Sciatica

The sciatic nerves are the largest nerves in the body.  They start at the spinal column low in the back, go behind the hip joint, down the buttock, down the back of the leg to the foot. Sciatica (pronounced sigh-at-ih-kah) is a symptom of an underlying medical condition, where one feels pain, weakness, numbness, or tingling typically from the low back (lumbar area) to behind the thigh and radiating down below the knee. The pain of sciatica is sometimes referred to as sciatic nerve pain.

 

The pain can range from slightly annoying to totally unbearable. Some people have pain in one part of the leg and numbness in another part of the same leg.

 

 

Causes

In many cases, no cause can be identified. The most common causes could be:

·         Injection into the buttocks

·         Prolonged external pressure on the nerve

·         Pressure on the nerve from nearby body structures

·         Pressure on the nerve where it passes through a narrow structure

·         Tumor or abscess

·         Bleeding in the pelvis

·         Slipped disk

·         Pelvic injury or fracture

·         Tumors

·         Herniated disc

·         Spinal stenosis

·         Spondylolisthesis

·         Effects of aging, such as osteoarthritis and fractures due to osteoporosis

·         Many women experience sciatica during pregnancy

 

 

Risk Factors

·         With age one is likely to have some deterioration in the disks in the back by the time one is 40.

·         A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods.

·         People who sit for prolonged periods or have a sedentary lifestyle.

·         Diabetes, the condition which affects the way your body uses blood sugar, increases your risk of nerve damage.

·         Due to the forward redistribution of body weight, shifting of abdominal organs and the loosening of ligaments in the pelvic area women are prone to back aches during pregnancy. This risk is higher in tall women.

·         Depression and a tendency to develop physical complaints in response to stress

·         Cigarette Smoking

 

 

Symptoms:

Sciatica symptoms include:

·         Pain along a path from your low back to your buttock and the back of your thigh and calf

·         Numbness or muscle weakness along the nerve pathway in your leg or foot

·         Tingling or a pins-and-needles feeling, often in your toes or part of your foot

·         A loss of bladder or bowel control

 

Symptoms associated with back pain that may require immediate medical attention include:

·         Pain that doesn't subside or worsens with rest

·         Pain worsens when you recline

·         Sudden or severe pain

·         Pain that worsens dramatically

·         Progressive weakness or numbness in a leg or foot

·         Difficulty walking, standing, or moving

·         Numbness in the genital or rectal area

·         Loss of bladder or bowel

·         Difficulty in urination or burning sensation while urinating

·         Fever, unexplained weight loss, or other signs of illness

·         Any trauma, fall or impact

·         History of cancer

 

 

Complication:

Depending on what's causing the nerve to be compressed, the following complications may occur:

·         Partial or complete loss of leg movement.

·         Partial or complete loss of sensation in the leg.

·         Recurrent or unnoticed injury to the leg.

·         Loss of bowel or bladder function

 

 

Facts and Myths:

Myth – All patients with sciatica experience the same symptoms.

Fact – The symptoms associated with sciatica vary in every patient because the type of pain depends on the location of the nerve compression.

 

Myth – Sciatica doesn't lead to permanent nerve damage.

Fact – Although rare, permanent nerve damage can occur.

 

Myth – Sciatica affects only sedentary people.

Fact – Active people can also develop sciatica, particularly if they engage in activities that involve twisting their backs or carrying heavy loads.

 

Myth – Sciatica always resolves in a few weeks with conservative treatment.

Fact – Although true in a lot of cases, for some patients, the pain can last much longer, and treatment should be individualized.

 

 

Prevention

It's not always possible to prevent sciatica. The following suggestions can help protect your back:

·         Sit and stand properly

·         Don't sit cross-legged because that puts pressure on your sciatic nerve

·         Learn to lift correctly

·         Exercise regularly

·         Attain and maintain a healthy body weight

·         Eat healthy foods (a well-balanced, low-fat diet rich in fruits and vegetables)

·         Select a mattress and box spring that offers good support

·         Stop smoking

·         Avoid excessive use of alcohol

·         Get plenty of rest

 

 

Modern Treatment Options

Self Care:

·         Cold packs

·         Hot packs

·         Stretching

 

Other possible treatment options could include:

Medications - Painkillers:

The long-term use of NSAIDs as a method of controlling pain is not usually recommended because they can cause problems with your stomach and digestive system, such as ulcers or internal bleeding.

 

If you need pain relief over a long time, the painkillers listed below may be used:

·         Paracetamol

·         Codeine (often prescribed in combination Paracetamol)

·         Tricyclic antidepressants

·         Gabapentin or Pregabalin

 

More aggressive treatments

·         Epidural Steroid Injections

·         Botulinum Toxin Injections

·         Antidepressants

·         Muscle Relaxants

 

Surgery and Invasive Procedures:

Surgery does not always improve things and, in some cases, can even make it worse.

·         Diskectomy

·         Herniated disk repair

·         Microdiskectomy

·         Laminectomy

·         Lumbar spinal surgery

·         Spinal Fusion

 

Other Surgical Procedures

·         Percutaneous Vertebroplasty

·         Percutaneous kyphoplasty

·         Artificial Disk Replacement

·         Intradiscal Electrothermal Treatment (IDET)

 

 

Side Effects of Modern Treatment Options

Mediaction:

·         Gabapentin, originally designed to prevent seizures in people with epilepsy has now been found useful in treating nerve pain. Possible side effects of gabapentin include:

o   Drowsiness

o   Dizziness

o   Tiredness

o   Loss of coordination

o   Abrupt stoppage could lead to withdrawal symptoms such as anxiety, insomnia, nausea, pain and sweating

 

·         Amitriptyline, originally designed to treat depression is also now known to be useful for treating nerve pain. Side effects include:

o   Drowsiness

o   Dry mouth

o   Blurred vision

o   Constipation

o   Difficulty urinating

 

·         Other possible side effects of NSAIDs may include:

Long-term, regular use of NSAIDs can increase the risk for heart attack, especially for people who have a heart condition. Long-term use of NSAIDs is also the second most common cause of ulcers and gastrointestinal bleeding. To reduce the risks associated with NSAIDs, take the lowest dose possible for pain relief.

 

Surgery

Percutaneous Vertebroplasty:  There is a risk of leakage of the polymethylmethacrylate bone cement used during the surgery which can cause damage to soft tissues and nerves. Care should be taken to go to a good doctor with ample experience in performing vertebroplasty procedure.

 

 

Alternative Treatment Options
 

Biofeedback

Biofeedback is a mind-body therapy that teaches you how to change, or control a habitual reaction to pain or stress.

 

Yoga
·         Supta Padangusthasana

·         Adho Mukha Shvanasana

·         Parsvokanasana

·         Ardha Chandrasana

·         Setu Bhandasana
·         Sarvangasana

·         Shavasana

·         Eka pada kapotasana

 

Exercise and Physical Therapy:

·         Exercises for back pain include

o   Low Impact Aerobic Exercises

o   Spine Stabilization and Strength Training

o   Yoga, Tai Chi, Chi Kung

o   Flexibility Exercises

 

·         Specific Exercises for Low Back Strength

·         Partial Sit-ups

·         Pelvic Tilt

·         Stretching Lower-Back Muscles

 

Aromatherapy

·         Chamomile Roman

·         Lavender

·         Eucalyptus

·         Geranium

 

Massage

Studies suggest that massage may ease low back pain symptoms

 

Hypnosis

During hypnosis, one can receive suggestions designed to decrease perception of pain and increase the ability to cope with it