What Are the Symptoms of Sciatica?

What Are the Symptoms of Sciatica? 

Sciatica, which is caused by irritation of the sciatic nerve, is excruciating and can last for several days, even hindering the patient. Learn how to prevent its onset and reduce its discomfort.

 

What Is Sciatica


Sciatica is the irritation of the sciatic nerve that causes the patient to feel pain in the lower back, a pain that extends to the back of one of the legs and can sometimes reach the tip of the foot. 


Sometimes the irritated nerve is not precisely the sciatic nerve, and the pain affects the side or front of the leg. Still, the name sciatica or sciatic attack is usually retained in popular parlance.

 

It is one of the most frequent causes of medical consultation and sick leave among middle-aged men. The pain can last for several days and incapacitates the sufferer.

 

Irritation of the sciatic nerve occurs when anybody in its path compresses it. The roots of this nerve arise from the spinal cord, exit through the vertebrae, and fuse to form the nerve, which is as wide as a finger on the hand (it is the largest nerve in the human body). 


From there, it travels down the leg behind the buttocks, thigh, and knee, innervating all the muscles it encounters along the way and the skin along the way until it reaches the outer edge of the foot.

 

Causes of Sciatica


The most frequent causes of sciatica are:

 

Herniated vertebral disc: this is by far the most frequent cause of sciatica. The vertebral discs are located between the vertebrae and cushion the friction between them due to movements, making the spine flexible.

 

Its interior is dense, and, over time, it can protrude (move) out of the disc itself into the spinal cord, where it compresses the sciatic nerve roots on one side. 


Herniated discs usually occur in adult males who perform weight-bearing jobs and are also common in overweight males.

 

Lumbar canal stenosis: occurs in older adults. The spinal cord is protected by the bony canal formed by the vertebrae, and over time this canal may narrow mainly due to osteoarthritis.


The lumbar region, i.e., the lowest part of the back, is usually the most affected area, and sciatica occurs when the nerve roots are compressed. 


In this case, sciatica can occur on both sides of the body simultaneously. Its principal characteristic is that progressive pain appears while walking, which disappears shortly after sitting or leaning forward.

 

Piriformis syndrome: the piriformis muscle is inserted into the pelvis and femur so that when it contracts, it pulls the leg closer. Usually, the sciatic nerve passes under this muscle, but there are people in whom the nerve passes through the power (approximately 10% of the population).


Contractures can form in the piriformis muscle that compresses the sciatic nerve; this happens mainly after injuries that limit walking.

 

Fractures: logically, any fracture of the bones located in the path of the sciatic nerve can alter its course and compress it. However, the first concern in these cases will be the fracture itself.

 

Tumors: they can compress the sciatic nerve as they grow out of control. The most common tumor-causing sciatica is chondrosarcoma in the elderly. Fortunately, it is not very frequent. 


Sciatica can also be caused by a pancreatic tumor invading the spine or vertebral metastases, although it is more frequent that they only cause lumbago.

 

Paget's disease: this disease does not often give symptoms, but it is more widespread than is thought among the elderly. It consists of uncontrolled bone formation without becoming a tumor. The pelvis is the most affected bone and grows gradually and can compress the sciatic nerve.

 

Pregnancy: during pregnancy, the uterus compresses the pelvis's internal organs, which causes muscle contractures that favor sciatica.

 

Symptoms of Sciatica

 

The main symptom of a sciatica attack is pain, although this can vary significantly in intensity and characteristics. 


It can range from a dull ache that lasts several days to a pain that appears almost suddenly and with great power and prevents the patient from moving from the couch.


In any case, the pain always affects one of the sides, from the buttocks to the knee, calves, or even the foot. It is also often accompanied by pain in the lower back, so doctors call it "lumbosciatica". 


The pain may increase with movement (sitting, sitting up...) or increased pressure inside the abdomen (coughing, defecation...).


It may also appear when lying down or waking up in the morning while lying in bed but does not usually interrupt sleep in the middle of the night.

 

This pain can be accompanied by alterations of the sensitivity of the skin that innervates the sciatic nerve. Sensations of tingling and corkiness usually appear in the same areas where there is pain.

 

Other frequent symptoms would be muscle weakness and decreased muscle reflexes. The sciatic nerve, being damaged, cannot correctly innervate the muscles, and hip and knee movements are limited.


This is why people with sciatica walk with a limp or cannot get out of bed independently.

 

We can also speak of "inverted sciatica". In this case, the sciatic nerve is not compressed, but the uppermost nerve roots forming the femoral nerve are compressed. 


The pain then appears in the front of the thigh up to the knee, sometimes even near the groin. Knee extension may also be weakened.

