sciatica

Sciatica

Sciatica is the term used when we have referenced pain down the leg, which often spreads from the seat (gluteal region) or back, towards the hip, further on the outside of the thigh, through the inside or outside of the calf and in some cases all the way to the foot.

 

The symptoms that occur, both sensory (change in sensitivity and / or numbness) and motor (muscle weakness), depend on which nerve root or nerve roots are affected / nauseated. The cause of true sciatica is usually nerve irritation due to damage to the intervertebral discs, prolapse or stenosis. Below you will also find recommended exercises.



False sciatica, on the other hand, is usually caused by dysfunction in the muscles and joints - such as piriformis syndrome, joint locks and / or seat myalgias. People with heavy physical jobs from an early age, and those who move too little, are at higher risk of developing such disc changes / injuries.

 

It is important that you take sciatica symptoms / complaints seriously and have it examined by a clinician. Feel free to contact us Our Facebook page if you have any questions or comments.

 

prolapse-in-lumbar

- Disc prolapse in the lower back may be a cause of sciatica symptoms / ailments. This is an example of what we call real sciatica. Contact a clinician if you have such symptoms - that way you can get optimal advice, referral to imaging (if needed), specific exercises and customized treatment.

 

Definition of sciatica

Sciatica is a term that describes more a symptom than a specific diagnosis or disease. It means pain along the sciatic nerve distribution - so in that way it is more of a general term, but if you start talking about certain areas and nerve roots that are affected, then you get a more specific diagnosis.

 

As for example if the nerve irritation is due to pelvic locking combined with piriformis syndrome on the right side. then you have the diagnosis 'iliosacral joint locking / restriction with associated piriformis syndrome' (an example of false sciatica) - and if the sciatica symptoms are due to a disc herniation then the diagnosis can be 'disc disorder / disc prolapse in L5 / S1 with root affection against the right S1 nerve root' (an example of real sciatica).

 

Causes of sciatica

As mentioned, symptoms of sciatica are caused by irritation or pinching of the sciatica nerve - and the symptoms can vary depending on where the pinching is and what it is that is the cause. Here are some of the most common causes that can cause sciatica symptoms / pain:

 

False sciatica / sciatica

It is important to remember that we also have - in contrast to disc herniation / disc disorder - what is called false sciatica, also known as sciatica. This is when myalgias, tight muscles, most often the gluteal muscles and piriformis, in combination with joint restrictions in the pelvis / lower back - puts pressure on the sciatic nerve, and thus gives symptoms that are related to real sciatica.

 

False sciatica can be treated conservatively through trigger point therapy, stretching, joint mobilization and soft tissue work - as well as custom exercises, such as said. It is important to consult a musculoskeletal expert (such as a chiropractor or manual therapist - both of whom have the right to refer to imaging if needed) for help in diagnosing false and true sciatica.

 

Also read: - 5 Exercises against Sciatica

VIDEO (in this video you can see all the exercises with explanations)

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Lumbar spinal stenosis as a cause of sciatica

Lumbar indicates that there is talk of the lumbar spine, and spinal stenosis means that there are tight nerve conditions in the spinal canal inside the spine itself. This can lead to nerve irritation or nerve pinching due to the fact that the spinal cord itself (the part of the central nervous system that lies inside the spine itself) passes through this spinal canal. Spinal stenosis mainly affects the elderly population due to wear and tear / osteoarthritis and age-related bone deposits in the back or neck joints. Spinal stenosis is common in the elderly population and is related to wear and tear. You can read more about this diagnosis here (in Danish) - as well as read more about forms of treatment and good symptom-relieving measures.

Also read: - Spinal stenosis of the lower back

 

 

Lumbar prolapse as a cause of sciatica

This describes a disc disorder in which the soft mass in one of the intervertebral discs in the lumbar spine (lumbar spine) has pushed through the more fibrous outer wall. Lumbar prolapse can be asymptomatic or symptomatic - depending on whether there is pressure on nearby nerve root / nerve roots. In folklore, the condition is often incorrectly called disc slipping - this is incorrect as the discs are stuck in between the vertebrae and can not be 'slipped out'. In the picture below you see an illustration of how the nerve root can be pinched by disc herniation. You can read more about this diagnosis here (in Danish).

Also read: - Prolapse of the lower back

 

Pregnancy-related sciatica

Due to the weight and position of the fetus, there may be pressure on the sciatic nerve, especially in more exposed positions - such as sitting. This is normally not dangerous for either the mother or the child, but can cause numbness and less feeling in the feet which can indirectly lead to loss of balance and consequent falls. It is also important to remember that pregnant women in many cases experience pelvic problems and changes in the pelvic position - which can lead to joint restrictions in the pelvis and lower back, as well as associated myalgias in the buttocks and lower back.

 

Spondylolisthesis

'Spondylo' indicates that this is a vertebra - and 'listese' means that there has been a 'slippage' of this vertebra in relation to the vertebra below. Anterolysis means that the vortex has had a forward slide and retrolistesis means that the vortex has slid backwards.

 

To get a better picture of what this means, we choose to show you an X-ray of this condition. On the radiograph here, which shows the lumbosacral columnalis (lower back and pelvis - seen from the side) laterally, then we see how L5 (the lower vertebra in the lumbar spine) has slid forward in relation to the vertebra below, ie S1. This is what we call spondylolisthesis. Gymnasts and gymnasts have a much higher risk of developing this condition in comparison to the general population.

Spondylysis of L5 over S1 seen by X-ray.

A significant spondylolisthesis of L5 over S1 seen x-ray diagnostic imaging.



 

Symptoms of sciatica

Typical symptoms are radiant or sore leg pain / ailments. Often called ice cream pain. The symptoms will vary depending on whether or not a nerve root is affected - as mentioned, a prolapse may be asymptomatic if there is no pressure against nearby nerve roots. If there is actually root infection (pinching of one or more nerve roots), the symptoms will vary depending on which nerve root is affected. This can cause both sensory (numbness, aching, radiation and impaired sensation) as well as motor (reduced muscle power and fine motor) symptoms.

 

Root infection against S1 (may occur in prolapse in L5 / S1)

  • Sensory sensation: Impaired or increased sensation may occur in the associated dermatoma that goes completely down to the big toe.
  • Motor skills: The muscles that have their nerve supply from S1 can also be experienced weaker during muscle testing. The list of muscles that can be affected is long, but often the impact is most visible when testing the strength of the muscle that is to bend the big toe backwards (extensor hallucis longus) e.g. by testing against resistance or testing of toe lifts and toe gaits. That muscle also has supply from the nerve L5, but receives most signals from S1.

 

Red flags / severe symptoms

If you have experienced that it is difficult to start a jet when you are on the toilet (urine retention) or have experienced that the anal sphincter does not work properly (that the stool goes 'straight through'), then these can be very serious symptoms that should be investigated with your GP or emergency room immediately for further investigation, as this may be a sign of Cauda Equina Syndrome. On a general basis, we recommend that you always consult a publicly licensed primary care physician (physician, chiropractor, or manual therapist) for assessment if you have sciatica symptoms / ailments.

 

Disc prolapse can be asymptomatic

You do not need sciatica because you have a disc prolapse. Many people still believe that everyone with prolapse must have surgery, but this is not the case. Research has shown that many in the adult population have a prolapse or disc herniation in the back, without this leading to symptoms.

 

In fact, the vast majority of people with prolapse do not have back pain. Whether the prolapse gives rise to pain or not, the therapist must consider in each individual case. A proven prolapse is therefore not synonymous with a serious back disorder or sciatica. It is safe to go for treatment with disc herniation.

 

Diagnosis of sciatica

A clinical examination and history collection will be central to making the diagnosis and finding the reason why you have sciatica symptoms / ailments. A thorough examination of muscular, neurological and articular function is important. It should also be possible to exclude other differential diagnoses.

 

Neurological symptoms of sciatica

A thorough neurological examination will examine strength of the lower extremities, lateral reflexes (patella, quadriceps and Achilles), sensory and other abnormalities.

 

Image diagnostic investigation of sciatica (X-ray, MRI, CT or ultrasound)

X-rays can show the condition of the vertebrae and other relevant anatomical structures - unfortunately it can not visualize relevant soft tissue and the like, but it can, among other things, help to see if it can be about lumbar spinal stenosis. In MRI examination is what is most frequently used to diagnose when there are long-standing sciatica symptoms / ailments that do not respond to conservative treatment. It can show exactly what is the cause of nerve compression. In those patients who cannot take MRI due to contraindications, CT can be used with contrast to evaluate the conditions. The contrast fluid is then injected in between the vertebrae of the lower back.

 

X-ray of 'sciatica' (spinal compression due to calcifications)

wear related-spinal stenosis-X-rays

This radiograph shows wear / osteoarthritis-related wear as a cause of nerve compression in the lower back. X-rays cannot visualize soft tissue well enough to indicate the condition of the intervertebral discs.

MRI image of sciatica due to prolapse in the lower back between L3 / L4

MRI-spinal stenosis-in-lumbar

This MRI examination shows spinal pinching in between the lumbar vertebra L3 and L4 due to a disc prolapse.



CT image of sciatica due to lumbar spinal stenosis

ct-with-contrast spinal stenosis

Here we see a contrast CT image showing lumbar spinal stenosis. CT is used when a person cannot take an MRI image, e.g. due to metal in the body or implanted pacemaker.

 

Treatment of sciatica

With sciatica symptoms / ailments it is important to find the cause so that one can optimize the treatment and the course of treatment. This can involve physical treatment of nearby tight muscles and joint treatment of rigid joints to ensure the best possible function. Traction treatment (commonly referred to as tension bench) can also be a useful tool to remove the compression pressure away from the lower vertebrae, discs and nerve roots.

 

Other treatment methods are dry needling, anti-inflammatory laser treatment and / or muscular pressure wave treatment. Treatment is of course combined with gradual, progressive training. Here is a list of treatments used for sciatica. The treatment can be performed by, among others, public health-authorized therapists, such as physiotherapists, chiropractors and manual therapists. As mentioned, it is also recommended that treatment be combined with training / exercises.

 

Physical treatment: Massage, muscle work, joint mobilization and similar physical techniques can provide symptom relief and increased blood circulation in the affected areas.

physiotherapy

Physiotherapy: It is generally recommended that patients with sciatica be instructed to exercise properly through a physiotherapist or other clinician (eg, a modern chiropractor or manual therapist). A physiotherapist can also help with symptom relief.

Surgery / surgery: If the condition worsens significantly or you do not experience improvement with conservative treatment, surgery may be necessary to relieve the area. An operation is always risky and is the last resort.

Joint Mobility / Chiropractic Joint Correction: Studies (including a major systematic review study) have shown that spinal joint mobilization is effective against acute sciatica pain (Ropper et al, 2015 - Leininger et al, 2011).

Chiropractic treatment - Photo Wikimedia Commons

Traction bench / cox therapy: Traction and traction bench (also called stretch bench or cox bench) are spinal decompression tools that are used with relatively good effect. The patient lies on the bench so that the area to be pulled out / decompressed ends up in the part of the bench that divides and thus opens up the spinal cord and relevant vertebrae - which we know provides symptom relief. The treatment is most often performed by a chiropractor, manual therapist or physiotherapist.

 

Sciatica surgery?

A very small proportion of patients with sciatica are operated on and / or benefit from surgery. You should be considered for surgery if you have unbearable pain, which cannot be relieved, or have severe paralysis of the feet and legs that worsens due to nerve compression. The therapist will refer to surgery when applicable. In case of urination disorders due to paralysis of the urinary bladder or anal sphincter problems, always refer to the assessment of surgery immediately. From experience, many recover while waiting for surgery.

