic nerve. Sometimes, despite the most advanced investigations, no obvious cause of sciatica can be established.

Other causes of sciatica

  • The outlet of the nerve from the spine narrows. This is called spinal stenosis. This leads to the compression of the sciatic nerve
  • Injury. When this happens, either the nerve itself or the spine vertebral column is affected
  • infections
  • inflammation of the sacroiliac joint
  • Cancerous or benign growths within the spine. If due to cancer, the cause may be from the site or as a metastasis from another part of the body.
  • A rare condition called cauda equine syndrome. This serious disorder follows spinal cord nerve damage due to compression.
  • Vertebral slip from its normal position. This is not the same as slipped disc where the problem is within the strong rubber-like tissue that lies between the boney vertebrae. This condition is also called spondylolisthesis. Here, either due to an injury or other problems, the vertebra moves forwards or backwards from the normal anatomical place.
  • Metabolic disorders that can lead sciatica include complications of diabetes
  • Piriformis syndrome. This is a muscle that runs deep in the buttock and very close to the sciatic nerve. Should this muscle get problems or goes into spasms, it presses on the nerve which can give rise to sciatica symptoms due to irritation. A common cause of piriformis is the habit of putting a wallet in the back trouser pocket.
  • Any irritation from the adjacent structures can lead to sciatica. This includes bleeding

Risk factors for sciatica

Factors that increase the risk for sciatica include:

  • Pregnancy. The increased abdominal pressure and spine curvature are responsible for this.
  • Hormonal changes are also thought to contribute to this risk.
    Obesity. As in pregnancy, the spine is strained and the excess body weight makes this worse.
  • Sedentary lifestyle. This involves prolonged sitting or just lying around.
  • An active lifestyle can also increase the risk for sciatica. This includes people who run and walk regularly. The repeated muscle activity can cause irritation of the nerve and subsequent sciatica symptoms.
  • Age. Advancing age leads to changes in the spine and increases the risk for problems that include herniated discs and other spinal disorders
  • Diabetes. Nerve damage is possible when diabetes is long-standing and the blood sugar control is poor.
  • Arthritis
  • Spinal or pelvis injuries
  • Spine congenital disorders
  • Menopause
  • Occupation. Jobs that require prolonged sitting or moving heavy loads may increase sciatica risk.

How is sciatica diagnosed?

History of the illness

An accurate diagnosis of this condition starts with a detailed history of the illness where the doctor (a GP may be the first contact medic to see) delves into how the symptoms started and the progression. A good history details about the site of the pain, the duration, how it radiates, the nature and its intensity. The direction of where the pain radiates to and what makes it worse or offers relief are more of the questions the doctor will want to know the answers to.

Finally he will want to know whether there is any associated tingling, burning or numbness on any or both of the lower limbs.

Physical examination

What does a thorough physical examination involve? The doctor starts examining you from the moment you enter the door to his office. He will observe how you walk in (gait) and the posture you assume. He will also carry out a general examination before focusing his attention on the problem area. He will note how far you can move a limb and if there are any limitations and associated pain.

Your specialist will carry out localized examination of your spine and note if there is any spine curvature or evidence of muscle spasms. This will be followed by a detailed neurological examination. This involves muscle tone and strength as well as the response of certain reflexes and relevant nerve functions. Depending on the findings, your doctor will go to the next step of looking for an accurate diagnosis.

Imaging tests

This may involve a combination of the following radiological imaging tests.

  • Plain spinal x-ray. This may show any bone growths or misalignment
  • Computerized tomography (CT) scans. This shows greater details and pinpoints any pathology more accurately. A contrast media may be injected into the spinal canal and serial scans are taken. This is called computerized tomography myelogram.
  • Electromyography (EMG). Here your nerves’ integrity is tested and problems arising from disc herniation or spinal narrowing can be identified.
  • Magnetic resonance imaging (MRI). This test gives great details about the boney structure of the spine vertebrae and the surrounding tissues.

Laboratory investigations

Depending on what the doctor has identified through the history, physical examination and radiological tests, specific laboratory tests may be carried out. The aim here is to rule out infections and possible malignancies as possible causes of the sciatica.

