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10 February, 2010

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Sciatica

Sciatica is nerve pain arising from the sciatic nerve. It can be produced by pressure on the nerve, where it passes through the buttock. Sciatica can be brought on by sitting on a hard seat. When your leg goes to sleep, that is also a form of sciatica.

The sciatic nerve is a large nerve, formed from nerve roots that originate from the spinal cord. These nerve roots pass out between the disc spaces and join up to form the sciatic nerve. It passes from the spine into the buttock, then into the back of the thigh and leg. The sciatic nerve controls sensation and function to the leg and foot. In sciatica, prolapsed or 'slipped' discs tend to bulge and press on the intervertebral nerve(s). This pressure irritates the nerve, causing referred pain.

Most cases of sciatica resolve by themselves within six weeks to three months. Sciatica can also be caused by narrowing of the nerve tunnel between discs due to osteoarthritis. Elderly people who suffer from disk degeneration as a consequence of ageing tend to be troubled the most by sciatica.

Symptoms
The symptoms of sciatica include:

Hot pain in the buttock
Aching in the buttock, back of the thigh (hamstring) and calf
Pain in the ankle and foot
Pins and needles
Increased pain when lifting, straining or coughing
Loss of power to the muscles of the leg and foot.

Lumbar vertebrae are vulnerable to injury
The area of the spine that takes the most punishment from movement and activity is the lower back, or lumbar region. This consists of five relatively large vertebrae. The discs cushioning these vertebrae are particularly susceptible to degeneration caused by ageing. The cushioning discs become progressively thinner and harder, which stresses this portion of the back and may result in a variety of lower back pain disorders, including sciatica.

Bed rest may not be helpful
Traditional advice for treating sciatica recommended complete bed rest. However, recent Australian studies have concluded that lying in bed may offer only minimal improvement, or may even exacerbate the condition. Unless specifically advised by your doctor, remaining active may be the preferred option. Gentle exercises can help. Swimming is particularly useful, as it is not a weight bearing exercise flexibility and strength can be improved without unduly stressing your back. Herniated spinal discs usually heal themselves with time.

Home remedies
Suggestions for managing sciatica include:

Rest
Over-the-counter painkillers
Ice packs
Proper posture
Resting the back by not bending, flexing or lifting heavy weights
Warm baths
Sleeping on a mattress that is neither too soft, nor too hard
Ergonomic furniture, such as chairs with lumbar support
Gentle exercises to strengthen and support the lower back.

Professional treatment options
Sciatica that doesn't resolve itself after a few days needs prompt medical attention. Professional treatment for sciatica includes:

Medication including painkillers and anti-inflammatories
Traction
Manipulative therapies such as chiropractic or osteopathy
Epidural injections that is, medication injected directly into the spine
Chemonucleolysis injection of a special enzyme into the disk
Physiotherapy including electrical stimulation of the back muscles
Alternative therapies including acupuncture
Surgery as a last resort.

Surgery procedures
The operation for sciatica that is caused by a ruptured or 'slipped' disc is called a 'partial discectomy'. Your lower back is initially x-rayed to identify the problem area. Under general anaesthetic, a small cut is made in the back, and the muscles and underlying ligaments are pushed aside. The fragments of the ruptured disc are then removed. Nine out of 10 people experience relief of symptoms following surgery. However, there is a chance of one in 20 that the pain will recommence at a later date.

Where to get help

Your doctor
Chiropractor
Osteopathic practitioner
Acupuncturist
Surgeon.

Things to remember

Sciatica is pain in the buttock and leg, caused by pressure on nerves in the lower back.
Sciatica can be caused by slipped discs, pinched nerves or some forms of arthritis.
Treatment options include rest, painkillers, epidural injections and surgery.

You might also be interested in:
Back pain.
Back problems.
Physical activity - it's important.
Pins and needles.

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