sciatica

Quick Overview

• What is sciatica? Damage to the sciatic nerve with pain that usually radiates to the leg. Doctors speak of sciatica.

• symptoms: Tingling, electric shock-like or drawing pains, numbness, paralysis

• Treatment: depending on cause and severity. Therapeutic options include medication, surgery, physiotherapy, heat treatments, massages etc.

• Causes: Herniated disc, vertebral injuries, articular rheumatism, inflammation, abscesses, bruising, tumors, infections etc.

• Forecast: With timely, proper treatment, the chances are good that the symptoms heal completely.

Sciatica: symptoms

Of the sciatic nerve (Sciatic nerve) is the thickest nerve of the human body. He pulls over the back of the thigh and branches at the level of the knee in his two lower leg branches, the peronaeus nerve (Nervus peronaeus) and the Tibial Nerve (Tibial nerve). It supplies the muscles in the leg and, with its sensory components, sends sensations from the lower extremities to the central nervous system.

The sciatica can cause painfully or suddenly. Doctors refer to the typical sciatic pain as neuropathic pain, Many patients express themselves more vividly: Sciatic symptoms should “feel like an electric shock” or “ants tingling in the leg”. In addition, you can numbness and paralysis occur.

Very characteristic is also that the Pain radiates, One speaks then of radicular (nerve root-derived) pain, This distinguishes the sciatica, for example, from a lumbago. This can also occur by unfortunate turning or lifting and manifests itself in sudden back pain. This does not pull in the leg.

If the fibers of the fifth nerve root of the lumbar spine (L5) are particularly affected, the pain runs from the buttocks via the posterior outer thigh to the outer knee to the front outer lower leg. He can even move on to the ankle. If the first nerve root of the sacrum (S1) is damaged, the sciatic pain will move from the sacrum over the buttocks into the thigh back. The pain continues over the popliteal fossa into the foot.

If the sciatica is trapped due to a herniated disc, the pain is often increased by coughing, sneezing or pressing (during bowel movements) as well as movement. Rarely, in addition, the urination and defecation are disturbed. If inflammation is the cause of sciatica, the pain often increases at night.

Sciatic Treatment: What to do when in pain?

How sciatica pain is best treated depends on the cause, severity and duration of the condition. However, in the first place sciatica treatment stands – especially in new pains – their the fastest possible relief, This is to prevent the pain from becoming chronic and developing a so-called pain memory. This is understood by physicians, that the central nervous system through “learning effects” later also reports pain, if there is no cause for it.

Sometimes the body alone manages to heal itself or the affected nerve. Often the pain then lasts for a few days to six weeks.

Tip: For acute complaints, it may be helpful to keep your legs high. You can build a so-called step bed yourself by lying on your back and pushing a pillow or mattress part under your legs so that the lower legs are raised and both hip and knee joints are bent at approximately right angles (90 degrees).

If the pain does not improve or is very severe right from the beginning, the sciatica can be treated in three ways: with medication, other conservative therapies (physiotherapy, etc.) and surgery.

Medicinal sciatica treatment

Sciatic pain can be alleviated with analgesics. The attending physician is usually guided by the World Health Organization (WHO) Pain Management Level Scheme. This scheme consists of the three stages:

• Non-opioid analgesics such as paracetamol, ibuprofen or diclofenac
• weak opioid analgesics (like tramadol) in combination with non-opioids
• strong opioid analgesics (eg morphine, buprenorphine or fentanyl) in combination with non-opioids.

First, it is attempted to alleviate the sciatica pain with non-opioid analgesics. If they are not effective, the doctor may prescribe weak opioids. Strong opioids are used only in the most severe, difficult-to-treat pain.

Opioids are very effective painkillers. But they can have life-threatening side effects and make them dependent. Therefore, they should be used with caution and under medical supervision.

Sometimes the cause of sciatica can also be specifically treated with medication. Then one speaks of one specific sciatica therapy:

For example, if an infection triggers the pain, the doctor may antibiotics (against bacteria) or antivirals (against viruses) prescribe. Antibiotics may also be needed in case of complications, such as a collection of pus that presses on the sciatic nerve.

Further conservative sciatica treatment

In addition to medicines, there are other conservative (non-operative) treatment options for sciatica. So can physical therapy relieve sciatica pain and improve prognosis in the long term. Depending on the method, it can loosen strained muscles, stabilize and strengthen the spine and correct any false and protective posture. For example, exercise therapy (physiotherapy, back exercises), heat treatments or massages are used. The therapist will select appropriate treatments for each patient.

Another important approach of the so-called multimodal treatment is the behavior therapy, It should help the patient to cope better with the symptoms. In addition, it is intended to prevent the patient being overprotected and less agitated for fear of sciatica pain. That endangers long-term treatment success. In modern sciatica treatment, the behavioral approach therefore plays an important role.

Bed rest can be advised in case of acute pain. But to prevent future sciatica complaints, sufferers should move a lot. So it is advisable, for example, in desk work to get up every now and then and do light gymnastics (back exercises, etc.). This relieves and strengthens the back and the intervertebral discs.

Operative sciatica treatment

Rarely, sciatica requires surgery. This can be the case, for example, if a herniated disc causes serious discomfort (such as defecation, paralysis, or severe, difficult to treat pain). Sometimes the sciatica is also the result of a narrowing of the spinal canal in the lumbar region (lumbar spinal canal stenosis). Then an operation may also be useful.

