Sciatica refers to severely painful spasms along the sciatic nerve of the leg. This nerve runs from the back of the buttock and thigh, down the inside of the leg to the ankle. There is numbness and tingling.
The pain is caused by pressure on the sciatic nerve as it leaves the spinal column. Sciatica can have a variety of causes, including a herniated (slipped) disk in the spinal column, arthritis, neuritis, or a fall or trauma. In most people who have sciatic, the disks in the backbone have become weakened, either with age or as a result of excessive strain. The disks and vertebrae provide the necessary flexibility for people to stretch and bend. Each disk consists of a soft center, which acts as a shock absorber, and a tough fibrous outer layer. Sometimes, this outer layer weakens in parts, and the soft center bulges out. The resulting bulge puts pressure on the nerve to the leg and causes the pain of sciatica.
Any pressure on the sciatic nerve causes sharp, stabbing pains in the buttock and down the leg. It may happen suddenly when someone is bending or stretching or it may come on gradually. Even a slight movement, such as coughing or sneezing, can bring on the pain or make it worse. For anyone suffering from sciatica, walking and sitting can be painful and difficult. The most comfortable position is lying on the back with knees bent.
What causes sciatica?
The intervertebral disks are pads of tissue that separate the vertebrae – the cylinder shaped bones that make up the spine. Together, the disk and vertebrae give the spine the necessary flexibility for people to stretch and bend.
Each disk consists of a soft center, which acts as a shock absorber, and a tough fibrous outer layer. With age or sometimes as a result of excessive strain being applied to the back, this outer layer weakens in part to allow the soft center to bulge out. This condition is rather inaccurately called a slipped disk. It is this protrusion that puts pressure on the nerve to the leg and causes the pain of sciatica.
The same sort of pain can be caused by other disease in the region of the nerve roots as they leave the spinal canal. These diseases are uncommon but have to be considered by the doctor when diagnosing sciatica. For example, the nerve roots can be irritated by pressure from a tumor in the spine or from a collection of inflamed tissue, which may occur after spinal injuries or following surgery. These other causes can be identified through examination and X-ray tests.
The sciatic nerve can be irritated, impinged, or compressed for several different reasons. Simple causes include awkward sitting postures and muscles spasms including spasms of the piriformis muscles. Material from a disk herniation can affect the nerve roots. If the foramen is being narrowed, this can affect the nerve, too. This narrowing could be from osteoarthritis, degenerative disk disease, facet joint syndrome, spinal stenosis, or spondylolosthesis. Rarely, infections or tumors can be the root causes of sciatica. Common causes of sciatic nerve compression include:
- Fibrositis of posterior sacral ligament
- Ankylosisng spondylosis
- Primary bone tumor
- Secondary carcinoma
- Hip joint or sacroiliac joint disease
- Haemorrhage adjacent to nerve sheeth in blood dyscrasias and anti coagulant therapy
- Misplaced therapeutic injection
- Infection of prostate or female genital tract
- Rectal impactions
- Tumors of lumbo- sacral plexus
- Protruded intervertebral disc
Symptoms of Sciatica
The onset may be sudden or gradual. The pain is felt in the buttock and radiates down the posterior aspect of the thigh and calf to the outer borders of the foot.
It is characterized by pain radiating down the back of the thigh that has been described as sharp, stabbing, electrical, and burning. The pain is worse on coughing or sneezing due to raised pressure in the spinal subarachnoid space. Parathesis and later numbness may be felt over the distribution of sciatic nerve.
In severe cases weakness of the calf muscles or foot drop may occur. Movement of the spine is limited. Due to intense pain the patient may not be able to sleep.
Involvement of first sacral root causes- loss of ankle joint jerk, a weak planter flexion of the foot and sensory loss over the outer border of the foot.
Involvement of the fifth lumber root causes- weakness of the dorsiflexion of the toes and sometimes foot drop. Sensory loss occurs on the dorsum of the foot and lateral aspect of the leg. Here ankle joint is unaffected.
Involvement of the fourth lumber root causes-weakness of invasion of the foot and there is loss of knee jerk. Sensory loss is over the medical aspect of the leg. A valuable sigh in limitation of flexion of the thighs if the leg is kept straight at the knee.
These symptoms can manifest in one or both legs. The pain may be distributed uniformly along the pathway but, often, specific and intense spots of pain are predominant. In many cases, the pain of sciatica is accompanied by sensations of numbness, tingling, weakness, and achiness.
Generally, the sharp, stabbing pain comes on suddenly, reaches a high intensity, then gradually fades away. The burning sensation, which suggests a pinched nerve, is often felt anywhere on the lower back, buttocks, legs, and/ or feet. The electrical sensation usually radiates pain from the specific area where the nerve is compressed and, from there, down the sciatic nerve pathway.
It comes on suddenly, then disappears, only to return and repeat the cycle. The tingling and numbness are further indications of nerve irritation along the pathway. Finally, the achiness is associated with strained or ever worked muscles. The symptoms of sciatica can be more severe when the individual bends forward, coughs, or sneezes.
Investigations of sciatica
Tests are guided by the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development. Investigations may include-various blood tests, X-rays, MRI, CT scan, and electromyogram.
