Sciatica

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What is sciatica?

Sciatica, commonly referred to as lumbago, ischias or rootlets, is a disease that manifests itself as severe back pain and one of the legs. Pain occurs in the lumbosacral spine and buttock, radiating through the back of the thigh and calf to the foot. If left untreated, it may take weeks or even months. It is caused by pressure or irritation of the sciatic nerve or nerve roots. It is usually preceded by pain in the lumbosacral spine. Treatment of sciatica with proper diagnosis is not difficult or invasive. Appropriate medications, injections and exercise allow the patient to quickly get rid of pain and regain full fitness.

Sciatica - symptoms

The onset of sciatica may be acute - sudden, stabbing pain occurs when performing activities that put a lot of strain on the spine (e.g. lifting heavy objects). Patients describe it as sharp, sharp, stabbing pain, not allowing the slightest movement. Sciatica can also appear as a growing pain that begins in the area of ​​the lumbar spine or buttock and gradually increases as it radiates down the limb. Characteristic of sciatica is that even the slightest uncontrolled exertion that causes the spine to move - walking, sneezing, coughing - causes a strong attack of pain. Patients complaining of lumbago may also experience muscle paresis, especially when flexing and straightening the foot, as well as sensory disturbances, and may even have problems with defecation. Sometimes the patient is unable to get out of bed because the pain is so strong that he feels paralyzed.

The causes of sciatica

The spine in the lumbar region is naturally bent - the so-called lordosis - so that it can play a supporting and shock-absorbing function. This section carries the weight of all higher parts of the body, which requires stability and resistance to mechanical deformation. At the same time, the mobility of the lumbar section must allow for the performance of flexion, extension, lateral bends and rotation (to a limited extent). The lumbar spine is therefore very vulnerable to all kinds of injuries. These injuries can sometimes cause compression of the nerve roots - and consequently - sciatica.

The intervertebral disc, or disc, consists of a centrally located pulmonary nucleus and a fibrous ring located peripherally. One of the most common causes of sciatica is the prolapse of the nucleus pulposus outside the area of ​​the intervertebral disc. Patients often misrepresent the term "prolapse of the disc" - in fact, only part of it is ejected.

The prolapse of the pulmonary nucleus occurs most often when lifting heavy objects or other activities that overload the lumbar spine. Discopathy is often recurrent and can sometimes occur even with a simple stoop or other decisive act. An attack of sciatica may also appear as a consequence of degenerative changes in the spine in the lumbar region. These changes are usually the result of prolonged stay in a forced position (e.g. in drivers), sedentary work, obesity and incorrect posture when carrying heavy objects.

Pregnant women also suffer from sciatica - it is associated with hormonal changes, causing the loosening of the pelvic joints, enlargement of the uterus, shifting the center of gravity and the high weight of the child and pressure on the pelvic bones and the sciatic nerve. The appearance of sciatica during pregnancy may be an indication for a caesarean section. Other causes of sciatica include poor diet, low in calcium, minerals and vitamins, as well as overweight / obesity, diabetes, inflammation or cancer.

Sciatica and nerve compression by the pear-shaped muscle

Irritation of the sciatic nerve can also be caused by the so-called pear-shaped syndrome, also called pear-shaped syndrome. The pear-shaped muscle is located in close proximity to the sciatic nerve. When a muscle works too much - increasing muscle tone and volume - it can compress the sciatic nerve. The main causes of the piriformis syndrome are mechanical injuries of the muscle, prolonged sitting, inadequate training, sudden weight gain (e.g. during pregnancy) or increased muscle tension. In order to avoid ailments related to the piriformis syndrome, it is necessary to introduce stretching and stabilization exercises, and to eliminate abnormal movement patterns.

Sciatica diagnosis

Patients with suspected sciatica complain of sharp pain that occurs when changing position, and even when coughing or sneezing. Diagnostics in this case is based mainly on an interview, functional examination and additional tests - such as, for example, magnetic resonance imaging of the spine (MRI). During the interview, the doctor collects information about the patient's health - checks whether there are factors that increase the possibility of the disease (e.g. sedentary work, sudden weight gain, or whether there have been any sudden events related to high overload of the lumbar spine). He can also palpate the curvature of the spine and carry out the so-called Lasèque test. This test involves lifting the leg straight in the knee in a supine position. If the patient experiences pain when lifting the leg - there is a high probability that this is sciatica.

