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Sciatica - Symptoms, Causes, Diagnosis, treatment

 

What is Sciatica?

Sciatica refers to pain that radiates from the lower back, up through the buttocks and down either leg. It is often accompanied by numbness and weakness in the affected areas. The pain is typically caused by a herniated or irritated intervertebral disc between one of our vertebrae (it can also be caused other injuries of the spine). Sciatica pain usually occurs along with muscle spasms, chest pain and fatigue.

 

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Symptoms:

Sciatica symptoms are similar to those of other back pain conditions, but the pain is often more severe and chronic. The pain may occur suddenly or gradually, and may change over time from one day to the next.

Symptoms include:

Widespread, or radiating leg pain

Numbness, tingling and weakness in the legs

Pain, stiffness and swelling in the lower back and buttocks

Pain in the back of the thigh that may travel downward into one or both legs

When to see a doctor?

If pain or discomfort persists even after several weeks, or if the back or leg becomes swollen and stiff, seek immediate medical attention.

When to see a specialist?

A doctor trained in spine surgery may be able to determine whether a herniated disc is causing your symptoms and possibly recommend surgical intervention. Alternatively, an otolaryngologist (ENT) may be able to place special tubes in your ear. These devices will allow your doctor to hear your spinal nerve roots from both ends of the muscle that supplies sensations from the spine: the peripheral nerve root and the spinal nerve itself. This will allow them to hear which areas are experiencing irritation, and potentially reduce pain in those areas.

Causes:

Intervertebral discs are the shock-absorbing cushions found between each of our vertebrae. They come out at birth and begin to deteriorate throughout life, so we must replace them about every 10 years. The average person has about 20 discs in their spine.

As we age, the water content inside of our discs diminishes, causing a retrograde change in the disc height. This is known as disc degeneration and occurs in the majority of people by their early 50s. Spinal stenosis (narrowing of the spinal canal) also commonly occurs as part of normal aging processes.

The Back: A disc is surrounded by a bony ring called the annulus. This ring is continuous with the bone above and below and is fixed to the vertebrae spinal column. In most patients, there are between 4 and 9 discs between each of our vertebrae.

The Disc: The disc acts as an air bladder -- it pushes out fluid that lubricates the spinal bones, which helps them move smoothly. The fluid pressure in the disc actually moves the vertebrae laterally across each other and also up and down on a pivot point known as a longitudinal arch.

As we grow older, the air in the spinal disc compresses (usually on the side of the disc facing the inside of the spine).

The following conditions place even more pressure on that side of the degenerating disc:

Spinal stenosis – usually a normal part of aging, spinal stenosis occurs when all or part of your vertebrae, or your nerve roots inside your spine, become compressed by bony growths. Spinal stenosis can also occur from an acute injury to your spine.

A herniated or slipped disc – a bulging or ruptured intervertebral disc can irritate nerves under and around it. This irritation sends pain signals to your brain. Discs that are bulging or ruptured normally take anywhere from seven to 28 months to develop. However, some cases of herniated discs may occur suddenly by a traumatic event (sports injury, car accident).

Diagnosis:

In many cases, your doctor can diagnose sciatica by reviewing your medical history and conducting a physical examination. In some cases, x-rays or other tests may be necessary to confirm the diagnosis and help determine the best course of treatment.

Before you begin any treatments, it is extremely important that you have a clear diagnosis of sciatica. While x-rays are often used in the early stages, if sciatica continues for a long period of time or causes serious pain, other imaging options may be used (eg: CT scan or MRI scan).

Your doctor will need to obtain detailed information about your medical history and lifestyle because this information will give them an idea about possible underlying causes of your sciatica. For example, they will want to know if you have any other health conditions that might be causing or contributing to your sciatica, such as an inflammatory disease (such as asthma or arthritis), degenerative disc disease, bone structure abnormalities such as osteoporosis, and/or certain spinal disorders.

