Sciatica

May 28th, 2007

Who would think that one nerve could cause such severe pain? Pressure on the sciatic nerve can force even the most hardy person to seek treatment . Sciatica. Just pronouncing it can be painful (sigh-AT-ik-ah).

Sciatica gets its name from the longest and largest nerve in the body, the sciatic nerve. It is composed of five small nerves that join together in the pelvis, after they exit the lower spine. The sciatic nerve then branches into two trunks that travel down the entire length of each leg, dividing again into smaller nerves as they reach the knees and the lower legs. Sciatica is defined as pain anywhere along the course of the sciatic nerve.

This pain can be caused when a nerve root in the lower spine that helps form the sciatic nerve is pinched or irritated.

Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also referred to as a ruptured disc, pinched nerve, slipped disk, etc.) in the lumbar spine. The problem is often diagnosed as a “radiculopathy”, meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve.

Sciatica occurs most frequently in people between 30 and 50 years of age. Often a particular event or injury does not cause sciatica, but rather it may develop as a result of general wear and tear on the structures of the lower spine. The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical treatments.

Pain That Radiates
Although it can come on gradually or virtually overnight, the main symptom of sciatica is
pain or discomfort that usually centers in the lower back and radiates down one leg. The
pain can vary greatly in intensity and location. In some cases it is minimal and feels like
a slight ache, a pins and needles feeling, or a slight numbness. In other cases, the pain can be extreme, making virtually any physical movement excruciatingly painful. And as noted, it can be felt anywhere along the length of the sciatic nerve from the lower back, hips or buttocks, all the way down the length of the legs and into the feet and toes.

Though it can affect anyone at any age, sciatica tends to be more common in men over age 40. Depending on the cause and the success of the subsequent treatment, sciatica can last fordays, weeks, months, or even years.

Causes Can Vary
Sciatica can result from a number of causes. Most commonly, it is caused by some part of the spine rubbing against or putting pressure on the sciatic nerve. Most often, this rubbing or pressure results when one of the discs (cushions) that sits between the vertebrae of the
spine becomes inflamed, ruptures or herniates (protrudes). What might cause these disc
problems?

Injury to the disc itself or to the ligaments around it
Arthritis in the lower back area
Constant pressure on the spine and lower back due to pregnancy, excess weight, or certain repetitive physical activities
Osteoporosis leading to fracture of the spine
Slippage of discs â€“ known as spondylolisthesis

Although much less common, sciatica can also very occasionally result when a blood clot,
abscess, or some type of growth or tumor puts pressure on the sciatic nerve. As odd as it
may seem, some men may be more susceptible to sciatica because they carry their wallets in their back pockets, at the exact spot where the sciatic nerve travels through the buttocks.
When sitting, the weight of the wallet puts pressure on and, over time, can aggravate the
sciatic nerve.

Self-infliction
The risk of self-inflicted sciatica has increased in recent years with the fashion trend of lower-hanging trousers as well as lower-positioning of the pockets. For instance, sitting on a wallet for prolonged hours every day can cause self-inflicted sciatica. Symptoms of numbness and/or pain behind the knee cap are associated with this form of sciatica.

The corrective action of removing any objects from rear pockets and not sitting on uneven surfaces can reverse the symptoms of sciatica if the damage has not been too severe.

Modern Treatment:

Treatment Is Conservative at First
In as many as 50% of all cases, sciatic pain will greatly diminish or disappear within a month with supportive treatments. Therefore, the initial treatment is generally conservative, including:

Avoidance of all strenuous physical activity
Application of ice packs for 10â€“15 minutes, sometimes alternating with heat every twenty
minutes, two or three times a day (NOTE: Never apply ice directly to the skin)
Adequate amounts of sleep. Anti-inflammatory drugs and pain relievers, such as aspirin, acetaminophen (Tylenol and others), or ibuprofen (Motrin and others)
Corticosteriods may occasionally be injected into the space around the spinal column for
temporary reduction of inflammation and relief of particularly severe acute pain. There is
little or no evidence that injections into the subdural space have any benefit in chronic pain
Kathy Shillue, a physical therapist at Boston’s Beth Israel Deaconess Medical Center,
stresses that, “Initially, you should get two to four days of bed rest, but no more than
that, followed by as much activity as can be tolerated within the limits of the pain.” Shillue also stresses that during the bed rest, you should lie on a firm mattress, keeping
your unaffected leg slightly bent, with your affected leg straight and elevated by a pillow.