Most such operations are performed minimally invasive today. The surgeon does not make a big cut to have a direct view of the area to be operated on. Instead, he makes several small cuts, through which he introduces fine optical and surgical instruments into the body.

Sciatica: examinations and diagnosis

Sciatica can be very painful, but usually disappears by itself within days to weeks. In case of persistent or recurrent complaints you should go to the doctor.

In general: If back pain is accompanied by numbness or paralysis in the leg and / or disorders of the intestinal and bladder emptying, one should urgently consult a doctor!

The doctor first asks you in detail about yours medical history (Anamnese). He may ask the following questions:

• Since when do you have the pain?
• Have the symptoms occurred suddenly and in connection with certain strains?
• How would you describe the pain (eg as shooting or electrifying)?
• Where exactly is the pain? Do you radiate?
• What gives you relief?
• What is your profession?
• Is your everyday life affected by sciatica pain?

At the following clinical examination Your doctor looks first at your back and legs. He looks for any malpositions and checks the mobility of the joints, the strength of the muscles and their reflexes. He also tests the touch sensitivity and feel of the legs by stroking the skin and letting you identify the point where he touched you.

With the so-called Lasègue test, your doctor will check whether the nerve roots of the lower spinal cord are irritated. You lie on your back and the doctor raises your stretched leg. If the sciatic nerve is trapped or otherwise irritated, pain in the back, which shoots into the leg, occurs halfway up.

In the search for the cause of the discomfort, the doctor may perform further examinations, for example one magnetic Resonance Imaging (MRI or magnetic resonance imaging) or Computed tomography (CT). Such imaging techniques are especially important when paralyzed or maladapted.

To determine the location and extent of the nerve damage, the physician can use electrodes to determine the muscle activity (electromyography = EMG) and the nerve conduction velocity (electroneurography = ENG).

If suspected of one Sciatic nerve inflammation The doctor will give you blood to determine the levels of inflammation and identify any pathogens (like Borrelia). It may also be necessary to remove and analyze cerebrospinal fluid (CSF). To do this, the doctor pricks a needle through the skin of the lower back and gently pushes it into the spinal canal adjacent to the spinal cord to remove a small CSF sample (Liquorpunktion).

lumboischialgia

A lumboischialgie manifests itself similar to “classic sciatica” (sciatica): The affected report, for example, of drawing pain, tingling and numbness in the leg. Muscle weakness is also possible.

Unlike sciatica, lumbo-analgesia not only irritates the sciatic nerve but also the nerves that leave the spinal cord at the level of the lumbar spine. Accordingly, the pain is less from the buttocks than from the lower back.

More about symptoms, diagnosis and treatment in the article Lumboischialgie!

Sciatica: causes and risk factors

The main cause of sciatica problems is a disc prolapse or its precursor, the disc bulge, But it can also Other diseases behind it when pressing on the nerve roots and fibers of the sciatic nerve. These include, for example:

• Vertebral injury
• tumors
• joint rheumatism
• Inflammation of an intervertebral disc and adjacent vertebral bodies (spondylodiscitis)
• Pus accumulations (abscesses)
• Bruising (hematoma)

Another cause of sciatica irritation may be one infection be, such as a Lyme disease. The bacterial agents of this infection (Borrelia) are transmitted by ticks. Even herpes viruses in shingles (herpes zoster) can cause sciatica problems.

Sciatica in pregnancy

Back pain is not uncommon in pregnancy. But it is rarely the sciatic nerve behind it. Instead, the pain is usually due to pregnancy-related factors such as the growing weight in the abdomen and the hormonal loosening of the band structures.

This does not mean, however, that sciatica (similar) complaints during pregnancy should be taken lightly. For example, as a herniated disc or other serious causes in question, affected women should definitely go to the doctor.

If this is actually a sciatica, it is usually treated with physiotherapy. Painkillers are used for the well-being of the unborn baby during pregnancy not or only to a limited extent.

Everything important about sciatica in expectant mothers read in the article Sciatica in pregnancy.

Sciatica: Disease course and prognosis

Crucial for the complaint process in sciatica is the trigger. If therapy is started early, the prognosis for sciatic nerve pain is good. If no surgery is required, a good pain therapy in conjunction with timely commenced physiotherapy can shorten the disease usually significantly.

It is important to specifically strengthen your back and abdominal muscles with regular exercises and sports. A strong muscular corset relieves and stabilizes the spine. This can relieve or prevent back problems.

Patients should also learn back-friendly behavior, such as when working at the desk or when lifting heavy loads. This can alleviate existing symptoms and prevent new sciatica problems.

In addition, social and psychological factors also influence the course and prognosis of back pain, including sciatica. For example, loneliness, depressed mood and stress can cause or worsen the symptoms. In addition, they can help make the back pain chronic and reduce the effectiveness of analgesics. That means:

An intact social life, the support of relatives and friends, good working conditions, a trusting relationship with the attending physician and a positive mood can be the prognosis of sciaticaSignificantly improve pain.

Additional information:

Guideline:

• Guideline “Disc-induced sciatica” of the German Society for Orthopedics and Orthopedic Surgery and of the Professional Association of Doctors for Orthopedics (2002)