I. Sciatica is a symptom and not a separate disease
A patient in the clinic today said he was sciatica when he entered the clinic, and after doing physical examination his performance was that of lumbar disc herniation, and he was given a CT order, and was surprised that he was sciatica, and probably thought that I was wasting medical resources by giving the order. And this kind of reaction is really normal. However, in the doctor’s opinion, “sciatica” is a symptom, just like “headache”. Just like Cao Cao’s headache, he personally might have thought it was a migraine caused by a cold, when Hua Tuo thought it was a brain tumor and gave him a craniotomy thinking he was murdered.
There are many causes of headaches; there are also many causes of sciatica (more on that below).
So don’t understand sciatica as a disease, and a doctor who makes this diagnosis in the medical record is not strict and standardized.
Second, sciatica is not unique to herniated discs, and herniated discs do not necessarily have sciatica.
Many medical manuals, advertisements or popular science books compare sciatica as a disease with lumbar disc herniation, lumbar spinal stenosis, acute lumbar sprain, chronic lumbar strain and other diseases. Our orthopedic professionals believe that this is not only uncritical but also misleading to patients, so it is necessary to give it a “proper name”.
The sciatic nerve is the longest nerve in the body, issued from the nerve root of the lumbar segment of the spinal cord, penetrated by the pear-shaped muscle of the buttocks below, distributed in the back of the thighs and calves, feet, commanding muscle movement and conducting skin sensation. In normal people, there is one on the left and one on the right. Of the five lumbar vertebrae, the fourth and fifth lumbar vertebrae below are the most heavily burdened and have the greatest mobility, and are prone to degeneration and aging. Long-term strain or sudden sprain can cause the lumbar intervertebral disc to protrude to the side and back. After the lumbar disc protrudes, it compresses the sciatic nerve root, causing pathological changes such as congestion, edema and even adhesions. The pain on the herniated side of the lumbar area radiates through the buttocks to the back of the thighs, up to the calves and feet, and sometimes there is numbness, which is aggravated by coughing. This symptom is sciatica. It is just a symptom like a fever. Pathological changes such as lumbar disc herniation or lumbar spinal stenosis are the cause of sciatica, just as the cause of fever is a cold, pneumonia or meningitis, etc.
Although there are many causes of sciatica, the most common one is lumbar disc herniation.
Most of them are herniated discs between the 4th and 5th lumbar vertebrae or between the 5th lumbar vertebrae and the sacrum. Thus, in the vast majority of cases, sciatica may be a lumbar disc herniation. In orthopedic clinics, we have found that in addition to lumbar disc herniation that can cause sciatica, there are many other diseases that can also cause this symptom. Some of the more common ones are lumbar spinal stenosis, lumbar spondylolisthesis, pear-shaped muscle syndrome, ankylosing spondylitis, and lumbar spinal canal tumor. However, sometimes, some hospitals and non-orthopedic physicians blindly treat patients with sciatica symptoms with a diagnosis of “sciatica” without investigating the deeper pathological causes, which is actually unscientific and irresponsible.
Therefore, when a patient goes to the orthopedic department, the orthopedic surgeon should make a detailed physical examination for the patient, and supplement it with X-ray, CT, MRI (magnetic resonance imaging), etc., to make a reasonable pathological diagnosis of the condition, in order to achieve a causal treatment and truly eliminate the patient’s pain.
It is important to point out that
Lumbar disc herniation does not necessarily manifest as sciatica. The human body has five lumbar vertebrae, corresponding to which there are five pairs of lumbar nerve roots, part of the 4th lumbar nerve root, the 5th lumbar nerve root and the 1st, 2nd and 3rd sacral nerve roots make up the sciatic nerve, while the 2nd and 3rd nerve roots and some fibers of the 4th lumbar nerve only participate in the femoral nerve distributed in front of the thigh, not in the sciatic nerve. symptoms of compression of the femoral nerve. It usually manifests as weakness in lifting the leg and dull sensation of the skin in the anterior or medial thigh; there are also some patients with lumbar 5 to sacral 1 disc herniation who do not have sciatica. In some cases, the early onset of the disease or the whole course of the disease may only be manifested as lumbar pain, and in others, intermittent claudication, walking a few hundred meters, then feeling soreness and weakness in the lower limbs, and having to rest or bend and squat for a while before continuing to walk; in some cases, the patient only feels coldness in the limbs; in some severe cases, paralysis, inability to move the lower limbs, and urinary and fecal incontinence.
Treatment
I. Bed rest.
Especially in the early stage of disc herniation lying on hard bed rest for 3-4 weeks, some patients have their symptoms relieved by themselves.
Second, drug treatment.
Western medicine: painkillers, vitamin B, a short course of corticosteroids taken orally can be beneficial to recovery.
Chinese medicine: topical patches, such as Lizheng pain relief patches and other pure Chinese medicine topical medications have a better therapeutic effect on sciatica.
Third, physical therapy.
