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Sciatica or sciatica is a generally painful condition that radiates along the course of the sciatic nerve (and sometimes into its roots).
What is the sciatic nerve?
The sciatic nerve, without going into too much anatomical detail, is a nerve that originates in the spinal cord and descends vertically over the posterior surface of the thigh and divides in two to the lower leg.
The spine is made up of several vertebrae. Each vertebra has a name according to its position. Thus, there are cervical, dorsal, lumbar, sacral and coccygeal vertebrae. In general, when we talk about sciatica, there is pain in the L5 or S1 vertebrae in the lower back. “L” is an abbreviation for lumbar vertebra and “S” for sacral vertebra.
Sciatica pain reflects a pinch, an irritation of the sciatic nerve, often due to a herniated disc.
Low back pain is a pain in the back, located in the lumbar region (lower back). Its cause, unlike sciatica, is not due to irritation of the sciatic nerve. The causes are often unknown. Low back pain is often triggered by a wrong movement, a spinal compression.
Epidemiology
Back pain is very common in today’s society. They are responsible for a high rate of absence from work.
As far as sciatica itself is concerned, it usually affects 2% of the western population. The most affected people are between 35 and 60 years old. Thus, in France, more than 400,000 new cases of sciatica are reported annually.
Although sciatica resolves on its own after a few weeks, it is very debilitating and can cause severe pain. These severe pains can prevent the patient from working.
Causes
In general, sciatica is caused by damage to the spine. The spine is made up of several vertebrae separated by discs, sometimes these intervertebral discs “wear out” and cause nerve compression (which causes pain), for example, caused by an unusual movement.
Disc herniation is the main cause of sciatica pain. In this case, the disk is damaged. Its center (nucleus) moves out of its axis and continuously presses on the sciatic nerve. The pain felt along the course of the sciatic nerve, the nerve that carries out the nerve transmissions of the gluteal muscles and lower limbs (legs, feet). Thus, pain is felt from the buttock to the leg, even down to the foot, even if these parts are healthy and only the nerve root is affected.
In some cases, sciatica problems can be caused by osteoarthritis , a dislocated hip, a tumor or a fracture. In case of osteoarthritis or vertebral bone tumor, the nerve is compressed by the bones. It could also be a tumor on the nerve root, called a neuroma.
Other cases of involvement of the sciatic nerve are: diabetes , herpes zoster , the fact of remaining in an inappropriate position for a long time, the fact of carrying excessive weight, etc.
Groups of risk
People likely to suffer from sciatica pain are people:
– very tall
– aged between 35 to 60 years
– who often carry heavy loads, as they don’t spare their backs
– suffering from bone cancer
– suffering from herniated disc
– who sit for long periods (car drivers, truck drivers, office workers)
Symptoms
At first, sciatica usually causes acute or chronic low back pain of varying but often brutal intensity.
The pain may then travel up the leg and may even radiate down the lower leg. However, these pains are usually unilateral (affecting only one leg at a time).
It all depends on the level at which the nerve is pinched (compressed). If it is only at the level of the 5th lumbar vertebra (L5), the painful path is as follows: from the buttocks to the big toe, passing along the outer surface of the thigh, leg and instep.
But when it is at the level of the 1st sacral vertebra (S1) only, the painful path is as follows: from the buttocks to the fifth toe, through the thigh, the calf, through the Achilles heel and the outer side of the foot.
In some cases, pain can occur at the foot of the buttock, especially if two nerve roots are affected.
Sciatica pain can be very severe and prevent the patient from sleeping. It can also be accompanied by tingling.
The pain can be aggravated by coughing, laughing, or when the patient is standing up.
Note also paralyzing sciatica, in this case there is a dorsiflexion paralysis.
Diagnosis
In general, the doctor will ask several questions about the pain (the most important one) and do a clinical examination.
During the anamnesis (medical history), the doctor tries to rule out other causes of back pain, such as common low back pain, ankylosing spondylitis, fractures. The doctor will also try to rule out lumbosciatica of cancerous origin, caused by a tumor on the nerve or bone. In the case of tumors, the doctor will perform extensive laboratory tests.
In the initial phase, the diagnosis is not necessarily made through imaging tests, the neurological examination alone is sufficient. In performing the neurological examination, the physician checks for proper nerve transmission and tests the patient’s muscle responses.
With this first examination, the doctor will know whether it is complicated sciatica or not. In case of uncomplicated sciatica, the doctor will not carry out further examinations. He may treat the patient with analgesic and/or anti-inflammatory medication. If the pain is very severe, he may also prescribe weak opioids. A new assessment should be performed after a few days of treatment.
In the case of complicated sciatica, if there is paralysis for example, emergency hospitalization is necessary, as well as more detailed additional tests, such as X-rays, a CT scan or an MRI, to identify exactly where the lesion is.
Complications
In general, when sciatica is uncomplicated, the condition resolves on its own within a few weeks (8 weeks to 1 year). Often 6 weeks are needed for a complete cure of sciatica pain, although the pain may disappear after ten days already.
