Sciatica: a pain in the backside
Sciatica refers to pain due to a problem with the sciatic nerve. It is the longest nerve in our body and in the thigh area can be as thick as a male finger. It runs from the lower back through the gluteal region and the back of the thigh all the way down to the sole of the foot and the toes.
The symptoms of sciatica vary and there are quite a few. It usually starts with some ache or occasional pain in the buttock area which could affect one or even both sides. The longer the problem causing the pain persists the further this pain can ‘travel’ down the leg along with the nerve’s location and even reach the toes. Further symptoms are tingling and numbness in the foot, and even weakness of the whole leg on weight bearing. Often these symptoms are worse in the morning when getting up, at night or when getting up from a sitting position. They usually seem to ease a bit ones you’re ‘up and a bout’. If left untreated sciatica can turn into a chronic condition which would require long term treatment and sometimes even surgery.
As a nerve doesn’t just get inflamed on its own it would be important to find the reason that initiated the inflammation. Wrong posture at work, long periods of sitting and/ or standing in the same position, overload of the lower back due to lifting heavy weights, sudden rotational movements and similar can cause some temporary pressure onto the sciatic nerve in the lower back region resulting in an inflammation. Sudden traumatic stretching or compression of the lower back region (road traffic accident, fall from a height…) or repetitive trauma (certain sport activities) are known reasons for sciatica. Numerous diseases like degenerative changes at the lumbar spine, advanced arthritis of the hip joint, osteoporotic fracture of a vertebra, a herniated disc or an infection inside the spinal canal (herpes zoster) can also be the reason for sciatica.
Sciatica can effect anyone in any age group, but it appears to be more frequent from the age of 50 on. Lower back pain is the most often diagnosis for sick leave in Europe and the USA. Sciatica is playing an important part in this. Therefore the most important part of successfully treating sciatica is the early diagnosis of this pathology.
Detailed information (anamnesis) and a thorough clinical exploration is the first and most important examination to detect a possible sciatic nerve inflammation. Radiographic images of the lumbar spine and the pelvis should be taken to exclude any bone disease or injury as the possible underlying problem. A MRI scan (special scan for soft tissue problems like herniated disc) might be needed in severe cases of sciatica (weakness of the leg, loss of reflexes) or if the applied therapy does not result in any improvement of the symptoms. In very rare occasions it might be necessary to take some liquid out of the spinal canal to confirm or exclude an infection.
Once sciatica has been diagnosed the treatment would commence immediately. This could be a specific physiotherapy approach, acupuncture, massage therapy, gentle osteopathy and similar, followed or combined by medical therapy in the form of anti- inflammatory medication administered as tablets or cremes or direct infiltrations of the inflamed nerve root with local anaesthetic and Cortisone (usually performed by orthopaedic surgeons). The important and often under- appreciated part of the treatment should follow those initial approaches. Physiotherapeutic exercises to deal with any muscular or postural problems that would contribute to the sciatic pain along with modifying certain habits like sitting position, appropriate furniture, sports activities and many more would help to prevent recurrence of the nerve inflammation.
Although the symptoms of sciatica can be severe, if diagnosed early and treated appropriately a complete remission is usually achieved. Surgical interventions are only very rarely, and mainly in cases of a structural damage, needed.source surinenglish