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SCIATICA – A SYMPTOM OR A DISORDER?

Posted Jun 01 2010 6:10am

          The sciatic nerve is the largest nerve in the human body.  Its diameter is about the size of a human finger.  Sciatica actually refers to pain resulting from irritation of the sciatic nerve.  Typically the pain is felt from the low back to behind the thigh and radiating down below the knee.  Further, sciatica usually affects one side of the body.  The term is a symptom caused by a disorder occurring in the lumbar spine.  The pain varies – it can be dull,  burning, sharp or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg.  Then, sciatica normally extends below the knee and may be felt in the feet.  Sometimes it is characterizes by tingling and numbness.  Trying to stand up or sitting for long periods of time can be difficult and painful, and coughing or sneezing may intensify the pain. 

          Sciatica should be looked at as a symptom of a “pinched nerve” that affects one or more of the lower spinal nerves.  The nerve might be pinched inside or outside of the spinal canal as it passes into the leg.  There are many conditions that cause sciatica, but the most frequent cause is a herniated or slipped disc that causes pressure on the nerve root.  Degenerative disc disease, a natural biological process associated with aging, is known to cause disc weakness that can be a precursor to a disc herniation.  Piriformis   syndrome is another cause that develops when the piriformis muscle (a small muscle located deep in the buttocks) becomes tight or spasms.  This can also irritate the sciatic nerve by putting pressure on it.  Spinal stenosis is a condition that results from narrowing of the spinal canal – it can also put extreme pressure on the nerves.  Finally, spondylolisthesis can cause sciatica by narrowing the opening through which the nerve exits – it is a slippage of one vertebra so that it is out of line with the one above it.

          There are several options for treatment of sciatica.  Most often patients will be instructed to participate in a customized physical therapy plan of care (including specific exercises) and to use medication that will treat the pain and inflammation.  Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise.  There are several over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs) which include ibuprofen (such as Motrin or Advil), naproxen (such as Naprosyn or Aleve) and aspirin.  Muscle relaxants, i.e. cyclobenzaprine (Flexeril) might have to be prescribed to relieve the discomfort associated with muscle spasms.  Depending on how severe the pain is, prescription pain medicines could also be used initially.  Further, an injection of a cortisone-like anti-inflammatory medicine into the lower back might help reduce swelling and inflammation of the nerve roots.  This will also allow for increased mobility.  Finally, surgery could be needed for those who do not respond to conservative treatment.  However, sciatic pain usually goes away with time and rest.  Most people with sciatica (80 – 90 percent) will get better without surgery. Close to half of those affected recover from an episode within approximately six weeks.

          Degenerative disc disease, accidental falls and back strain due to pregnancy are some of the sources of sciatica that are not preventable.  Although it may not be possible to prevent all cases of sciatica, you can take certain steps to protect your back and reduce your risk.  Prevention would include practicing proper lifting techniques by lifting with your back straight and bringing yourself up with your hips and legs and holding the object close to your chest.  As with just about everything theses days, avoid or stop cigarette smoking – this promotes disc degeneration.  It is extremely important to exercise regularly to strengthen the muscles of the back and abdomen because these work to support your spine.  Good posture helps to relieve pressure on the lower back so be sure to use good posture when you are standing, sitting and sleeping.  Last, you need to avoid sitting for long periods of time.

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