Note that recovery may be complete, although sciatica is caused by a herniated disc and is not necessarily treated immediately.
Also note that a herniated disc can put so much pressure on the nerve that it even prevents normal urination (urinating) or causes severe constipation.
Paralysis is the main complication and problem of sciatica, but it is a rare event.
Furthermore, it is possible that the patient, once cured, suffers again in the future from sciatica, which is often recurrent. Some supportive medications can prevent relapses from occurring.
When sciatica is complicated (paralyzing, for example), emergency surgical treatment is often necessary to prevent progression to permanent paralysis.
The pain can often be intense, to the point of disabling daily activities and preventing return to work. If the pain becomes chronic and work stoppage continues, the patient may become depressed, remaining on the margins of society for a long time.
When to see a doctor?
In cases of sciatica pain, it is necessary to consult a doctor when:
– there are frequent relapses
– the pain does not subside after 10 days
– the pain is very intense and prevents the patient from carrying out daily activities
– muscle sensitivity drastically decreases
– there is a micturition disorder (problem passing urine) or severe constipation.
Treatments
The doctor must investigate the cause of sciatica pain, for example, if the cause is a herniated disc, the doctor will treat this pathology.
In general, the doctor advises bed rest, especially if the pain is very severe.
To treat sciatica, your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), muscle relaxants (muscle relaxants), or, in some cases, corticosteroid injections. Analgesics, anti-inflammatories and muscle relaxants are first-line treatments. If the pain is very severe, administration of opioid medications (morphine derivatives) may be necessary.
Rest and painkillers are prescribed for a few days. Then, a new assessment is made by the doctor, to determine whether this is the presence of complicated sciatica pain or not, requiring emergency surgical treatment.
If it is not a complicated sciatica, but the patient’s condition does not improve (persistent pain), the doctor may adapt the treatment (stronger medication) or inject corticosteroids. A new medical evaluation should be carried out after a few days.
In two-thirds of sciatica cases, there is spontaneous healing within the first eight weeks.
It should be noted that when sciatica is paralyzing, the treatment is surgical.
Note:
A study published on March 22, 2017 in the leading journal New England Journal of Medicine showed that pregabalin (Lyrica®, trade name in many countries) capsule was not more effective than placebo in cases of sciatic pain . The study was carried out by Christine Lin of the University of Sydney in Australia.
Herbal medicine
In cases of sciatica, it is necessary to relieve pain and inflammation. Thus, all plants with analgesic and anti-inflammatory components are interesting, such as willow, devil’s claw or meadowsweet .
Note, however, that the onset of devil’s claw action (3 weeks minimum) makes this plant a great ally in rheumatism, while in the case of sciatica, wintergreen essential oil is preferable.
Wintergreen essential oil is easily recognizable as it is present in many anti-inflammatory creams and ointments. The main component felt is methyl salicylate. Its analgesic and anti-inflammatory actions are very popular during sciatica and acute pain.
Do not hesitate to apply pure wintergreen essential oil or with arnica vegetable oil . Arnica vegetable oil is a very good remedy, and it also has anti-inflammatory properties.
When sciatica, it is important to massage gently, apply only seeing how deep tissue massage can intensify the pain. On the other hand, a gentle massage allows for good absorption of the medicine or essential oil, but in addition, the heat generated by passing your hand several times over the painful area also relieves pain and inflammation.
Tips
– Heat can help with sciatica. Example, you can apply warm compresses or take a hot shower.
– You can do sessions with a physiotherapist to improve your sciatica problem (it only works in some cases, talk to your doctor)
– The lying position has the advantage of relaxing the back, vertebrae and intervertebral discs, which reduces pain. Go to bed and elevate your legs (to 90°) to relax your spine.
– Indeed, it is advisable to follow rest during intense pain. However, once you’re better, it’s preferable to move a little, smoothly and without making any false moves. The activity allows for a little faster recovery.
– An appropriate sport also helps relieve back pain. Swimming is a typical example of an adapted sport in cases of sciatica.
– It is advisable to promptly take analgesics (against pain) and anti-inflammatories. Inflammation must be treated quickly and strongly. So, for 3 days, it is advisable to take ibuprofen 3 times a day after meals to prevent stomach upset.
Prevention
– Do sports like swimming, hydrogymnastics and bodybuilding. Think of the musculature of the back as relieving the spine and discs. There are certainly places that do pilates in your area. This practice re-educates people so that they have a correct posture, strengthen their dorsal muscles and also know how to relax. Learn and enjoy.
– Keep your back straight when carrying objects and bend your knees whenever lifting a load.
– Try to change position frequently when carrying out work or a task, for example in the office. Always maintaining the same position is not good for your back. It is also advisable to get up regularly. Do stretches, exercises helping to relax the back muscles.
– Choose an adapted chair to better support your back. In addition, there are utensils to make your chair ensure a proper dorsal position, such as cushions.
– Sleep on a good pillow and a good mattress (preferably hard).
– Wear shoes that allow you to feel comfortable. Shoes should also carefully consider the feet.
– Avoid getting too obese or overweight (which is bad for your back)
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