Зміст
Sciatica is a condition caused by pressure on the spinal nerves. Its characteristic symptom is intense pain localized in the lumbosacral spine. Sometimes it is also accompanied by muscle weakness and problems with movement. The most common causes of sciatica include diseases and inflammation of the spine, diabetes and cancer.
Sciatica is associated with dysfunction of the spinal nerves that make up the sciatic nerve, which is considered the largest nerve in the human peripheral system. It is located in the area of the lumbosacral spine, the piriformis and gluteal muscles, and the popliteal fossa.
What is sciatica? – causes of the disease
Sciatica, also often called radiculopathy, is a condition that is directly caused by pressure on the sciatic nerve. Depending on its location, there are:
- brachial sciatica, the characteristic symptom of which is pain radiating to the neck, arms and upper limbs,
- lumbar sciatica, which causes pain in the lower back, buttocks and lower extremities,
- femoral sciatica, localized primarily in the lumbar and sacral spine and hips.
The immediate cause of sciatica is pressure on the spinal nerves. This condition is usually caused by diseases of the spine, including degenerative diseases, spinal curvatures and discopathy. Sometimes this pressure is caused by obesity, diabetes or cancer. Pregnancy and excessive physical activity, which put stress on the intervertebral discs, are factors that predispose to the onset of sciatica symptoms. Sometimes this condition can also be caused by a diet low in vitamins and minerals.
Read also: Pain in the lumbar spine – causes, treatment
Symptoms of sciatica
Sciatica is a disease with characteristic symptoms, which makes it relatively easy to diagnose. The most common symptom of this condition is sudden and very severe pain, most often localized in the lumbosacral spine. Sometimes it can radiate to the buttocks and lower extremities (a special case of sciatica is its shoulder form, in which pain appears in the neck, hands and arms).
The pain is usually accompanied by muscle weakness, numbness and tingling sensations. In severe cases of sciatica, paresthesia (pressing sensations) and sensory disturbances may occur. Sometimes these painful symptoms may also be accompanied by diarrhea and urinary incontinence.
Sciatica attack – what to do?
An attack of sciatica cannot be ignored. The pain is so severe that it automatically forces you to change your position and lower the weight. For the first 2 days you should simply rest: lying on your side with your hips and knees bent, or lying on your back with your legs bent may provide some relief, although you should not stay in bed for too long. Consultation with a doctor is necessary if the pain persists for longer than 3–4 days and does not subside. Over-the-counter medications such as ibuprofen, diclofenac, and meloxicam can be used to relieve pain. You can use painkillers and anti-inflammatory ointments, as well as warm compresses or special patches.
How to treat sciatica?
In the diagnosis of spinal diseases, including sciatica, magnetic resonance angiography, computed tomography and radiography are used. In most cases of the disease, treatment is aimed at eliminating symptoms and risk factors. The patient is prescribed non-steroidal anti-inflammatory drugs and painkillers. It is also recommended to rest and not overload the spine, for example, to refuse physical work. In many cases, rehabilitation is supportive treatment.
In severe cases, surgical treatment is performed. Indicated when symptoms such as paresis of the lower extremities, urinary retention, sensitivity disorders in intimate areas and reflex disorders occur. Surgical treatment often includes microdiscectomy, which involves removing the nucleus pulposus.
Sciatica – rehabilitation and exercises
Rehabilitation and exercise are (after the acute phase of very severe pain has subsided) the best way to restore mobility more quickly, reduce the intensity of symptoms and resolve them earlier.
The condition for starting such measures is a consultation with a doctor, which allows you to exclude the presence of neurological symptoms in the form of paresis or paralysis. Additional imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), can check to see if pressure is causing the problem, such as complete prolapse of the nucleus pulposus or other damage that requires surgery.
The task of rehabilitation of a patient with sciatica is, first, to place the spine in the correct position (without lateral curvature, excessive flexion and hyperextension) so that it does not put pressure on the roots of the spinal nerves. If this goal is not achieved, symptoms will worsen and paresis will develop in the lower extremity.
Rehabilitation measures protect against muscle x contractures in case of pain, and in case of impaired innervation of muscles, they increase their strength.
We should also not forget that massage and physical activity release an additional dose of endorphins in each person, which not only improves mood, but also has an analgesic effect.
In the period between relapses of the disease, intensive rehabilitation (mainly physical) helps to strengthen the paraspinal muscles responsible for maintaining correct body position and improve the biomechanics of movements. During special instructions, the patient can also be taught what exercises and how to perform them when the next episode of the disease occurs.
Read also: Multilevel discopathy – symptoms, causes, treatment
Rehabilitation methods for sciatica
Rehabilitation for sciatica includes methods such as:
- passive kinesitherapy – used during pain – the therapist moves the patient’s limbs and helps him actively perform other movements,
- active kinesitherapy – the patient trains independently, under the supervision or with a little help from a rehabilitation therapist; some of these exercises can be done without weights, such as in water,
- manual techniques (massage, mobilization and manipulation) – these techniques relax contracted, tense muscles that either themselves cause pain or do not allow the spine to return to the correct position,
- electrotherapy – for example, transcutaneous nerve stimulation (TENS), diadynamics (DD), short-wave diathermy (DKF) – methods that support the treatment of pain and prevent muscle weakness,
- taping – application of special patches (tapes) to the patient’s skin, which force the patient to maintain the correct body position and limit excessive movements.
