Nerves are complex fibres in our body which carry impulses from the periphery to the central nervous system ( brain and spinal cord) and vice versa. In simple language, they are wire connections of our body which carry current (impulses/signals) between brain and muscles, joints, skin, etc. without which communication of impulses related with sensation, movement, reflex, control,
- One-sided pain
- Lightning or shooting in character
- Symptoms are aggravated with change of posture (regarding hip and leg) especially leaning forward, raising leg in lying posture. They often add fuel to the fire of suffering.
Incidences – Sufferers are mostly sedentary workers (computer professionals) and long distance travelers/drivers. They will be weak and get trapped with their own occasional strain. Even though, it can occur in any person of any age group, females around menopause are the most common victims. It is mainly due to development of osteoporosis and friction loss. Also it is commonly noted after strenuous exercises, spinal injury, improper jumping, lifting heavy objects improperly, prolonged sitting, etc. The commonest site where the sciatic nerve gets trapped often is near the spines or greater sciatic foramen where it emerges with piriformis muscle.
Causes – The development of sciatic pain i.e., sciatica, is due to compression / prick / pinch of sciatic nerve by bones or muscles or external factors (pressure) or internal factors (disease and tumours). Here sciatic nerve gets trapped and inflamed. Sciatica can be due to a variety of reasons:
- Injury or fall or accident or physical strain (even sitting continuously for a prolonged time which exerts pressure over the buttock area) either with or without fracture
- Degeneration or friction loss/wear and tear phenomenon ( herniated disc or prolapseddisc or spondlytis)
- Adhesion of sciatic nerve to adjacent muscle or ligaments (commonly with piriformis muscle)
- Inflammation or abscess formation in spine (cold abscess – tuberculosis)
- Tumours – of vertebral bones, nerve roots and pelvic organs
- Diseases – Nervous disorders, diabetes, etc.
Sciatica symptoms usually vary from person to person in type, intensity and suffering period depending upon the nerve fibres involved and nature of the complaint or disease. Some patients tolerate the pain or condition with day-to-day activities and some may be bedridden all of a sudden. It all depends upon the site of affliction and intensity. Most often it occurs as a catch in the hip after a strain or fall. Also, mostly, the complaint radiates down the leg in one side. The common symptoms are:
- Tightness and stiffness in the lower back
- Difficulty in rising and standing immediately after sitting on a chair for a long time
- Violent sharp lightning / shooting down / flickering type pain in hip or buttock or leg or in all parts
- Pain radiates from buttock down the leg to foot in the posterior (back) and inner (medial) aspect of the leg
- Numbness or tingling sensation with weakness in the parts involved
- Restlessness due to pain
- Difficulty in gait due to tight low back muscles and development of partial or complete paralysis in muscles below knee which reflect as wasting of muscles
- Development of paralysis may proceed further to hinder bladder and bowel control
Diagnosis – It is must to diagnose a complaint before starting treatment or suppressing it with a pain-killer. To pinpoint nerve compression or disc degeneration or disc prolapse, one can go with plain X-ray, CT scan or MRI. History of the complaint i.e., incidence, nature of disease, aggravating factors, etc., and neuromuscular examination with respect to injury, scar, pain on particular posture, sensation, temperature, muscle power, reflex, muscle wasting can also provide outline for the diagnosis. Also, before diagnosing and fixing sciatica as the complaint, it is better to examine and scan the abdomen also to rule out renal stones, gall stones, pelvic tumours, etc., since these complaints also mimic initial sciatica symptoms.
- Sit, stand, sleep in straight/erect position
- Brisk walking or swimming or any active exercise daily at least for 30 minutes
- Sleep lying on back in hard flat surface if you have sciatica complaints
- Lift weight close to the chest if you have sciatica complaints
- Stress and strain
- Sitting continuously for a long period
- Foam mattress
- Leaning forward for lifting any objects
- Lifting heavy objects
- Curling up in bed and chair
- Exercises while there is pain
General treatment – The routine mode of treatment is generally based on symptoms and its intensity. Along with exercise (physiotherapy), posture corrections are also commonly advised to sufferers. Other than that, on requirement, pain-killers and non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed with supplements (calcium, magnesium and essential fatty acids).
Sciatica should not be treated just with anti-inflammatory drugs and pain killers, since the situation will often get worse with time, leading one to surgery. One should be aware that “instantly killing pain with a pain-killer is just like putting off the light when you don’t want to see the things around. Surely the day will come when / where you cannot switch off the pain”. Here pleasure with pain-killers is nothing else but the intermission of pain.