The clinical picture of sciatic pain, also known as sciatica or sciatica for short, is one of the most frequently encountered clinical pictures in the developed industrial nations. Since the average duration of sciatica is often several weeks, its economic significance is enormous. Nevertheless, the treatment options and prognosis of sciatic pain are good.
What does sciatica (sciatic pain) mean?
Under the colloquial term lumbago, medically referred to as lumbago or sciatica, occurs a sudden, stabbing and persistent pain, especially in the lumbar region, with subsequent movement restrictions. Often referred to as lumboischialgia, the cause of sciatica is irritation of the posterior nerve root of the sciatic nerve in the lower back. Sciatic pain is therefore not a disease of the spinal cord proper, as is often and erroneously thought. The experienced, clinically active physician can differentiate this sciatic complaint symptomatology from purely muscular back pain (so-called LBP, low back pain) by applying careful examination techniques.
Causes
The cause of the above-mentioned irritation of the sciatica is, in more than 90% of all cases, age-related wear processes of the associated bony vertebral elements, between which the nerves protrude. However, in rarer cases, consequences of accidents, inflammations or even tumors can also be considered as causes of sciatic pain.
Symptoms, complaints and signs
When sciatica is affected, back pain typically occurs at the level of the lumbar spine. It travels from the small of the back down the back of the thigh to the back of the knee, sometimes even to the foot. The type of pain varies depending on the underlying cause. If the sciatic nerve is pinched by a herniated disc, the pain occurs quite suddenly and presents as pulling or tearing. It is often felt as electrifying and is described by doctors as neuropathic. With nerve irritation, on the other hand, the pain develops gradually and is usually accompanied by muscle tension and restricted movement. A typical feature of sciatic inflammation is that the pain becomes more severe at night. If the nerve is already very damaged, there may be additional sensory disturbances. It usually starts with a tingling sensation, which gradually turns into numbness and may even increase to paralysis. In addition, the patient may have difficulty standing on their toes or heels. Existing pain may increase when coughing or sneezing. Straining during bowel movements may also be painful. If a severe form of sciatic nerve impairment is present, incontinence may occur, both bladder and bowel.
Diagnosis and course
The course of sciatica, which often lasts several weeks, is characterized by pain that is initially often very severe (to the point of being truly insufferable), which may, for example, initially require the use of infusion treatments. Initially, immobilization is indicated until the acute symptoms of sciatic pain have subsided. A typical feature of sciatica is the spread of pain along the so-called general stripe line. This in reference to that gold border which may have adorned the side of a general’s trousers in earlier times. This stage of irritation of the sciatic nerve requires early and regular medical observation and progress control, because it can happen under certain circumstances that acute paralysis symptoms occur. The patient notices this most quickly when climbing stairs only then, when the leg in question is no longer subject to his will. Immediately, utmost urgency is required and the neurosurgeon must surgically relieve the distressed sciatica so that the nerve distress stops and the paralysis does not persist. Surgery for sciatica should take place within a few hours of the onset of paralysis symptoms, otherwise the nerve tissue will be permanently damaged.
Complications
As a rule, sciatic pain represents very unpleasant pain for the affected person. In this case, these lead mainly to pain in the back and spine. It is not uncommon for back pain to spread to other regions of the body and cause pain there as well.Furthermore, rest pain can lead to sleep problems and thus to irritability of the patient or to depression and other psychological upsets. Furthermore, many affected persons suffer from paralysis or sensory disturbances. These can significantly restrict the daily life of the affected person and, if necessary, also lead to movement restrictions. In extreme cases, the patients are then dependent on the help of other people in their daily lives due to the sciatic pain. Likewise, it can lead to a herniated disc. The treatment of sciatic pain is usually carried out with the help of medication or by means of various therapies. This can limit the pain. It cannot be generally predicted whether this will result in a positive course of the disease. If necessary, the patient is then dependent on lifelong therapy. The patient’s life expectancy is usually not limited by the sciatic pain.
When should you see a doctor?
A doctor should be consulted in the event of back discomfort, severe pain or restrictions in mobility. If the discomfort sets in unexpectedly and suddenly, the affected person often can no longer move as usual. If there is numbness in the back, sensory disturbances or hypersensitivity, a visit to the doctor is necessary. If there are signs of paralysis, restrictions in physical resilience and changes in the usual range of movement, the symptoms should be clarified by a doctor. A loss of strength, sleep disturbances or a feeling of stiffness in the back should be examined and treated. If everyday demands can no longer be met or it is not possible to engage in the usual sporting activities, it is advisable to consult a doctor. If there is an inability to arch the back, stretch, stand up or walk without discomfort, a doctor should be consulted as soon as possible. If movements can only be implemented very slowly, a visit to the doctor is necessary. If existing pain has an increasing intensity or spreads further on the back, a doctor is needed. Before taking a painkiller, it is advisable to consult a physician to avoid undesirable consequences. If emotional or psychological problems arise in addition to the physical complaints, further examinations and medical treatment are advisable. Otherwise, without medical care, the affected person risks lifelong impairments or mobility disorders.