 

Diagnosis of Sciatica

 

The diagnosis of sciatica is arrived at by the symptoms that we have pointed out in the previous point. Still, it is convenient to identify further the cause that provokes it and the area where the nerve is compressed. For this, there are a series of simple tests that help the physician in the diagnosis of sciatica:

 

Lasègue maneuver: with the patient lying on his back, the extended leg on the affected side is raised.


When the pain increases before rising more than 60 degrees, it is due to the sciatic nerve, which is stretched when we perform this maneuver. It should be performed on both legs to verify that the pain affects only one of the sciatic nerves.


In older adults, it is difficult to achieve this maneuver since they usually have problems in the hip joint, and pain is more easily provoked, increasing the number of false positives.

 

Bragard maneuver: it is performed after the Lasègue maneuver and consists of the same movement, but when we reach the point where the pain appeared, we stop elevating the leg more and push the sole flexing the ankle. If the pain occurs, it supports the suspicion of sciatica.

 

Examination of the sensitivity: the doctor can check the affectation of the skin's sensitivity that innervates the sciatic nerve, constantly comparing it with the unaffected side.

 

Examination of muscle strength: in the same way, the physician compares both sides of the body to check the lost muscle strength. 


A more straightforward method is to have the patient walk. Sciatica usually prevents walking on tiptoe or heels, as the muscles that allow this are not strong enough.

 

Exploring tendon reflexes: when a sharp blow is given to the tendons, there is a reflex contraction of the muscle they belong to. This happens because the nerves that form this reflex are healthy, and during sciatica, their ability to contract may disappear. 


The reflex that the physician may see diminished most often during an attack of sciatica is the Achilles tendon reflex in the ankle. In reverse sciatica, the patellar reflex will be affected.

 

Treatment of sciatica

 

To relieve the pain it causes during an attack, the treatment of sciatica will consist of:

 

Analgesics and anti-inflammatory drugs that soothe the pain. They are usually taken every eight hours during the days of the episode. Afterward, it is recommended to reduce the frequency of doses and continue with the medication for up to two weeks.

 

Relative rest, that is to say, the patient will be able to move but should not make efforts or walk long distances. Bed rest is not recommended once the pain is relieved with analgesics.

 

Corticosteroids: they should only be administered in situations where anti-inflammatory drugs are not sufficient.

 

Apply cold to the affected lumbar or buttock area for the first two days of pain. This will reduce the inflammation that accompanies the nerve compression. The cold should be applied for about 10-15 minutes and always indirectly, covering the ice with cloths.

 

Apply heat the following days with an electric blanket, hot water bottle, or bath. Do not exceed 20-25 minutes of application. It calms the pain and is more effective when muscle contractures accompany the pain.

 

Massages in the lumbar area; have the same effect as the application of heat. Trained persons should perform them.

 

Suppose after two weeks, the patient still has pain. In that case, he/she should see a doctor, who will increase the treatment of sciatica by adding muscle relaxants and more powerful analgesics, which should end the problem in another two weeks most.

 

Prognosis of Sciatica

 

The prognosis for sciatica is excellent, although the pain may last for several days. The treatment only helps to ease the pain, and sciatica goes away on its own in two weeks at the most. This is the case most of the time. Likewise, sciatica will recur in most patients who suffer from it.

 

There are warning signs that compel the physician to perform further tests to rule out tumors, nerve injuries, or other serious causes of sciatica. These signs are:

 

·        Being over 50 years of age and not having suffered previous attacks of sciatica.

·        No response to treatment after four weeks.

·        Progressive increase of the area without sensitivity.

·        Loss of sphincter control.

·        Loss of weight or appetite, or accompanying fever.

·        Previous cancer.

·        Endocarditis or previous sepsis.

 

If any of these signs are present, a blood test, a spinal X-ray, and an MRI should be performed. With these tests, a specialist can identify serious causes or propose a definitive treatment.

 

Prevention of Sciatica

 

To prevent sciatica, the best measures to take are:

 

·        Avoid obesity and being overweight.

·        Walk a minimum of five hours a week.

·        Practice sports that favor the development of the lumbar musculature, such as swimming or tennis. Yoga can also help maintain good muscle tone.

·        Do not bend over with your back bent, but bend your knees with your back straight.

·        Do not carry heavyweights.

·        Do not adopt bad postures while sitting at a desk or driving. The backrest or a cushion should always support the lumbar area.

·        Sleep on flexible but rigid mattresses so that the spine is always in a straight position.

 

Adam Hari

This is my profile, I seek to provide helpful content on several areas, especially health and fitness.

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