The visit to the Traumatologist for a sciatica problem is quite frequent, as it causes a significant limitation of the patient’s daily activity. The pain may start in the lumbar region and travels down the leg from the gluteal region and posterior thigh and may reach more distant areas such as the sole of the foot.
What is sciatica?
Sciatica is a neuropathic, irritative and difficult to control analgesic pain. It usually makes it difficult to rest at night and is aggravated if we sit or cough. It also causes altered sensitivity, cramping and tingling sensations along the path of the irritated nerve and can sometimes cause loss of strength.
Why does sciatica appear?
The roots of the sciatic nerve emerge from the spinal cord, pass through the lumbar and sacral vertebrae through the foramina of conjunction and all of them join to form the common sciatic nerve. Irritation of the sciatic nerve usually occurs at the level of the back, due to impingement at the foramen of conjunction.
Muscle contracture, disc degeneration and lumbosacral arthrosis are the most frequent causes of sciatica. Others may be disc herniation, narrowing of the lumbar canal or facet syndrome.
Who is more likely to suffer from it?
It usually affects middle-aged people, sedentary or with a forced posture for long periods of time. Muscular overloads, obesity or pregnancy are related to its appearance.
In people over 50 years of age, it is usually related to disc degeneration and osteoarthritis of the lumbar spine. In younger people, between 20 and 50 years of age, it may be caused by a herniated disc.
What warning signs indicate that I should see a specialist?
If adequate pain control is not achieved, the patient should consult a specialist in traumatology, since neuropathic pain usually causes great limitation and may require an adjustment of the treatment.
Furthermore, if the alteration in sensitivity is maintained or progresses and, above all, if the weakness of the lower limb increases, secondary causes of lumbosciatica should be ruled out.
What can we do to prevent it?
Prevention measures for sciatica include avoiding obesity and a sedentary lifestyle, avoiding muscle overload, as well as maintaining good postural hygiene of the back.
A sedentary lifestyle predisposes to progressive muscle atrophy and muscle contracture, whereas gentle physical activity and abdominal and lumbar muscle strengthening therapy protect our discs and vertebrae from daily overloads.
What is the most effective treatment?
Medical treatment should be used for pain control in the early stages of sciatica. Surgical treatment is reserved for cases with sustained radicular involvement or herniated discs with sensory and motor involvement.
In general, the patient should rest for a few days and progressively begin gentle physical activity. Excessive rest is not good for sciatica; on the other hand, gentle exercise such as pool therapy, yoga or physiotherapy exercises for stretching and progressive strengthening of the lumbar musculature help progressive functional recovery, as well as the prevention of subsequent episodes.