Sciatica

What are the causes of sciatica?

Most often, a sciatica attack occurs as a result of irritation of the small nerve roots that make up the sciatic nerve. Sometimes, when the sciatic nerve has already formed, and this becomes in the pelvis, the area near the exit of the buttock can also be touched, pinched - the symptoms are similar. However, such a condition is far less common.

What are the symptoms of sciatica?

"Classic" sciatica is a situation in which, most often, a bulging intervertebral disc, or what is popularly called a herniated disc or herniated disc, affects a small nerve branch. A person feels unpleasant pain radiating from the lumbar spine or buttock along the lower limb. In theory, the pain should travel along the entire lower limb, all the way to the foot, but this is not always the case. Sometimes it reaches the mid-thigh or part of the calf. There are cases when the thigh is gently bypassed and the symptoms here are weaker, and the calf and foot are the most disturbed. This pain is of a burning, pulling, burning, "currents" nature. - these words appear in patients' desc.riptions.

How to tell if it's sciatica?

As a rule, the pain appears suddenly. Yes, something has been aching in the spine for the past few days - whether when bending or twisting, or after sitting for a long time. However, it was not a big pain. One day, as a rule, with trivial activities (bending down for something that is low, carrying something light, bending over), a paralyzing pain appears: in a limb or buttock. It is constant and does not allow normal functioning. As a rule, each patient looks for a pain-relieving position, and mostly such a position is found.

Sciatica - home treatment

In the case of sciatica, there are so-called "pain-relieving positions" that give noticeable relief from the discomfort. The most common pain-relieving positions in are lying in an embryonic position or the other way - lying in an upright position, as if reading a book while lying on your stomach. However, not everyone is successful in finding these positions. Many patients experience pain with simple and everyday activities: sitting for a long time, doing something while bent over, washing dishes, doing the morning toilet while bent over. What bothers most is the pain in the limb, which is impossible to get rid of. It does not go away at night, but often intensifies. We feel that it is even worse - patients complain that even if they fall asleep, after a while they get up and look for a new position.

What should be done if sciatica is suspected?

First of all, we should try to determine where this pain occurs. It will not affect the entire leg and its entire circumference. Sciatica pain is usually felt more on the side or back, a whole band that is a few or several centimeters wide, for example. If one feels pain in the whole leg, the likelihood of rv is less. It is also important to know whether there is a tendency to get worse at night, and whether it mostly involves a stooped position. In many cases, people driving vehicles explain that after 5-10 minutes they have to take a break, that's how their leg hurts.

Sciatica - diagnosis and treatment

Most often, sciatica can be confirmed by examining the patient's symptoms. There is no need to use an MRI before consulting a doctor. Many patients find out through panto mail that when pain occurs, an MRI is needed, and half the time it will not be warranted. Based on the symptoms, the doctor will know what to advise the patient. An MRI may be recommended if sciatica symptoms are more severe:

• sensory disturbances appear, the body feels as if "out of sorts"
• the sensation is too much (the so-called "hypersensitivity") - every touch is burning, you can not cover yourself with bedclothes at night, because it burns and burns
• patients feel that the limb is weaker, does not "listen" to commands, muscle strength is lower, which is the most disturbing symptom.

Sciatica - MRI or X-ray?

In determining sciatica, the most accurate imaging test is a lumbar MRI, because it accurately shows the disc. Often, however, a simple X-ray taken at an outpatient clinic shows the arrangement of the vertebrae in relation to each other. Then the doctor can determine if there is something worrisome going on in that area, and at the same time, whether he needs to expose the patient to an MRI. This is because it means an additional financial cost and additional time needed to perform this test. With an MRI scan, one has to persevere in one position for tens of minutes, which may not be feasible for patients with sciatica.

What medications for sciatica?

Painkillers help. Painkillers, such as ketonal, can be effective for patients, in the short term. Most of them significantly reduce the feeling of pain, but rarely do patients say they feel good. It is also usually necessary to find a suitable position.

Sciatica treatment - surgery is rare

More than 90 percent of sciatica cases can be cured non-operatively - through pharmacotherapy, rehabilitation and most importantly: patient education.

Pharmacotherapy will reduce pain, which will improve the comfort of daily life. Rehabilitation depends on the site and type of symptoms, and there are different rehabilitation schools. It consists of manual therapy. The first line of defense against pain is high muscle tension - patients tense up and try not to do movements that bother them. Usually people with sciatica problems do not have a straight spine, but bend. Over time, this begins to bother them, and the physiotherapist looks for movement patterns for pain relief. This includes kinesiotaping and learning exercises to help avoid recurrence.

Sciatica symptoms will go away on their own, but....

In the case of sciatica, there is a regularity that in the case of the first such episode, even if the disc becomes protruded, the symptoms will go away on their own within a month anyway. The problem is that no patient can endure such a long period with massive pain. Treatment helps shorten the painful period, and with proper education, the patient will learn what he should avoid, what situations harm him and what he should do when pain occurs.

Sciatica - when to have surgery?

Virtually never "on the spur of the moment" does a doctor decide on surgery. This applies to extreme situations, when there are disorders of muscle strength. The patient is unable, for example, to lift up his foot. Then it is necessary to act faster and more aggressively, because after possibly waiting a few days, the symptoms will subside, but due to extensive nerve damage, motor function in the limb will not return. This applies to a very narrow group of sufferers. Most often, however, people who are relatively young, usually in the range of 30-40 years. Such a procedure is carried out either endoscopically or with minimal access invasion (tiny incisions).

How long does sciatica last?

Recovery time after a sciatica attack is usually 3 - 4 weeks. Patients then say there is no or minimal pain, but they feel no restrictions. However, they know what to do to make it subside.

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Learn about other possible causes of spine problems.

Bibliography:

• Seoyon Yang, MD, PhD, Won Kim, MD, PhD, Hyun Ho Kong, MD, Kyung Hee Do, MD, PhD, and Kyoung Hyo Choi, MD, PhD (2020) Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain.
• Crystian B OliveiraChristopher G MaherManuela L FerreiraMark J HancockVinicius Cunha OliveiraAndrew J McLachlanBart W KoesPaulo H FerreiraSteven P CohenRafael Zambelli Pinto (2020), Epidural corticosteroid injections for lumbosacral radicular pain
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• Kyung-Chung Kang, Hee Sung Lee, and Jung-Hee Lee (2020), Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis