SCIATICA

SCIATICA

General Infomation
Definition: 

The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. The term "sciatica" refers to pain that radiates along the path of this nerve — from your back down your buttock and leg.
Sciatica isn't a disorder in and of itself. Instead, sciatica is a symptom of another problem involving the nerve, such as a herniated disk. Depending on the cause, the pain of acute sciatica — which you may find considerably uncomfortable — usually goes away on its own in four to eight weeks or so.
In the meantime, self-care measures may help you ease sciatica. Some times, your doctor will suggest other treatment.

Symptoms: 

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting also can aggravate symptoms. Usually only one lower extremity is affected.
Sciatica symptoms include:
• Pain. It's especially likely to occur along a path from your low back to your buttock and the back of your thigh and calf.
• Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another.
• Tingling or a pins-and-needles feeling, often in your toes or part of your foot.
• A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that requires emergency care. If you experience either of these symptoms, seek medical help immediately.

Causes & Complication
Causes: 

Your sciatic nerve runs from your spinal cord to your buttock and hip area and down the back of each leg. This nerve controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet.
Sciatica frequently occurs when a nerve root is compressed in your lower (lumbar) spine — often as a result of a herniated disk in your lower back. Disks are pads of cartilage that separate the bones (vertebrae) in your spine. They keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move.
But as you grow older, the disks may start to deteriorate, becoming drier, flatter and more brittle. Eventually, the tough, fibrous outer covering of the disk may develop tiny tears, causing the jelly-like substance in the disk's center to seep out (herniation or rupture). The herniated disk may then press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the middle or lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot.
Although a herniated disk is a common cause of sciatic nerve pain, other conditions also can put pressure on your sciatic nerve, including:
• Lumbar spinal stenosis. Your spinal cord is a bundle of nerves that extends the length of your spine. It's housed inside a channel (spinal canal) within the vertebrae. Nerves branch off the spinal cord, providing communication between your brain and the rest of your body. In spinal stenosis, one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of the branching nerves. When the narrowing occurs in the lower spine, the lumbar and sacral nerve roots may be affected.
• Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves your spine.
• Piriformis syndrome. Running directly above the sciatic nerve, the piriformis muscle starts at your lower spine and connects to each thighbone (femur). Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the sciatic nerve. The pain may radiate down the back of your thigh but doesn't extend below the knee. Prolonged sitting, car accidents and falls also can contribute to piriformis syndrome.
• Spinal tumors. In the spine, tumors can occur inside the spinal cord, within the membranes (meninges) that cover the spinal cord, or in the space between the spinal cord and the vertebrae. As it grows, a tumor compresses the cord itself or the nerve roots.
• Trauma. A car accident, fall or blow to your spine can injure the lumbar or sacral nerve roots.
• Sciatic nerve tumor or injury. Sometimes, the sciatic nerve itself may be affected by a tumor or injury.
• Other causes. In some cases, your doctor may not be able to find a cause for your sciatica. A number of problems can affect your bones, joints and muscles, all of which could potentially result in sciatic pain.

Risk Factors: 

Risk factors are health problems, lifestyle choices and inherent qualities, such as age or race, that make it more likely you'll develop a particular condition. Major risk factors for sciatica include:
• Age. Age-related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 30, and most people who develop herniated disks are in their 30s and 40s.
• Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica.
• 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.

Complications: 

Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including:
• Loss of feeling in the affected leg
• Loss of movement in the affected leg
• Loss of bowel or bladder function

Tests
Tests and Diagnosis: 

To help diagnose sciatica and pinpoint which nerves, if any, are affected, your doctor will ask about your medical history and perform a thorough physical exam, paying special attention to your spine and legs.
You're also likely to have some basic tests that check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during these activities.
If your pain lasts longer than four weeks or is very severe, or you have another serious condition such as cancer, you may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes for your symptoms.
These tests include:
• Spinal X-ray. Because ordinary X-rays can't detect herniated disk problems or nerve damage, they're not usually helpful for pinpointing the cause of sciatica. A spinal X-ray can show most cancers affecting the bony structures of the spine, narrowed disks and spondylolisthesis, however, and can help rule out other causes of nerve root impingement.
• Magnetic resonance imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments as well as the presence of tumors. MRI is noninvasive and has no harmful side effects.
During the test, you lie on a movable table inside the MRI machine, which is essentially a large magnet. If you have a hard time lying still for the required period of time or you're anxious about the enclosed space, you may be given a sedative. Some MRI units may be wider, shorter or open on all sides, which may be more comfortable for you, although the quality of images taken with these systems may vary.
• Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body. 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.

Medication & Prevention
Treatments and Drugs: 

For most people, sciatica responds well to self-care measures. These may include use of hot packs or cold packs, stretching, exercise and use of over-the-counter (OTC) medications. Beyond the self-care measures you may have taken, your doctor may recommend the following:
• Physical therapy. If you have a herniated disk, physical therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries.
Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor will have you start physical therapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home.
• Prescription drugs. In some cases, your doctor may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, your body's natural painkillers.
More aggressive treatments
When conservative measures don't alleviate your pain within a few months, one of the following may be an option for sciatica treatment:
• Epidural steroid injections. In some cases, your doctor may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels, corticosteroids suppress inflammation around the irritated nerve, thereby helping to relieve pain.
Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited — usually no more than three in one year.
• Surgery. This is usually reserved for times when the compressed nerve causes significant weakness, bowel or bladder incontinence, or you have pain that gets progressively worse or doesn't improve with other therapies.
Surgical options include lumbar laminectomy and microdiskectomy. In lumbar laminectomy with diskectomy, surgeons remove a portion of a herniated disk that's pressing on a nerve. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiskectomy).
Success rates of standard diskectomy and microdiskectomy are about equal, but you may have less pain and recover more quickly with microdiskectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks.