Other tests will include a physical exam and possibly an electrodiagnostic test (such as a nerve conduction study). A nerve conduction test is really a neurological exam that tests the speed and strength of nerve signals from the legs. The patient is asked to stand up from a sitting position without flexing their legs. This test tells your doctor which nerves are affected and how weak they are in those nerves.

Treatment:

A herniated disc is treated by removing the pressure from the herniated spot. Your doctor may perform a variety of procedures to help relieve your pain and discomfort, including:

Laminectomy – surgery to cut away part of one or more lumbar vertebrae

Intrathecal (ie. into spinal fluid) steroids – your doctor will insert a needle into the muscle around your spinal canal. He/she will then fill the space with powerful medications (steroids). These medications will help reduce inflammation and pain in the spine and surrounding tissues. Percutaneous discectomy – surgery performed under a local anesthesia, which means no surgery is performed through cuts directly into your nervous system. An instrument is inserted into your back, where it removes the herniation by gently pushing it back into the disc space. This less invasive procedure is commonly used as an alternative to open surgery and has been shown to be effective in many patients with long-term relief of sciatica.

Treatment options:

In addition to medical treatment options, there are also several non-medical treatment options that can help reduce your discomfort and ease your recovery. These include: cold packs, hot packs, bed rest and physical therapy. You should also avoid any activity that may cause further injury or worsen your symptoms, such as lifting heavy objects or running until you have been pain free for several weeks.

Preventing sciatica:

If you experience the symptoms of sciatica, it is important to try and identify the cause of your pain so that you can avoid such symptoms in the future.

If you experience back pain, you should:

Be sure to give proper and careful attention to your spine - if not properly treated, this condition can lead to serious long-term problems. Use a pillow or cushion beneath your knees, hips and other painful spots for added support. If you have any type of spinal damage... Get immediate treatment and care from qualified health care professionals first - don't wait! Don't participate in sports or activities that could aggravate your condition. See a doctor if you have any questions regarding your back pain.

Remember that there is a big difference between this type of back pain, which is caused by a pinched nerve, and another type of back injury which can be caused by an injury to the spine or bony protrusions from the spinal column itself. If you have any type of nerve damage or degeneration, you should see a medical professional immediately for treatment and care... don't wait!

Self-treatment options:

If you have a pinched nerve and have been experiencing sciatica, it is very important to give your back the attention it needs in order to heal and avoid future episodes. In order to do this, you should try to be more active, even though it is painful. You should try to perform all of the basic day-to-day tasks that you perform each day, such as getting dressed or brushing your teeth. If these activities are too painful and aggravating, you will need to find an alternative way of performing these duties that does not cause pain in your back or lower limbs.

If you continue to perform your daily activities, you will be able to stay more active and maintain your overall health and well-being.

Alternative treatments:

Many patients who suffer from a ruptured disc will find sufficient relief by doing the stretches and exercises recommended by their healthcare providers. This exercise is done in order to maintain normal levels of flexibility in the muscles surrounding the spine and has been shown to give significant relief from many spinal conditions, including a ruptured disc.

Finally, some people find that alternative therapies such as yoga and tai chi also help relieve back pain and are often recommended as part of an overall treatment plan for sciatica pain.

What to expect after having a herniated disc repaired:

Following surgery, you are likely to experience some pain and swelling in your back, even with the use of pain medication. The leg pain usually goes away within a few days. Most patients report that they continue to have new sciatica pains for several weeks or months after surgery.

If you find that you still have numbness or tingling in your leg(s) following the repair, this may be the result of nerve damage due to the herniated disc and may take several weeks to correct with treatment.

A herniated disc does not cause nerve damage in the legs, it is just the pressure from the disc cutting off the flow of blood, causing pain and symptoms. The nerve damage may persist even after a successful surgery to repair a ruptured disc, though often that sensation will go away as well with time and treatment. If you are still having symptoms after having had your ruptured disc repaired, be sure to see your doctor early so that you can get treatment for your back pain and avoid permanent nerve damage.

Other than surgery, there are several alternative treatments that can give you additional help with your low back pain including chiropractic care and massage therapy.

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