Metabolic disorders such as diabetes that increase the risk of the condition should also be ruled out where necessary. Otherwise, where a specific disorder such as a herniated disc has been identified, then laboratory tests add no value to the patient’s management; unless there are comorbidities with the sciatica.

History, physical examination, imaging tests and laboratory investigations are all meant to confirm the exact cause of the symptoms since other spine-related symptoms may be confused with sciatica. This other conditions that may mimic this condition must be ruled out.

Treatment of sciatica

The treatment of sciatica is an individualized affair. It depends on the causative factor(s) and other considerations such as weight, age, pregnancy and other things that may have been identified during the diagnosis.

Prevention

Preventing sciatica is recommended when possible. It is also cheaper. Some of the steps you can take to achieve this include:

  • Leading a healthy lifestyle. This means avoiding risk factors such as smoking, obesity and a sedentary lifestyle.
  • Learn to assume a good posture all the time
  • Always have a warmup and cooldown session before and after exercising. This should involve stretching.
  • Make sure your mattress is neither too soft nor too hard. The heavy body parts such as the shoulders and the hips should be comfortable lying on it.
  • Learn how to lift things safely to avoid straining your back.

At home measures

Sciatica pain can resolve on its own. It can also persist so that you are forced to take certain measures to alleviate the pain and discomfort. The steps you can take at home include:

  • Taking over-the-counter analgesic medications
  • Remaining physically active
  • Using warm packs
  • Using ice packs
  • Massage liniments
  • Where possible, remove any risk factors associated with the pain.

These measures may offer gradual improvement and there may be no need to consider any other steps.

When the sciatica pain persists

If this happens, then it’s time to seek professional help. Common measures may include:

  • A physical exercise program by your physical therapist. Initially this may be at a health facility but once you have understood the program, then he may allow you to continue at home. Find out if sciatica exercises work
  • Massage therapy and spine manipulation techniques as carried out by physiotherapists and alternative and complementary medicine specialists such as osteopaths and chiropractic doctors. Acupuncture, acupressure and other related techniques can also be tried.
  • Use of stronger analgesics. Nonsteroidal anti-inflammatory drugs (NSADs) are commonly used.
  • For severe pain, narcotic analgesics may be used for a short period to avoid the risk of addiction.
  • Use of muscle relaxing medicines
  • Intra-thecal injections of analgesic and or anti-inflammatory drugs. Corticosteroids may be used for short periods of time.
  • Sciatica can be a source of depression. Psychological support is necessary for some patients and a few may even require antidepressant drugs. Antidepressant drugs such as amitriptyline have also been found to relief nerve pain and so they can be prescribed for that reason even where there is no depression.
  • Part of psychological support can include cognitive behavioral therapy (CBT). This helps a patient to have the right attitude towards the pain they are suffering from.
  • Gabapentin is a drug that is better known for use by epileptic patients. However, it has been found to possess a positive side-effect by reducing nerve pain. You may ask your doctor about ongoing clinical trials on sciatica. Volunteering for such trials may expose you to therapies that are not yet available to the mainstream medical practice.

Complications of sciatica

  • Chronic pain
  • Progressive neurological deficiencies on the lower foot
  • Bowel/bladder issues
  • Psychological problems

When is surgery necessary for sciatica?

Surgery is avoided as much as possible. However, there are situations where it is unavoidable. These include:

  • Where the sciatica has led to bladder and or bowel problems – retention or incontinence
  • Some cases of spinal stenosis
  • Severe neurological deficiencies of the lower limbs

The surgeon will decide on the exact surgical technique to use depending on the nature of sciatica problem.

Prognosis of sciatica

Majority, up to 90%, of sciatica patients will recover without surgery. About half of all cases recover completely within six weeks. A few of the remaining will need surgical intervention to relieve the pain.

Related Articles

Do sciatica exercises work

References
Tarulli AW, R. E. (2007). Lumbosacral radiculopathy. Neurologic Clinics, 387-405.

Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica BMJ : British Medical Journal, 334(7607), 1313–1317.