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Sciatica

By Zeinah Keen 

Sciatica is nerve pain arising from the sciatic nerve. It can be produced by pressure on the nerve or irritation, where it passes through the buttock.

The sciatic nerve is a large nerve, about the diameter of a 10c piece, possibly larger in some people. It is formed from nerve roots that originate from the spinal cord in the lower part of the lumbar spine and sacrum. These nerve roots pass out between the disc spaces and join up to form the sciatic nerve. It passes from the spine into the buttock, then into the back of the thigh and leg.

The sciatic nerve controls sensation and function to the leg and foot. In sciatica, prolapsed or ‘slipped’ discs tend to bulge and press on the intervertebral nerve(s). This pressure irritates the nerve, causing referred pain.

Most cases of sciatica resolve by themselves within six weeks to three months. Sciatica can also be caused by narrowing of the nerve tunnel between discs due to osteoarthritis. Elderly people who suffer from disk degeneration as a consequence of ageing tend to be troubled the most by sciatica.

Symptoms of sciatica

The symptoms of sciatica include:sciatic pain

Hot pain in the buttock.

Aching in the buttock, back of the thigh (hamstring) and calf.

Pain in the ankle and foot

Pins and needles

Increased pain when lifting, straining or coughing

Loss of power to the muscles of the leg and foot.

Lumbar vertebrae are vulnerable to injury

The area of the spine that takes the most punishment from movement and activity is the lower back, or lumbar region. This consists of five relatively large vertebrae. The discs cushioning these vertebrae are particularly susceptible to degeneration caused by ageing. The cushioning discs become progressively thinner and harder, which stresses this portion of the back and may result in a variety of lower back pain disorders, including sciatica. 

Traditional advice for treating sciatica recommended complete bed rest. However, recent Australian studies have concluded that lying in bed may offer only minimal improvement, or may even exacerbate the condition.

Unless specifically advised by your doctor, remaining active may be the preferred option. Gentle exercises can help. Swimming is particularly useful, as it is not a weight bearing exercise so flexibility and strength can be improved without unduly stressing your back. Herniated spinal discs usually heal themselves with time. However, once a disc is injured, the susceptibility for a recurrence is increased.

Treatment is focused on relieving the symptoms and preventing a recurrence.

Treatment Options

Suggestions for managing sciatica include:

Avoid any aggravating factors. This may include sitting for extended periods of time, bending forward, lifting or doing a particular activity or exercise.

Manual treatment-Osteopathy, Massage or Acupuncture.

Over-the-counter or prescription pain-relieving medication.

Heat packs.

Proper posture.

Resting the back by not bending, flexing or lifting heavy weights.

Warm baths.

Sleeping on a mattress that is not too soft or too hard.

Ergonomic furniture, such as chairs with lumbar support.

Gentle exercises to strengthen and support the lower back.

Guided inter-vertebral steroid injections.

Surgery if no improvements for other conventional methods and every day functioning is impeded. (laminectomy/discectomy/fusion). No guarantees of 100% improvement.

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