 

In the "recent medical age", the last 30-40 years, there has been a tightening in criteria of symptoms that lead to surgery, due to the danger of increased back symptoms and severe relapse over time in back surgery - and that it has been seen that conservative treatment (physical treatment, joint mobilization, traction treatment combined exercises / specific training) has very good results, as well as almost no negative side effects. That is why, as a modern clinician with a sense of evidence and research, one chooses'training in front of the scalpel'.

 



Measures to reduce the occurrence of sciatica

Here are some general advice and tips for sciatica symptoms / ailments, though We recommend anyone who experiences such symptoms to contact a clinician for examination / eventual treatment. This way you are sure what the symptoms are and you will also be instructed in the best exercises tailored to you.

- Move the toes and ankle to stimulate the nerve pathways to the muscles.

- Use painkillers if necessary, for acute pain, ibux and paracetamol in combination can give a summative effect - 1 + 1 = 3! … As ibux has more anti-inflammatory properties, while paracetamol contains other active ingredients to reduce pain perception. Always consult a doctor or pharmacist before taking medication.

- Find movements and positions that reduce the pain in the leg, avoid movements and positions that increase these.

Short-term use of crutch if absolutely necessary

- Cold treatment: Place an ice pack on the lower back for 10-15 minutes. Repeat 3-4 times / day. follow Icing protocol. Biofreeze can also be used.

- Lie on your back with a bend in your knees and hips with your legs on a chair (so-called emergency position).

- A little movement is good even if you have great pain, such as strolling around the house. Take many short walks rather than a long one.

- Massage or be massaged in the thighs, seat and calves, this can relieve.

- Sit as little as possible. The pressure in the disc is greatest when you sit.

Also read: - 8 Good Advice and Measures against Sciatica

 

 

How to prevent sciatica?

Sciatica is best prevented in daily life through activity and movement that maintains the back muscles and provides circulation and lubrication to joints and discs. If you have problems with your back, there may be acute deterioration in the form of sciatica. Therefore, take your back seriously and do not wait to seek help from a therapist. Use common sense with especially heavy and heavy loads, not lifting ability.

 

Exercises against Sciatica

Here you will find an overview and list of exercises we have published in connection with the prevention, prevention and relief of sciatica, sciatica pain, sciatica and other relevant diagnoses.

 

Overview - Training and exercises against sciatica:

5 Good Exercises Against Sciatica

5 yoga exercises for hip pain

6 strength exercises for stronger hips

 

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Also read: - The 5 Worst Exercises If You Have Prolapse

 

Frequently asked questions about this topic:

How long does false sciatica take before it gets good?

The time it takes before you get rid of false sciatica or sciatica depends on how quickly you get into the very cause of the symptoms. This can be, for example, tight muscles of the seat and piriformis syndrome and / or pelvic joint / transition to the lower back. We recommend that you go to a clinic to diagnose the very reason why you experience nerve irritation / nerve pain down the bone.

 

Where's the sciatica nerve?

The sciatic nerve is the body's longest nerve. It is a large, thick nerve that is really a collection of long nerve fibers. It starts in the lower back, goes through the pelvis and seat to the back of the thighs and calves, and ends up at the front of the toes. On the way down, it supplies many different structures with nerve impulses, including muscles, tendons, ligaments, joints, veins and skin.

 

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Sources:

  1. Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica." The New England Journal of Medicine.372 ( two:10.1056 / NEJMra1410151.PMID 25806916.
  2. Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd (2011). «Spinal Manipulation or Mobilization for Radiculopathy: A Systematic Review». Physical Medicine and Rehabilitation Clinics of North America. 22 ( two:10.1016 / j.pmr.2010.11.002. PMID 21292148.
  3. Toueq et al (2010). Prevalence of spondylolisthesis in a population of gymnasts. Stud Health Technol Inform. 2010; 158: 132-7. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/20543413

 

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Photos: Wikimedia Commons 2.0, Creative Commons, Freestockphotos and submitted reader contributions.

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