In the acute stage, ultra-short wave therapy and ultraviolet radiation for erythema can be used. In the chronic stage, short wave therapy and direct current iodine ion introduction can be used.
Acupuncture treatment of sciatica.
Main acupuncture points: lumbar 2-5 pinch points, ayurvedic points, ring jump
1. Wind-cold damp paralysis
Diagnosis】Cold pain in the lower back and legs, with up and down movement and inconvenience in flexion and extension, aggravated by rainy and cold weather, or with swelling of the lower limbs; thin white or white greasy moss, floating and tight or sinking pulse.
Prescription】Chichibian, Yanglingquan, Zhengmen
2.Blood stasis and obstruction
[Diagnostic Features]: History of internal contusion of the lumbar region, stabbing pain in the lumbar leg, refusal to press the painful area, stabbing pain released after pressing, pain is worse at night, inability to stoop and tilt, unfavorable rotation; purple tongue or petechiae, stagnant pulse.
Prescription】Yanglingquan, Diayu, Blood Sea, Zhizhong
3.Insufficient positive energy
[Diagnostic Features]: Recurrent pain in the lower back and legs, worse with exertion, atrophy and weakness of the lower extremities, aversion to wind and cold, rubbing and pressing, fatigue and weakness, lack of color; pale tongue with little coating, sunken and thin pulse.
Prescription】Yanglingquan, Zhizhong, Sansanli, Sanyinjiao
4. Other acupuncture therapies.
Ear acupuncture pressure: sciatic nerve, hip, lumbosacral vertebrae, kidney, pressure pain points
Skin acupuncture: percussion of the lumbosacral region and stabbing at pressure points for bleeding, plus fire cupping.
Sciatica exercise therapy
Sciatica mostly occurs unilaterally and worsens at night, when coughing or defecating. Sciatica is divided into two types: primary and secondary. Primary sciatica is mainly caused by inflammatory lesions of the sciatic nerve; secondary sciatica is mostly caused by lumbar disc herniation, lumbar spine hyperplasia, soft tissue injury of the lumbar and hip areas, as well as pelvic and spinal canal lesions. Patients in addition to avoid cold, appropriate to strengthen the waist and leg functional exercise, will get good results.
A. Swing the legs left and right.
Standing position, hands on the wall, take turns to swing the legs in the left and right direction, swinging the foot does not touch the ground.
Second, alternating straight leg up movement.
Supine position, alternately in, right leg straight after lifting, regular exercise can gradually improve the lifting angle.
Third, pedal bike exercise.
Supine position, the two lower limbs like riding a bicycle in turn pedaling, pedaling amplitude can gradually increase.
Four, sitting leg lifts.
Sitting position, both legs close to or on a thick book, straight knees, heels on the ground, holding the edge of the bench, lifting the leg over the umbilicus, and then put down. At the beginning, the affected leg may not be raised very high, and the degree of elevation of the affected leg will gradually increase after persistent exercise.
Five, sit flat and push the leg.
Sitting position, the foot followed the ground, toes stilted, both hands flat on the thigh, then bend forward, both hands simultaneously pushed to the foot. When first practicing two hands is difficult to push to the foot, adhere to a period of time will receive good results.
Six, squat jump.
Hands on the bench, the left leg bent knee squat, the right leg as straight as possible to the right side, so alternating between the left and right.
Sciatica prevention common sense.
Many patients with sciatica can clearly state that the onset of the disease is related to a sudden lumbar “sprain”, such as occurring after lifting heavy objects, carrying heavy objects, prolonged bending activities or falls. Therefore, when a sudden weight-bearing movement is required, the lumbar region should be moved in advance to avoid lumbar “sprain” as much as possible, and the incidence of this disease can often be reduced by strengthening the lumbar muscle strength and improving the humid living environment. Patients with this disease should seek medical attention in the acute stage, rest in bed, and cooperate closely with the diagnosis and treatment, the prognosis is usually good.
Treatment of acute phase of sciatica.
1, should be treated for the cause. The acute phase of lumbar disc prolapse can often be stabilized by resting on a hard bed for 1-2 weeks.
2, symptomatic treatment, pain can be paracetamol plus codeine 30mg, 3-4 times / d, and other non-steroidal analgesics, such as isobutyleneacetic acid, naproxen, etc.. For muscle spasm, Valium 5-10mg orally, 3 times/d; or Cyclobenzaprine 10mg orally, 3 times/d, may be effective.
3, severe cases can be used dexamethasone 10-15mg / d, intravenous drip, 7-10 days; general can be oral prednisone 10mg, 3-4 times a day, 10-14 times for a course. Can also be used 1%-2% procaine or plus prednisolone each 1ml paravertebral closure. It can be combined with acupuncture and physiotherapy, and conservative therapy can mostly relieve. If the treatment is not effective, pelvic traction or prednisolone epidural injection can be used, individual ineffective or chronic recurrent cases can be considered for surgery.