Treatment and therapy
Since numerous nerve cords cross each other on your way to the muscles of the legs supplied with it and also the butt musculature and also separate again, it can come with the sciatica to a complicated, colored and changeable clinical picture. A sound knowledge of anatomy and neurology is therefore required. The diagnosis should therefore be left to a physician or specialist, preferably one for orthopedics, trauma surgery or neurology. In most cases, in addition to the necessary physical examination, people plagued by sciatic pain also undergo an imaging procedure. Today, high-resolution images of the body region in question can be made without the use of X-rays by means of magnetic resonance imaging, also known as MRI technology, which then help to secure the diagnosis. In rarer cases of ischialgia, a puncture and / or further laboratory diagnostics are also required. As a rule, however, sciatica heals with conservative medical treatment. This includes, in addition to the necessary pain-relieving medications, the use of supportive, regularly performed physiotherapeutic applications and regular physiotherapeutic support. These therapies can be performed for sciatica, depending on the severity, both as an inpatient, i.e., in an acute hospital, and, in less severe cases, as an outpatient.
Outlook and prognosis
Sciatic pain has very different prognoses. In almost all sufferers, they occur on and off, although they may become more frequent with age and depending on the cause. Pain management of whatever type can shorten the course of the disease and delay or prevent the recurrence of sciatica. However, it is likely that several possible causes of sciatic pain (for example, rheumatism and spinal problems) will cause recurrent problems.Therapy of the cause can correct the problem, but also carries a certain risk of recurrence. Sufferers who want to reduce the likelihood of sciatic pain recurring are well advised to train their muscles. The better and stronger the muscles in the abdomen and back are, the more stable the body is. Accordingly, conditions that trigger sciatic pain are less likely to occur. Accordingly, a back-friendly lifestyle is also one of the measures to be taken by those affected. Furthermore, the prognosis improves in a stress-free environment. Since sciatic pain is often also brought to light by psychological stress, sufferers should take care to avoid stress after treatment. A longer period of recovery can further strengthen the body and makes further sciatica problems less likely.
Prevention
Then, after several weeks, sciatica pain is restored to the ability to work. In some cases, it is also advisable to recommend an inpatient rehabilitation and to carry out at the expense of the health insurance or pension insurance carrier. There then, in addition to the necessary medical treatment, an intensive transfer of knowledge to the patient is carried out. This should lead to the patient taking his health into his own hands as far as possible through health-promoting behavior after discharge, in order to avoid a recurrence of the ischialgia in this way. This is completely successful in a large number of cases. In further patients with sciatic pain, medication can often be significantly reduced in this way. Other preventive measures against sciatic pain are in principle similar to those for back pain and against herniated discs. This means sports and exercise as well as training of the back muscles. On the other hand, too heavy loads should be prevented from permanently damaging the back. Sitting for long periods of time or sitting incorrectly should also be avoided. Back exercises can be extremely beneficial in this regard to prevent sciatic pain.
Aftercare
Sciatic pain can often be treated well with self-help. In many cases, it depends on the cooperation of the patient to relieve the discomfort. This is because sciatica is often caused by poor posture or poor weight-bearing, sometimes in conjunction with obesity, so it is up to the behavior of the affected person to bring about improvement. In acute cases, the step position often helps. Here, the patient lies with his back on a stable surface and places his lower legs on a chair or other elevation. The angles in the hip and knee joints are 90 percent. Heat can also be helpful. Muscular training is important for chronic sciatica. Muscles to be strengthened are those in the buttocks and the trunk muscles composed of the abdomen and back. The often shortened muscles of the back of the thighs, on the other hand, should be gently stretched. Incorrect postures and overstraining in everyday life and at work are to be avoided. Breaks and relaxation during long car journeys are just as important in this context as an ergonomic seat at the desk. Back exercises in the gym stabilize the overall corset of the spine. The exercises learned there can also be continued regularly at home. Back swimming and water gymnastics are also often helpful. In addition, relaxation techniques and yoga help to improve or even eliminate muscle tension in the long term. Progressive muscle relaxation according to Jacobsen is particularly recommended.
What you can do yourself
For acute sciatic pain, the so-called stepped position is recommended to relieve pressure on the spine: in this position, the patient lies flat on his or her back with the legs elevated at a 90-degree angle on a chair or pillow. Heat applications are also helpful in easing the tension in the lower back that is typical of sciatica. A hot-water bottle or a cherry pit cushion can do the trick, and a warm bath with soothing herbal additives such as hay flowers, rosemary or lavender also loosens the cramped muscles. The application of compresses soaked in mustard or horseradish and compresses made of healing earth are proven home remedies; alternatively, warming ointments from the pharmacy are available. Bed rest is recommended for a maximum of one to two days, after which light exercise should be resumed. It is important to pay attention to the body’s signals and not to put excessive or incorrect strain on the aching back.If sciatic pain occurs repeatedly, strengthening the back muscles through targeted training can bring relief. Heavy lifting should be avoided, and care should be taken to maintain an ergonomic posture when working at the computer. Choosing the right mattress also helps prevent recurring sciatic pain: It should not be too soft and should be adjusted to body weight and size.