Then the doctor conducts a neurological examination to check muscle strength, detect possible sensory paresis, muscle atrophy and check whether there are any nerve conduction abnormalities.

To confirm an initial diagnosis of sciatica, your doctor may order a magnetic resonance imaging (MRI) of the lumbar spine. This imaging test is extremely helpful in the diagnosis of sciatica, as it shows very accurately any protrusions and hernias of the intervertebral discs. The doctor is able to very precisely check where and to what extent there is pressure on the nerve roots. MRI is the most accurate examination in the diagnosis of sciatica. Its advantage is also that it is completely non-invasive and the magnetic field used in this study has no effect on the human body.

In patients with contraindications to MRI (e.g. screws, plates, pacemakers incompatible with MRI), the doctor may order additional imaging tests - computed tomography or X-ray of the L-S (lumbosacral) spine.

Treatment of sciatica

Treatment of sciatica can be either conservative or operative. The treatment process should begin as soon as possible after a correct diagnosis is made, in order for the patient to return to normal functioning and to avoid complications.

Treatment of sciatica at home

Sciatica treatment should not be carried out on your own, but while waiting for the doctor's appointment, you can ease your pain a little. When severe pain occurs, the easiest way to ease your symptoms is to get into a position that brings relief. This position may be different for each patient, but it is recommended to lie down on a rather hard surface, with bent legs - this is the so-called decompression position allowing maximum relief of the spine. Laying a large roller under the knees (e.g. from a duvet, pillow) may help. It is also necessary to limit motor activity, because uncontrolled movement may aggravate pain.

Cold and warm compresses can also provide pain relief. First, apply cold compresses - it can be ice wrapped in a cloth, frosted wet cloth or chilled gel compresses. The low temperature leads to the constriction of the blood vessels and the reduction of swelling. After the acute condition subsides, you can use warming compresses - you can use a hot water bottle, electric pad or simply a hot water bottle. Warming up will increase the blood supply to the tissues, which in turn accelerates the healing process. To reduce pain, you can take over-the-counter non-steroidal painkillers (e.g. paracetamol) and anti-inflammatory drugs (ibuprofen, ketoprofen).

Treatment of sciatica - drug therapy

 In the first phase of treatment, the most important thing is to extinguish acute inflammation through the use of pharmacotherapy. For this purpose, non-steroidal anti-inflammatory drugs are administered - the fastest and most effective is to administer the drugs directly to the source of pain, through an epidural injection. Patients are advised to limit their physical activity, preferably if the patient is resting in a supine position. It is inadvisable to walk or even sit - especially for long periods, e.g. at the computer. It is recommended to lie in bed in order to relieve the lumbar spine as much as possible. Avoid sudden movements that may alter the position of the spine.

Rehabilitation in the treatment of sciatica

The next step in the treatment of sciatica is proper rehabilitation under the supervision of a specialist. Incorrectly conducted rehabilitation may lead to the aggravation of the problem and, as a consequence, lead to further incidents and even the need for surgical treatment. That is why it is so important to correctly diagnose and thoroughly investigate the cause of the pain.

The aim of rehabilitation in sciatica is, first of all, the optimal positioning of the spine in such a way as to minimize pressure on the root and thus relieve pain, prevent complications such as, for example, muscle contractures. Rehabilitation also improves muscle strength, eliminates paresis and prevents recurrence of attacks by restoring the correct posture. The patient learns the correct movement patterns as well as can implement special exercises that he performs at home.

In the rehabilitation of sciatica, manual therapy, the McKenzie method, muscle relaxation massages, and neuromobilization are used. Central stabilization is extremely important - that is, strengthening individual groups of muscles that keep the spine in the correct position. Strong stabilizing muscles allow you to maintain the correct posture and reduce the overload to which the spine is exposed. By maintaining a strong CORE, the patient can avoid relapses in the future.