Looking for the Source of Pain
Many physicians recommend initial x-rays for persons over 50, with a history of cancer, or with persistent pain or pain worse at night. If pain is very severe or causes numbness,
tingling, strange sensations, loss of sensation, difficulty in walking, or especially when
there is associated difficulty with urination, bowel movements, or (in men) erection, your
doctor or physical therapist may order tests to locate the source of the sciatica. Prompt CT scanning or magnetic resonance imaging (MRI) may be done. A type of x-ray of the spine
called a myelogram may also be performed. This involves an injection of a dye into the spine.

Treatment will depend on what the tests find and on the duration and intensity of the pain. Positive findings may lead to emergency surgery; however sciatica, no matter how painful, is only rarely a surgical emergency. For most people there is no benefit in seeking the exact location of the source of pain. Waiting 2-4 weeks for pain improvement is the usual procedure.

If the tests discover a growth, tumor, or blood clot, surgery to remove it or drugs to clear
or shrink it are usually prescribed.If the tests discover a disc problem, surgery, physical therapy, chiropractic or osteopathic treatment, or injections to reduce the inflammation are all options.

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Exercise: Probably the Best Treatment
While many treatments, including spinal manipulation, have been shown to be helpful for
treating acute sciatica, exercise has increasingly emerged as among the most important
treatments for both acute and chronic sciatica. Strengthening of core muscles is probably
helpful, as is exercise supervised by a physical therapistâ€”especially when the therapist
identifies in which directions the least pain is experienced.

Dealing With Disc Problems
Because of the risks associated with surgery, particularly around the spine, many people
will first opt for physical therapy, chiropractic, and/or osteopathic treatment to try to
ease the pressure the disc places on the sciatic nerve.If therapy doesn’t work, you may have corticosteroid injections to reduce the inflammation. Though generally less risky than surgery, the injections do entail some risk, including the
risk (though relatively low) of nerve damage. These procedures have produced mixed degrees of success in people with unrelenting sciatica, and recent studies have questioned the effectiveness of corticosteroid injections. Electro-thermal surgery is an experimental
procedure that offers an alternative to receiving injections, using electricity to heat and
shrink the swollen tissue. Some patients choose less conventional, although increasingly
more accepted, procedures such as acupuncture or biofeedback.Surgery May Be Necessary
If none of these treatments adequately control your sciatica or you have any sensory
changes, your doctor may suggest surgery. Surgery is usually a last resort though, and the desired results are not always obtained. The most common type of surgery for sciatica is a
discectomy, whereby all or part of the disc that is pressing on the sciatic nerve is removed. Since the advent of laser surgery, some patients and their surgeons now opt for
laser discectomy, a somewhat less invasive procedure whereby a laser is used to remove the portion of the disc that is pressing on the sciatic nerve. Removing part of the vertebra
that presses on the sciatic nerve is a procedure called laminotomy.Though both types of surgery are relatively safe and can reduce or eliminate the sciatic
pain, both are considered major surgery of the spinal area and only have moderate success rates. Surgery to this area always carries some degree of risk, including the risk of nerve
damage.Prevention: Taking Care of Your Back
As with most conditions, prevention is your best medicine. To avoid developing sciatica, take the following precautions:

Keep physically fit, exercise regularly, and strengthen your abdominal and back muscles.
Try to maintain good postureâ€”both when sitting and standingâ€”and avoid sitting for extended periods of time.
Avoid carrying your wallet in your back pocket, or keep its contents to a minimum.
Never bend over to lift something. When lifting an object, keep your back straight, bend
your knees, and extend your arms to grab the object. Keep it close to your body and raise it by straightening your legs.

Finally, Shillue stresses that “While it may or may not be connected to a problem with your sciatic nerve, anytime you have a loss of muscle control in the leg (or loss of bowel or
bladder control), it is imperative to seek medical attention immediately.”

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Ref:
http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=14678

http://www.spine-health.com/topics/cd/d_sciatica/sc01.html