Sciatica is a painful and sometimes debilitating problem that affects lots of people. Symptoms range from just the odd twinge to pain so intense that to move is unbearable. Even getting off the sofa can be a major feat. Most people find out they have sciatica when they visit the doctor after the pain becomes intolerable. The sciatic nerve is actually a group of nerves that exit the spine together at the lower part of the back. These nerves are directed to various points in your legs. Sharp pain, aching and numbness are all symptoms of sciatica and can affect the patient in different ways. So how would a patient suspect they have sciatica?
Pain or numbness in the calf and foot. This may inhibit the patient to bring the foot upwards and may make the patient look clumsy.
Numbness or pain in the top of the foot and possibly the ankle. The patient may have problems in extending the big toe.
The patient may be unaware that they have reduced ankle-jerk response. Numbness and pain are quite often reported on the sole of the foot, or the outside edge. The patient may be unable to walk on tiptoes: ie, unable to bring the heel of the foot off the ground.
To see the area of the back relating to L4, L5 and S1 sciatica, please refer to this picture of a Sciatic Nerve.
Sciatic nerve compression can cause any of the above symptoms. Permanent damage to the nerve is very rare, but Caude Equina Syndrome is an extremely dangerous disorder that requires treatment straight away. If the patient experiences increased leg weakness or becomes incontinent, the area to check is the perineum1. The area will be numb to the touch. If the patient does suspect that they have this disorder, they must contact a medical person straight away to avoid permanent paralysis.
Sciatic nerve compression can be caused by herniated discs2, Degenerative Disc Disease, Lumbar Spinal Stenosis or Ischemic Spondylolisthesis. Infections in the spine or spinal tumours may also compress the sciatic nerve, but these problems are rare.
Treatment of Sciatica
Sciatica rarely requires surgery and can respond quite well to other forms of treatment. Time, non-steroidal anti-inflammatory (NSAIDs) medication, short-term use of a narcotic for acute pain, lumbar injections, and physical therapy may well be all that is needed.
In most cases, sciatica can be avoided by maintaining good posture whilst sitting and standing. Slumping or slouching can put extra pressure upon the spine and hence cause problems. Simple ideas such as keeping the chin elevated whilst walking can dramatically improve posture. For office workers, it is important to maintain the 90 degree position. This means that all joints are at 90 degrees. This helps sustain the natural curvature of the spine.
It is important to remember that narcotic drugs are extremely addictive. Doctors should tightly control the use of the drugs with each patient using them. The writer of this Entry is currently on codeine and paracetamol. A mixture called 30/500s. Through experience, it is vital that any person taking this drug does not drive.
It is important though that the patient remains as mobile as is possible. Light exercise such as gentle stretching, walking and yoga are all good things to do. During severe pain, short-term bed rest is also recommended.
Occasionally surgery is required to provide relief for the patient. The patient's condition and diagnosis will be taken into account to make a specific choice of surgery. Typically the options for surgery are to trim a herniated disc, to 'scoop out' the inside of the vertebrae or to purposefully break the vertebrae causing the problem which will allow a release of pressure on the nerve.
Depending upon what type of treatment the patient has had, it is beneficial to relieve unnecessary stress on the spine. For example, when standing, it is a good idea to rest one foot slightly higher than ground level, ie, a stool or step. While driving, it may be a good idea to place a pillow behind the back to help keep the natural curve of the spine. It is possible to buy specialist back rests that strap onto the car seat. At night time, place a pillow underneath the knee if lying on the back. If lying on the side, pop the pillow in-between the knees.