SCIATICA

 

-Sciatica is condition in which patient experienced pain and parasthesias in distribution of sciatuc nerve and associated with lumbosacral nerve root.

-It originates from the l4 to s2 nerve roots and starts from pelvis and inferior to piriformis muscle.

-It is upto 2cm in diameter and it is largest nerve in the human body.

-Sciatic nerve provide motor function to hamstring,lower extremity,adductors,calf muscle,anterior lower extremity and some of intrinsic muscles of leg.

-Most of the cases of sciatica result from inflammatory condition leading to irritation of  sciatic nerve.

-Any condition that may structurally impact or compress sciatic nerve causes sciatica.

Causes:

Herniated or bulging of lumbar of intervertebral dics.

In older person, lumbar stenosis 

Spondylolisthesis or any misalignnment of vertebrae on one another

Lumbar or pelvic muscle spasm or inflammation may impinge a lumbar or sacral nerve.

Spinal or paraspinal mass include maligancy ,epidural,abscess mass like effect the nerve.

• No gender predominance
• Peak incidence occurs in patients in their fourth decade
• Lifetime incidence reported between 10% to 40%
• Annual incidence of 1% to 5%
• No association with body height has been established except in the age 50 to 60 group.
• Rarely occurs before age 20 (unless traumatic)
• Physical activity increases incidence in those with prior sciatic symptoms and decreased in those with no prior symptoms.
• Occupational predisposition has been shown in machine operators, truck drivers, and jobs where workers are subject to physically awkward positions.
• Clinical features:                                                                                                                                                                                      

It may also present neurological symptoms.

Pain[instense pain on buttocks]

Lumbosacral radicular pain 

Numbness

Muscle weakness

Gait dysfunction

Sensory impairement and disturbance 

Hot and cold or tingling & burning sensation 

Reflex impairement

Parasthesia or odema that cause irritation.

Sciatica symptoms can also differ, depending on which nerve is affected.

• L4: When the L4 nerve is compressed or irritated, the patient feels pain, tingling and numbness in the thigh. The patient also feels weak when straightening the leg and may have a diminished knee jerk reflex.
• L5: When the L5 nerve is compressed or irritated, the pain, tingling and numbness may extend to the foot and big toes.
• S1: When the S1 nerve is compressed or irritated, the patient feels pain, tingling and numbness on the outer part of the foot. The patient also experiences weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.

Sciatica is most commonly diagnosed by:
1. History

• Complaints of radiating pain in the leg, which follows a dermatomal pattern.
• Pain generally radiates below the knee, into the foot.
• Dermatome maps used to locate the distribution of the pain.
• Patients complain about low back pain, which is usually less severe than the leg pain.
• Patients may also report sensory symptoms.

2. Imaging (if warranted)

• Plain films of the lumbosacral spine may evaluate for fracture or spondylolisthesis.
• Noncontrast CT scan may be performed to evaluate fracture if plain films are negative. Pain that has been persistent for 6 to 8 weeks and not responding to conservative management should be imaged.
• In cases where the neurologic deficit is the present or mass effect is suspected, immediate MRI is the standard of care in establishing the cause of the pain and ruling out pressing surgical pathology.

PHYSIOTHERAPY FOR SCIATICA

Extension and flexion back exercises

Strengthening exercises include bodyweight and resistance exercises to strengthen the muscles of the abdomen, low back, hips, and legs.

Functional retraining

Joint mobilization

Joint manupilation

Muscle energy technique

Gait training

Heat and cold packs 

Muscle stimulation 

Traction