Lifestyle and Home Remedies: 

For most people, sciatica responds well to self-care measures. You'll heal more quickly if you continue with your usual activities, but avoid what may have triggered the pain in the first place. Although resting for a day or so may provide some relief, prolonged bed rest isn't a good idea. In the long run, inactivity will make your signs and symptoms worse.
In addition to resuming usual activities, try the following measures:
• Cold packs. Initially, using cold packs may be able to reduce inflammation and relieve discomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply to the painful areas for 15 to 20 minutes at least several times a day.
• Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
• Stretching. Stretching exercises for your low back can help you feel better and may help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.
• Over-the-counter medications. Pain relievers (analgesics) fall into two categories — those that reduce pain and inflammation and those that only treat pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and acetaminophen (Tylenol, others) can both be helpful for sciatica.
Although they can provide real relief, both types of medication have a "ceiling effect" — that is, there's a limit to how much pain they can control. If you have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. What's more, NSAIDs can cause side effects such as nausea, stomach bleeding or ulcers, and acetaminophen can cause liver problems if taken in excess.
If you use these medications, talk to your doctor so that you can be monitored for problems. In addition, periodically re-evaluate whether you still need them. Exercise, stretching, massage and other nondrug treatments can often provide the same benefits without side effects.
• Regular exercise. It may seem counterintuitive to exercise when you're in pain, but regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts your body to release endorphins — chemicals that prevent pain signals from reaching your brain.
Early in the course of sciatica, water exercise or other low-impact exercise such as a stationary bicycle will help you stay active without worsening your symptoms. Later, as you improve and the pain lessens, combining aerobic activity with strength training and core stability exercises that improve the strength of your back muscles can help limit the effects of age-related degenerative changes in your back.
If you're new to exercise, start out slowly and progress to at least 30 minutes most days. To prevent injury, consider learning proper weightlifting techniques from a certified personal trainer, fitness specialist or physical therapist.

Alternative Medicine: 

Complementary and alternative medicine (CAM) refers to medical and health care systems, practices, and products that aren't currently part of conventional medicine — the care you receive in your primary care doctor's office. Many of these therapies are being studied intensely, and some have proved to help alleviate back pain.
• Acupuncture. This therapy is based on the idea that your health depends on a vital energy called qi — pronounced "chee" — that flows along pathways in your body. It's believed that when qi is blocked, disease and pain result and that inserting fine needles into specific points along the pathways unblocks energy flow and restores balance.
During an acupuncture treatment, you'll have hair-thin needles inserted into your skin. In most cases, you won't feel the needles — in fact, many people find the treatments extremely relaxing.
Research into acupuncture's safety and efficacy has been inconsistent. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide you'd like to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
• Chiropractic. Chiropractic treatment is based on the philosophy that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain.
Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm.
Some studies done on spinal manipulation have found it to be as effective and safe as standard treatments, especially for initial pain relief, though the optimal number of treatments is unknown.
• Massage. It's difficult to conduct objective clinical trials in massage due to variances in practitioners and in massage types. However, studies that have been conducted suggest that massage may ease low back pain symptoms.
• Hypnosis. Hypnosis produces an induced state of deep relaxation in which your mind stays narrowly focused and open to suggestion. During hypnosis, you can receive suggestions designed to decrease your perception of pain and increase your ability to cope with it. No one knows exactly how hypnosis works, but it may alter your brain wave patterns in much the same way as other relaxation techniques.

Prevention: 

It's not always possible to prevent sciatica, and the condition may recur. The following suggestions can play a key role in protecting your back:
• Exercise regularly. This is the most important thing you can do for your overall health as well as for your back. Pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. For cardiovascular benefits, try using a stationary bike, treadmill, elliptical trainer or cross-country ski machine. Cycling outdoors also is beneficial, but be certain your seat and handlebars are adjusted properly.
• Maintain proper posture when you sit. A good chair should comfortably support your hips, and the seat shouldn't press on the back of your thighs or knees. If the chair doesn't support the natural curve in your lower spine, place a rolled towel or pillow behind your back.
When working at a computer, adjust your chair so that your feet are flat on the floor and your arms rest on your desk or the chair's arms, with your elbows bent at a right angle. Take frequent breaks, even if it's just to walk around your office.
When you drive, adjust your seat to keep your knees and hips level, and move the seat forward to avoid overreaching for the pedals.
• Use good body mechanics. Being conscious of how you stand, lift heavy objects and even how you sleep can go a long way toward keeping your back healthy. That's because poor posture stresses your back, leading to fatigue and stress on joints and nerves. If you stand for long periods, rest one foot on a stool or small box from time to time. While you stand, hold reading material at eye level instead of bending forward.
Before you lift something heavy, decide where you'll place it and how you'll get there. Bend at your knees, not your back, so that your legs do the lifting. Carry objects close to your body at about waist level. If possible, set the object down on a surface between shoulder and knee height to avoid lifting objects over your head or bending over too far. Don't twist at your waist. Instead, turn by pivoting your feet.
Be careful moving heavy things when you're tired — fatigue can cause you to move more awkwardly. Heavy loads pose the greatest risk, so know your limitations. Don't attempt to lift something you feel is beyond your ability.
For the best sleep posture, choose a mattress that feels comfortable to you. Use pillows for support, but don't use one that forces your neck up at a severe angle.

Tags:

By Anonymous on 01 June 2011