The main characteristic of sciatica is the presence of intense pain that starts in the lower back and spreads to the foot through the back of the thigh and buttock.
Generally, these pains affect only one of the legs and can also be located in the lower back or buttock.
As a consequence, the patient suffers changes in the sensitivity of the affected area, which worsens when the person sits or stands up, a sensation that may subside when lying down or walking.
All these symptoms can impair the life of patients suffering from sciatica, as they may become severely limited in their movements.
What are the main symptoms that make it possible to detect it?
The symptomatology is characterized by intense and persistent pain starting in the lower back and spreading to the foot through the back of the thigh and buttock, as well as tingling in the legs, burning in the lower back and numbness in the feet.
In some cases, lameness and loss of sensitivity to touch and temperature may also occur.
Causes of sciatica
The causes can be diverse and generally depend on the patient’s lifestyle and morphology.
The most common is the pinching of the sciatic nerve, which is usually caused by a herniated disc or protrusion in the spine or by an overgrowth of bone in the vertebrae.
Less frequently, there are tumor causes that can obstruct the nerve or diabetes, which can generate changes in the physiology of the area that can end up damaging the nerve.
There are also osteopathic causes, such as irritations due to excess toxicity in the area, caused by poor diet.
On the other hand, there are causes due to visceral irritations such as dysfunctions of a specific part of the intestine: iliac colon, sigmoid colon and rectum, which congest the pelvis, as well as the veins of the Azygos system.
What is the diagnosis?
The therapist has different tests to find out the cause of the sciatica and the area where the nerve is compressed:
- Lasègue maneuver: it is performed with the patient lying on his back, raising the extended leg on the affected side. When the pain increases before elevating more than 60º, it indicates that it is due to the sciatic nerve. This maneuver should be performed on both legs to verify that the pain only affects one sciatic nerve.
- Bragard maneuver: it is performed after the Lasègue maneuver and consists of the same movement, but when you reach the point where the pain appears, you must push the sole of the foot by flexing the ankle. If pain appears, it confirms the suspicion of sciatica.
- Examination of the sensitivity: it is carried out by comparing the sensitivity of the skin of the sciatic nerve with that of the side that is not affected.
- Exploration of muscle strength: the therapist compares both sides of the body to check the lost muscle strength. Generally, sciatica prevents walking on tiptoe or heels, so a simple method to test this is to have the patient walk.
- Exploration of tendon reflexes: the therapist provokes the reflex with a sharp blow to the tendons, which should produce a contraction. This happens because the nerves that form this reflex are healthy and during sciatica their ability to contract may disappear.
What is the treatment?
There are different treatments for sciatica:
- Analgesics and anti-inflammatory drugs to relieve pain. They are usually taken every eight hours during the days of the episode. Afterwards, the frequency of doses is reduced, but the medication should be continued for up to two weeks.
- The patient should rest relatively, without exertion or walking long distances.
- When anti-inflammatory drugs are not sufficient, corticoids should be administered.
- Apply cold in the lumbar area or affected buttock during the first two days of pain to reduce inflammation.
- Apply heat during the following days with an electric blanket or hot water bottle to soothe the pain.
- Massage the lower back.
- Physiotherapy treatments to relieve tension in the lower back, through massage, stretching, dry needling and mobilization.
- Vertebral axial decompression is a novel treatment for acute and chronic sciatica pain, which, thanks to technology, stretches the spine and decompresses the intervertebral disc that presses on the nerve.
Once recovered, could the patient develop it again?
The patient must be careful to maintain correct postural health, and must be followed up by the physiotherapist and osteopath. He/she should complement these precautions with a healthy lifestyle, practicing sports and following a correct diet.
In this way, you will be able to avoid a relapse with its corresponding adverse effects.