Sciatica by Farshid Mokhberi

ByFarshid Mokhberi

Shahid Beheshti University of Medical Sciences

What is Sciatica?Injury to or

compression of the sciatic nerve.

Low back pain that travels down through the buttock and possibly into the leg.

This pain is started slowly & increases with passes time.

It will be worse in sitting , standing , sneezing , coughing .

The feature of this pain is involving only one of the lower limb.

In lots of intensive cases of pain , probably loosing the control of bladder or intestine. In this situation surgery is necessary.

Sciatic Nerve BackgroundLargest nerve of the body.Usually a combination of

nerves roots that include: L4, L5, S1, S2, S3.

Leaves pelvis through the greater sciatic foramen and passes through gluteal region, which then enters into the posterior compartment of thigh.

Sciatic Nerve then divides into common fibular and the tibial nerve.

Physiology of sciatic pain This type of pain is caused by a problem with one or more

nerves themselves. The function of the nerve is affected in a way that it sends pain messages to the brain. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an electric shock.

Neuropathic pain is less likely than nociceptive pain to be helped by traditional painkillers. However, other types of medicines often work well to ease the pain.

Causes neuropathic painTrigeminal neuralgia.Postherpetic neuralgia (pain following shingles).Diabetic neuropathy - a nerve disorder that develops in some

people with diabetes.Phantom limb pain following an amputation.Multiple sclerosis.Pain following chemotherapy.HIV infection.Alcoholism.Cancer.Atypical facial pain.Various other uncommon nerve disorders.

Mechanism of InjuryHerniated or slipped disc.Posterior dislocations or fractures

to the hip joint

Piriformis syndrome. Inflammation of the piriformis

muscle.Pinching of the sciatic nerve.Injections to buttock.Trauma to the buttock.

Herniated DiscWith extreme forces these disc

bulges may tear the annulus fibrosus & allow leakage of nucleus pulposus

The chemicals of nucleus pulposus can cause swelling of nerves resulting in constant burning pain termed lumbar radiculopathy or sciatica, pain radiating down the leg & feet

Risk FactorsAge. Age-related changes in the spine, such as herniated disks and

bone spurs, are the most common causes of sciatica.Obesity. By increasing the stress on your spine, excess body weight

may contribute to the spinal changes that trigger sciatica.Occupation. A job that requires you to twist your back, carry

heavy loads or drive a motor vehicle for long periods may play a role in sciatica, but there's no conclusive evidence of this link.

Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.

Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

Genetics. There is two gene that maybe is cuases sciatica.

Signs and Symptoms Described as shooting or

tingling pain and sometimes numbness.

Prolonged sitting or standing can worsen pain.

Usually only occurs on 1 side of the leg.

Weakness of muscles in the posterior thigh could be due to spasm, trauma, and inflammation.

Weakness of the muscles can also show an abnormality in the patient’s gait.

Palpation of Sciatic nervePatient flexes hip,

press firmly between the ischial tuberosity and the great trochanter

The nerve is barely palpable but if injured it will become point tender.

Special Test

Special TestsStraight leg raising test should be performed to detect nerve

root irritation Even with a soft tissue pain source, SLR can be used as an

index of finding the place of pain Well Leg Straight Leg Raising Test

Lifting uninjured leg produces pain.Sitting Root Test

Patient sits with neck flexed and their knees extended, while hips are flexed at 90o. (pain is the positive sign)

Further Testing to confirm sciatica would be:Spinal X-ray MRICT Scan

Imaging Test

Imaging tests

X-ray. overgrowth of bone (bone spur) that may be pressing on a nerve.

Magnetic resonance imaging (MRI). Cross-sectional images of your back. MRI produces detailed images of bone and soft tissues such as herniated disks.

Computerized tomography (CT) scan. When CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.

Management OptionsRest IceNSAIDsMoist HeatStretching and strengtheningMassage

Long term nerve damage can occur if not treated promptly.

TherapyPharmacologic agents

Opioid analgesics Anti-inflammatories Adjuvants and nonopioid analgesics Anti Spasm ( Baclophen)

Nonpharmacologic therapies Rehabilitative Physical Therapy Psychological counseling

Epidural steroid injection•60-80 mg of triamcilone with 0.25% bupivacaine injected.

•Cortisone injection for suppress inflammation.

Surgical TreatmentDiskectomy- removal of a

portion of the herniated disc that is irritating the nerve root.

This surgery helps alleviate pressure and inflammation, if conservative management options such as the ones we just discussed do not relieve pain.

Sciatica RehabAfter back surgery, you will generally need Avoid:1- Driving2-lifting3-bending forward for about a monthThere's an excellent chance you'll be able to get

back to all your usual activities.

ExercisesFocus on exercises that

strengthen and stretch the abdominal and back muscles for core stabilization.

Decreases muscle imbalance, which can result in decreasing spasm and pain.

PreventionMaintain a healthy diet and weight Do not using pocket bagExercise regularly Maintain proper posture Avoid prolonged inactivity or bed rest Do not smoke Use good body mechanics when liftingNot sleeping on your stomach

The time to visit a doctorThe pain is usually becomes better after 2 weeks, but

if it lasts more that 6 months you should visit a Dr.If the pain is becoming more severe every day in this

case you should also visit a Dr.Other conditions that necessary to visit a Dr.• Having an accident• Having the most severe pain at the first time with lack

of sensation• Having problem on defecation

Thanks for your attention

Sourceswww.rullichiropractic.com

www.mayoclinic.com

www.nlm.nih.gov/medlineplus

www.emedicinehealth.com

www.spine-health.com