Sciatica is not a condition in itself, but a term we use to describe the manifestation of pain felt in the lower back in the lumbar region. From this point, the pain radiates to the hips and then descends to the leg. The pain is caused by compression of the sciatic nerve and usually occurs on one side of the body.
The sciatic nerve is the widest and longest nerve in the human body and consists of the nerve roots that start from the spinal cord (L5, which starts between the 4th and 5th lumbar vertebra and S1, which starts between the 5th lumbar vertebra and the first sacral vertebra) and descends to the ankles.
Sciatica can be of two types:
1. Acute, when it lasts between 4 and 8 weeks and can be treated with exercise, hot or cold compresses or painkillers.
2. Chronic, when it lasts more than 8 weeks and requires medical intervention (physiotherapy).
What are the causes of Sciatica?
Sciatica therefore means the pressure on the sciatic nerve. The causes can be multiple, but keep in mind that there is no obvious cause to explain the inflammation or irritation of the sciatic nerve. It can be about:
- disc herniation: is the most common cause of sciatica (it is the movement of an intervertebral disc). The spine has 3 parts: the vertebrae (the bones that protect the afferent nerves), the nerves and the intervertebral discs. The discs between the vertebrae are made of cartilage, which acts as a shock absorber between the vertebrae and allows flexibility of the spine. Herniated disc means that such an intervertebral disc is pushed out of place, which puts pressure on the sciatic nerve;
- tuberculous spondylitis (Morb Pott): is a very old disease, it was first described by Percivall Pott, in 1779. It is also called spinal tuberculosis disease. The incidence of this disease has decreased in developed countries, but there are still many cases in developing countries. The disease involves significant morbidity, neurological deficiencies and severe vertebral deformities;
- piriformis syndrome: is a rare neuromuscular condition. The sciatic crisis is caused by the piriformis muscle, which puts pressure on the sciatic nerve, leading to sciatica neuralgia;
- spinal tumors: the larger the tumor, the greater the pain;
- secondary tumors: they install near the spine, but get on nerves causing pain. There are nerve metastases, such as localized metastases in the lumbosacral plexus in the case of bladder cancer, or uterine cancer;
- inflammation / nerve damage: trauma, pelvic fractures;
- osteoarthritis: is a degenerative disease of the intervertebral discs. They shrink and lose their flexibility. It leads to a herniated disc and inflammation of the nerve;
- stenosis: narrowing of the spinal canal leads to compression of the spinal cord and nerve damage
immobilization of patients in bed;
- cauda equina syndrome (ponytail): is a rare and serious disease that requires emergency medical care;
- spondylolisthesis: the displacement of a vertebra;
- pregnancy (the uterus puts pressure on the sciatic nerve).
What are the symptoms of Sciatica?
Symptoms are often felt along the sciatic nerve. These can be:
Sciatica pain is felt as a persistent burning sensation or a sharp, stinging pain that starts in the lumbar area or buttocks and radiates in front or behind the thigh and / or calf to the heel. If, in addition to affecting the sciatic nerve, other low spinal nerve pathways (ponytail syndrome) are damaged, in addition to pain, the possibility of controlling urination and defecation may be affected.
If such symptoms occur, immediate medical consultation is required.
Sciatica pain may be accompanied by numbness in the back of the foot. Sometimes tingling or weakness may be present.
Symptoms of sciatica can worsen when sitting, when you try to get up, when you bend your spine, when you twist your spine, when you lie in bed or when you cough / sneeze, but also after activities such as walking, running, climbing stairs, Stretching the leg tends to make the pain worse, and keeping the back upright reduces the intensity of the pain.
What is the treatment of Sciatica?
There are several types of treatment for sciatica: rest, lifestyle change, medication, alternative treatment, or surgery.
The specialist doctor may recommend the administration of:
- non-steroidal anti-inflammatory drugs;
- steroidal anti-inflammatory drugs;
- vitamin therapy (especially vitamin B1 and vitamin B2);
Medical recovery is an alternative treatment and consists of:
- balneoclimateric treatment.
Exercise for sciatica
Exercise for sciatica can relieve low back pain, reduce tension and stimulate muscles. Here are some examples of exercises you can do at home:
- stand with your back straight and your feet together;
- stretch your arms forward and bend down until your head reaches your knees;
(repeat the movement 8-10 times; don’t forget to breathe)
- lie on your back;
- bend your legs and cross them;
- grab the back of the legs and pull them both to the chest;
- stretch your legs and relax.
(repeat the movement 8-10 times)
- lie on the floor with your legs outstretched;
- sit with your back straight;
- put your right foot on top of your left, keeping your left one as straight as you can;
- embrace your right leg, pulling it towards you;
- hold the position for 30-40 seconds, then return to the starting position.
(repeat, reversing the legs)
- you lie face up, with a pillow under your knees and your legs apart;
- the lumbar area must be in contact with the ground;
- stay in this position as long as you breathe 10-20 times, deeply.
(focus more on expiration)
There are other exercises to relieve pain in sciatica, but you must remember that it is very important to do them correctly. If you can’t or have difficulty, consult a coach or physiotherapist.
If the sciatica persists for a few weeks, the specialist may recommend surgery. There are several types of operations:
- In most cases, the operation involves the surgical removal of the intervertebral disc that puts pressure on the sciatic nerve.
if the patient suffers from lumbar stenosis, the specialist may recommend lumbar leminectomy (which aims to decompress the spinal nerves).
- In the case of traumas that involve suturing the nerves sectioned at both ends, the intervention is called neuroraphy. There are three types of neurorafias: primary (it is performed immediately after the trauma), secondary (it is performed about one month after the trauma), late neuroraphy (it is performed 6 months after the trauma).
- If there is no problem of a degenerative lesion, the compressed nerve is released through an intervention called neurolysis. Neurolysis only makes sense when there are no nerves with signs of degeneration.
- In the case of sciatic nerve injuries and ankylosis of the knee, nerve grafting is recommended.
- In very severe cases of permanent paralysis, a specialist may recommend myoplasty.