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Sciatica
Sciatica Definition:
Sciatica is not an injury or a disorder, but a symptom of an underlying problem involving the sciatic nerve. It is the term used to describe the pain that is felt as a result of damage to, or compression of, the sciatic nerve.
The sciatic nerve is the longest nerve in the body and is actually two nerves, the tibial and common peroneal, held together in a sheath of connective tissue. Nerve roots leave the side of the lumbar (lower) spine at intervals, eventually joining to form one large nerve that travels through the buttock and down the back of the thigh, dividing back into the tibial and common peroneal nerves at about knee level.
Causes:
A herniated disc is the most common cause of sciatica. The bulging or rupture of an intervertebral disc can compress the nerve, triggering pain.
Spinal stenosis, which is the narrowing of the spinal cord, can also compress the sciatic nerve.
Spondylolisthesis, a condition where one vertebra slips out of position and over the one beneath, can result in the nerve being pinched.
A disorder, known as piriformis syndrome, causes the muscle that connects the lumbar spine to the thighbone to spasm or get tight, placing pressure on the nerve.
A tumor on the spine can also press on the sciatic nerve.
An accident or some trauma to the nerve root, such as a hip dislocation, can trigger sciatica.
Osteoarthritis, or wear and tear on the vertebral joints, is another possible cause.
Sometimes pressure from the uterus during pregnancy can compress the nerve and cause pain.
An injection into the buttock muscle, improperly administered, can also be a cause.
Sciatica Risk factors:
Aging. Being over 40 increases the risk.
A job that involves prolonged sitting, heavy lifting or twisting.
Diabetes increases the risk of damage to nerves.
A sedentary lifestyle.
Sciatica Symptoms:
Sciatica can be felt anywhere along the path of the sciatic nerve, but typically it is felt as pain radiating from the lumbar spine into the buttock and down the back of one leg.
The type of pain varies. It can be constant or just from time to time. It can be felt as a mild ache, a burning sensation, or even as an electric shock. A tingling, pins-and-needles feeling is common. Numbness and/or weakness felt anywhere in the leg is also possible.
Pain from sciatica tends to be worse when sitting for a long time, coughing, sneezing or straining to pass a stool.
If very severe pain is accompanied by a loss of bladder or bowel control, or if such symptoms are experienced after an accident, call for immediate medical help. You may have cauda equine syndrome, a serious condition where the entire bundle of nerves has been damaged.
It is rare for sciatica to cause any permanent damage, and most symptoms disappear with time and self-treatment.
Sciatica Diagnosis:
Your health care provider will take your medical history, ask questions concerning the onset and severity of your symptoms, and perform a physical examination. This will include testing muscles for strength and also testing your reflexes.
For very severe or long lasting pain, an x-ray or a CT or MRI scan might be needed.
Sciatica Treatment:
Most cases of sciatica are resolved within a few days to a few weeks, and nearly all cases within 6 to 12 weeks. Time and self-treatment are usually all that are needed.
Self-help options:
Do not stay in bed unless the pain is so severe that you are really unable to get up. It has been found that bed rest tends to make the pain worse, and also leads to weaker muscles. Instead, reduce your activity for the first few days and start with some very gentle exercises as soon as you are able. Exercise is known to stimulate the production of endorphins, which are our natural painkillers.
When the pain is acute, apply ice, crushed in a bag and wrapped in a towel, to the site of the pain. Keep it there for 15 minutes and repeat several times a day. After 2 or 3 days, when the pain has eased, you can apply heat.
Over the counter medication will ease pain and reduce inflammation. You can take acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil).
A physiotherapist can supervise a gentle and gradual return to exercise, and teach specific exercises to improve posture, build muscle strength and increase flexibility.
Acupuncture, chiropractic, osteopathy and massage are other treatment options that might help with sciatica.
Your doctor may prescribe stronger medication if needed. Such medication might be an anti-inflammatory combined with a muscle relaxant, or perhaps antidepressants, which block pain messages to the brain and also produce endorphins. An epidural steroid injection is also a possibility. These reduce inflammation around the nerve, thereby relieving pain. Such injections can produce unwanted side effects, however, so they can only be given a limited number of times.
Rehabilitation exercises:
Be guided by your health care provider who will be able to give you information and supervision as you begin rehabilitation. You will probably be able to start with low impact exercises in water, and using a stationary bicycle. As the pain eases, you should add in aerobic exercise and muscle and core strengthening exercises.
Hamstring stretch:
Most of us have tight hamstrings, and stretching them nearly always improves sciatic pain.
Lying down on your back, raise the affected leg into the air. Using your hands, a towel or exercise belt, hold it behind the knee. Slowly start to straighten the knee until a stretch is felt. The aim is to eventually straighten the knee enough so the sole of the foot is facing the ceiling, but it may take some time to achieve this. Hold the stretch for 10 seconds to begin with, gradually working up to 30 seconds.
Extension:
This exercise is helpful if your sciatica is due to a herniated disc.
Lying on your stomach on the floor, gently prop yourself up on your elbows. Go carefully as this can cause some discomfort at the beginning. Hold for 5 seconds, working up to 30 seconds. Repeat the exercise 10 times.
Prevention:
Develop a regular exercise regime.
Maintain good posture.
Take care when lifting heavy objects.
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