SCIATICA WITH PT MANAGEMENT

 SCIATICA

 INTRODUCTION:-

• Most frequent radicular pain syndrome of spinal origin. 

• Occurs due to irritation of a spinal nerve root associated with disc herniatition at L4 – L5 or L5–S1.

• Pain usually begins in the lower back radiating to the sacroiliac regions, buttocks,thighs ,calf & foot 

• Sciatica is a symptom , NOT A DIAGNOSIS. 

Branches:-

•  The sciatic nerve branches into 2 main divisions behind the knee—

• the tibial nerve and the common peroneal nerve.

1.The tibial nerve courses down and supplies the back of the leg and the sole of the foot. 

2.The common peroneal nerve supplies the front of the leg and foot. 

 Pathway:-

• After its individual contributions end, the sciatic nerve exits the pelvis through the greater sciatic foramen, below the piriformis muscle.

•  The nerve then runs along the back of the thigh, into the leg, and finally ends in the foot.

ONSET :-

• Onset is often traumatic 

• Exertion or a forced movement results in acute low back pain ,followed by referral to the leg.

• Relieved by lying down .

CAUSES :-

• herniated or slipped disk  

• Lumbar Spinal stenosis 

• Osteoarthritis. 

• Spondylolisthesis 

• Pregnancy 

• Trauma

• Lumbar herniated disc. 

• Degeneration

• Sacroiliac joint dysfunction

 Inflammatory :-

• Sciatic neuritis 

• Arachnoiditis

Nerve root compression 

• Compression in vertebral canal by disc , tumour,  TB

• Compression in the buttocks or pelvis by abscess ,tumours , hematoma 

• Compression in the intervertebral foramen due to root canal stenosis because of OA , spondylolisthesis ,facet arthropathy,tumours. 

PIRIFORMIS SYNDROME 

• Neuromuscular syndrome that occurs when the sciatic nerve is compressed by the priformis muscle causing pain ,tingling  & numbness in the buttocks & along the path of sciatic nerve supply. 

• Wallet sciatica :- wallet syndrome 

• Caused :- by sitting with a large wallet in the affected side's rear pocket.

Clinical examination :-

• Straight leg raising test is positive 

• Patient in supine position 

• Examiner lifts the leg gradually with the knee kept straight. 

• Between 30 &70 degree nerves comes into contact with the prolapsed disc & the patient complaints of pain.

• LASEGUE'S SIGN :-

• Modification of SLRT

• Hip is flexed &the knee is also flexed at 90 °

• The knee is then gradually expended by the knee examiner. 

• If nerve stretcth is present:- 

• Patient will experience pain in the back of thigh or leg.

sciatica pain feel like.. 

• People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as “burning,” "electric” or “stabbing.” 

• The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. 

• The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. 

• A forced and sudden body movement, like a cough or sneeze, can also make the pain worse. 

Can sciatica occur down both legs? 

• Sciatica usually affects only one leg at a time. However, it’s possible for sciatica to occur in both legs. It’s simply a matter of where the nerve is being pinched along the spinal column. 

 common is sciatica? 

• Sciatica is a very common complaint. 

• About 40% of people in the U.S. experience sciatica sometime during their life.

•  Back pain is the third most common reason people visit their healthcare provider.

Does sciatica occur suddenly or does it take time to develop? 

• Sciatica can come on suddenly or gradually.

•  It depends on the cause. A disk herniation can cause sudden pain. Arthritis in the spine develops slowly over time.

the risk factors for sciatica 

You are at greater risk of sciatica if you: 

• Have an injury/previous injury

• Are overweight

• Lack a strong core

• Lack proper posture in the weight room

• Have diabetes

• Smoke

• Lead an inactive lifestyle 

• Have an active, physical job: 

• Vitamin B 12 deficiency

• Genetic susceptibility 

• Certain types of occupation (such as truck drivers, carpenters, or machine operators)

 

symptoms of sciatica 

• The symptoms of sciatica include: 

• Moderate to severe pain in lower back, buttock and down your leg. 

• Numbness or weakness in your lower back, buttock, leg or feet. 

• Pain that worsens with movement; loss of movement. 

• “Pins and needles” feeling in your legs, toes or feet. 

• Loss of bowel and bladder control (due to cauda equina).

• Severe cases present with muscle weakness 

• Burning sensation in legs .

Sciatica Pain Relief 

• As many as 4 out of every 10 people will get sciatica, or irritation of the sciatic nerve, at some point in their life. 

• This nerve comes from either side of the lower spine and travels through the pelvis and buttocks. 

• Then the nerve passes along the back of each upper leg before it divides at the knee into branches that go to the feet. 

• Anything that puts pressure on or irritates this nerve can cause pain that shoots down the back of one buttock or thigh.

•  The sensation of pain can vary widely. 

• Sciatica may feel like a mild ache; a sharp, burning sensation; or extreme discomfort. 

• Sciatica can also cause feelings of numbness, weakness, and tingling. 

• Pain may be made worse by prolonged sitting, standing up, coughing, sneezing, twisting, lifting, or straining.

•  Treatment for sciatic pain ranges from hot and cold packs and medications to exercises and complementary and alternative remedies.

TREATMENT 

Medications for Relief of Pain From Sciatica 

• Several types of medications may be used for sciatic pain. Oral medications include: 

• Over-the-counter pain relievers such as acetaminophen, aspirin, or NSAIDs (such as ibuprofen  ketoprofen, or naproxen ) 

• Prescription muscle relaxants to ease muscle spasms 

• Antidepressants for chronic low back pain 

• Prescription pain medications for more severe pain

• Tricyclic antidepressants, such as amitriptyline 

• Opioid analgesics, such as tramadol or oxycodone

In some cases, a steroid medication is injected into the space around the spinal nerve. Research suggests these injections have a modest effect when irritation is caused by pressure from a herniated, or ruptured, disc.

 SURGERY:-

• When neurological deficit is present 

• Failure of conservative management 

• Chemonucleoloysis

• Percutaneous disectomy. 

Physical Therapy for Sciatica 

• Physical therapy incorporates a combination of strengthening, stretching, and aerobic conditioning and is a central component of almost any sciatica treatment plan. Therapeutic exercises may also be added to a physical therapy program.

• The goals of physical therapy and exercises for sciatica include: 

• Strengthen the spine and muscles of the lower back, abdomen, buttocks, and hip. 

• Increase core strength 

• Stretch tight and inflexible muscles, such as hamstrings 

• Encourage the exchange of fluids and nutrients in the body by light aerobic exercises such as walking, swimming, or pool therapy

Common forms of physical therapy include: 

• Passive physical therapy (modalities), 

• which includes things done to the patient, such as heat application, ice packs and electrical stimulation. 

• For example,

• a heating pad may be applied to warm up the muscles prior to doing exercising and stretching,

•  and an ice pack may be used afterward to sooth the muscles and soft tissues 

• Active physical therapy,

•  which focuses on specific exercises and stretching.

•  For most low back pain treatments, active exercise is the focus of the physical therapy program.

Massage Therapy 

• Certain forms of massage therapy, such as deep tissue massage, may have benefits for pain relief.

•  The benefits of massage therapy include: 

• Improving blood circulation, which in turn creates a better healing response in the body 

• Relaxing tight muscles, which may be contributing to the pain 

• Releasing endorphins, which are hormones in the body that function as natural pain relievers