- History – of trauma, exposure to damp or cold, sphincter control and history of previous attack
- Physical examination – lumber spine include shape, mobility, muscle spasm.
- Other investigations include
- Imaging of spine – straight x-ray, MRI
- CSF – may show increased protein with normal cell count in large protruded intervebral disc.
- EMG – may be used to comferm presence of denervation of affected muscles.
- Procaine injection test – for diagnosis of fibrostic pain
Treatment of Sciatica
Sciatica due to slipped disk, while very unpleasant on some occasions and often disabling when it occurs, will usually improve on its own if the proper measures are taken.
The initial problem is to relieve the pain, and this is most easily done by resting in bed in the most comfortable position. It may be helpful to have the shoulders raised a little with pillows, which will ease the curve on the lower back, since the muscles there will have gone into some spasms in response to the pain. All unnecessary movement must be avoided.
Continuous bed rest for two weeks, with the knees and the hip joints slightly flexed and sometimes with weight traction to the pelvis, is now the routine initial treatment for slipped disk. Such treatment will reduce the disk herniation in 90% of cases. If it does not, surgery may be required.
Painkillers may be prescribed if the sciatic pain is particularly bad, but ordinary analgesic drugs such as aspirin or acetaminophen are usually adequate enough back rest is given. The crucial thing is to stay in bed and to resist the temptation to be up and about when the disk is only half healed; otherwise the whole process will return to square one.
Often a hard bed is best because a soft bed encourages the spine to sag and puts more pressure on the interverterbral disks. Once the sciatica has improved, it is equally important to avoid straining the back and lifting heavy objects.
Surgical treatment of sciatica is a last resort, usually for those who have had repeated episodes that have not improved with ordinary rest in bed and for those who cannot afford to take time off work. However, surgery can be successfully performed only for certain types of disk problem, so special X-rays of spinal canal may need to be performed before a decision to operate can be made. In this test, called a myelogram, some special dye that shows up on X-ray is injected via a lumbar puncture into the fluid filled space around the nerve roots. The X-rays taken then show up the shadow of the spinal cord and its nerve roots, and reveal whatever is causing the symptoms. From these pictures, the doctor can see whether surgery is possible and how extensive the surgery needs to be in order to solve the problem. If the sciatica is caused by a single disk bulging out, the protrusion can be removed. If there are many disks producing pressure on the nerves, then more extensive surgery may be needed to relieve the pressure.
Homeopathic treatment of Sciatica
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat sciatica but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat sciatica that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following homeopathic remedies which are helpful in the treatment of sciatica:
Colocynth – the most important remedy in sciatica, corresponding to the worst cases; there are pain in sciatic nerve extending to the knee or to the heel, worse from any motion, and especially aggravated by cold. The pain is paroxysmal and followed by numbness and partial paralysis. There is a sensation which has been described as if the thigh were bound with iron bends, or as though screwed in a vise; the muscles are fearfully tense and fixed. Particularly is the right side involved, and there are stitches during walking.
These is sense of constriction around the hip, the pains, too, may come suddenly and leave suddenly, they may be sticking and burning, and all are worse from cold or damp and at night, when the patient can find no easy position for the limb.
Arsenic album – with this remedy the pain is marked by complete intermissions; it exacerbates every night at a particular hour, and becomes unbearable; it is increased by vigorous and relieved by gentle motion. It is aggravated by cold, but relieved by momentarily by warmth. It is a pure neuralgia, neither inflammatory, toxaemic nor reflex.
Lycopodium – chronic cases; burning and stinging pains; with complete intermissions; stiffness and weakness in the affected limbs; worse by rest and slightly alleviated by motion, but ameliorated by keeping moving.
Ruta – this remedy also has shooting pains down the back, down the sciatic nerve on first moving or on rising after sitting; the patient obliged to walk about constantly during the paroxysms of pain. The pains are felt most in the region of the knee. It is worse during damp or cold weather and from cold applications.
Bryonia – pain in the lumber region, extending to the thigh, worse by sitting up, by moving and late in the evening; lies best on painful side; often relieved by cold eater; atrophy and emaciation of the affected limbs.
Sulphur – subacute sciatica from some dyscrasia in organism; pain in small of back, stitching-drawing on raising from a seat; tensive pain in hip joint, especially left one; drawing down the limb, accompanied by a bruised sensation.
Magnesia Phos – inability to lie in bed at night, must stand all the time, paroxysm in violent lightning-like shocks, aggravated on right side.
Gelsemium – obstinate sciatica, pains aggravated at rest and particularly when beginning to walk; burning pains, aggravate at night, compelling her to lie awake; shooting pains in paroxysms; ameliorated when in a sweat; pains in sole of foot when walking.
Calcarea Carb – sciatica pains causes by working in water, pain aggravated from limb hanging down and ameliorated from elevating knees.
Zincum met – rheumatic sciatica, worse from being overheated and from exertion; hysterical hyperaesthesia.
Kali bichromicum – sciatica of left leg; amelioration by walking and flexing the leg, aggravation from standing, sitting, or lying in bed.