Rehabilitation can be supported by physical therapy - magnetotherapy, solux lamp irradiation, ultrasounds, cryotherapy, histamine iontophoresis, dynamic currents or TENS currents. The scope of therapy is always selected individually by a doctor or a physiotherapist, depending on the needs and condition of the patient.

Surgical treatment of sciatica

In some cases, pharmacotherapy and rehabilitation are sufficient, but sometimes surgical treatment is indicated. The decision to qualify a patient for surgical treatment depends on the stage of prolapse of the intervertebral disc. Patients who develop symptoms such as significant muscle weakness, decreased sensation, uncontrolled bowel movements, and patients in whom pharmacological treatment is ineffective are qualified for surgical treatment. Surgical intervention is also necessary in people who, despite treatment, experience sciatica relapses that prevent normal functioning. Surgical treatment involves removing the part of the disc that directly presses the nerve and causes acute pain. It is important to keep as much of the disc intact as possible during surgery to preserve the natural anatomy of the spine.

Currently used surgical treatment methods are minimally invasive and safe, what's more - they give an immediate effect and allow you to quickly return to normal life. Patients feel a great relief right after the surgery - when the part of the disk pressing on the sciatic nerve is removed. Reaching full fitness takes - usually from several weeks to several months, but by strictly following the recommendations of the therapist and doctor, the patient can get rid of sciatica-related symptoms forever.

Methods of surgical treatment of sciatica

Surgical treatment of sciatica can be performed in two ways. The doctor decides about the choice of method. The first method is discectomy. It is performed under general anesthesia, placed on the abdomen. The doctor makes a few centimeter cuts in the skin, then moves the paraspinal muscles away, and then proceeds to remove the part of the disc that puts pressure on the nerve roots.

Currently, microdiscectomy is the “gold standard” of surgical treatment of sciatica performed at the Dworska Hospital. Its undoubted advantage is minimal invasiveness and no need for long hospitalization after surgery, as well as shortening the period and recovery after the procedure. The treatment is relatively simple and safe, and it does not require any special preparation from the patient before the procedure. The operation itself involves the removal of a fragment of the intervertebral disc with the use of micro-tools and an operating microscope. The tools are inserted through a small - up to 3 cm - incision in the skin and muscles. Usually, patients can walk on the second day after the surgery and hospitalization lasts about three days. An important aspect of the operation is that acute pain disappears immediately. Surgical treatment at the Dworska Hospital includes both preoperative and postoperative diagnostics.

Rehabilitation after sciatica surgery

It usually takes 1 to 3 months to recover from surgery. Correct rehabilitation after surgery is essential for full recovery. Its course is determined by a doctor or physiotherapist, you should not take any actions on your own, as this may lead to dangerous complications.

Rehabilitation after sciatica surgery should begin in the first 24 hours after the procedure. Initially, it consists of instructional and simple deep stabilization exercises. The stitches are usually removed 7-10 days after the procedure. For the first two weeks after the procedure, it is recommended to avoid staying in a forced position (e.g. sitting) to a minimum. The patient can rest in a supine position. You can also stand and walk, as long as it is not for long periods.

Wearing a lumbar corset is helpful in stabilizing the spine after the surgery - it is important not to make the decisions yourself, without the participation of a physiotherapist or a doctor. A corset is sometimes indispensable when moving outside the home, but at home and while sleeping, it should not be worn in order not to “laze” the stabilizing muscles. Exercises recommended by the physiotherapist should be performed to strengthen stabilization. After 4-6 weeks after the surgery, a follow-up visit is recommended to check the effects of the treatment and to establish further rehabilitation.

Sciatica, even if it is recurrent, is not a sentence, but the paralyzing pain can be quickly and easily eliminated. The prerequisite, however, is a comprehensive diagnostic examination and the use of an appropriate treatment method, as well as subsequent rehabilitation. It is good if all these stages are carried out by one team, then the treatment is most effective.

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