1.The concept of sciatica
Sciatica: refers to sciatic neuropathy, a painful symptom group occurring along the sciatic nerve pathway, namely the lumbar, hip, posterior thigh, posterior lateral calf and lateral foot.
2.Etiology of sciatica
The sciatic nerve is composed of nerve roots from lumbar 5 to sacral 3. According to the location of the lesion, there are two types of sciatica: radicular and dry. The former is mostly seen in radicular sciatica lesions located in the spinal canal, and the most common causes are lumbar intervertebral disc herniation, followed by intravertebral tumor, lumbar tuberculosis and lumbosacral radiculitis. The lesions of dry sciatica are mainly on the extra-vertebral canal sciatic nerve stroke, and the etiology includes sacral arthritis, intrapelvic tumor, pregnancy uterine compression, hip trauma, pear-shaped muscle syndrome, improper gluteal muscle injection, and diabetes mellitus.
3.Symptoms of sciatica
The disease is common in male young adults and is unilateral. The degree and duration of pain are often related to the cause and the urgency of the onset of the disease.
Root sciatica
The onset of the disease varies according to the cause. The most common type of lumbar disc herniation has an acute or subacute onset, often triggered by exertion, bending or strenuous activity. In a few cases, the onset is chronic. The pain often radiates from the lumbar region to the hip, posterior thigh, popliteal fossa, lateral calf and foot, with burning or cutting-like pain, which may increase with coughing and exertion, and is worse at night. In order to avoid nerve strain and pressure, patients often take special pain-reducing positions, such as sleeping on the healthy side, hip and knee off flexion, standing on the healthy side, resulting in scoliosis over time, more bending to the healthy side, sitting into the hip tilt to the healthy side, in order to reduce the pressure on the nerve root. Pulling on the sciatic nerve can induce pain, or increased pain, such as Kernig’s sign positive (the patient lies supine, first flexing the hip and knee at right angles, and then lifting the lower leg up. As a result of flexor spasm, knee extension is limited to less than 130 degrees with pain and resistance); a positive straight leg raise test (Lasegue’s sign) (the patient lies supine, the lower limb is extended and the affected limb is raised less than 70 degrees, causing leg pain). There may be pressure pain in the sciatic nerve pathway, such as the parietal point, gluteal point, national point, ankle point and metatarsal point. There is often numbness and hypoesthesia in the lateral calf and dorsum of the foot of the affected limb. The gluteal muscle tone is relaxed and the thumb extension and flexion muscles are weakened. The Achilles tendon reflex is weakened or absent.
Dry sciatica
The onset of the disease varies according to the cause. If the pain is triggered by cold or trauma, the onset is more acute. The pain often radiates from the buttock to the posterior femur, posterior lateral calf and lateral foot. The pain increases with walking, activity and traction on the sciatic nerve. The pressure point is below the gluteal point, and the Lasegue sign is positive while the Kernig sign is mostly negative. The spinal scoliosis is mostly bent to the affected side to reduce the strain on the sciatic nerve trunk.
4. Diagnosis and differentiation of osteopathic neuralgia
The diagnosis is not difficult but it is important to determine the cause of the pain based on the location and direction of radiation, factors that aggravate the pain, pain-reducing posture, traction pain and pressure points.
Lumbar disc herniation
Patients often have a long history of recurrent low back pain, or a history of heavy physical work, often with acute onset after a lumbar injury or bending work. In addition to the typical symptoms and signs of radicular sciatica, there is lumbar muscle spasm, limitation of lumbar movement and loss of lumbar forward flexion, and significant pressure and radiating pain in the intervertebral space at the site of disc herniation. x-ray radiographs may show narrowing of the affected intervertebral space, and CT examination may confirm the diagnosis.
Cauda equina tumor
The onset of the disease is slow and gradually worsens. At the beginning of the disease, it is often unilateral radicular sciatica, which gradually develops into bilateral. The pain is significantly worse at night, and the course of the disease is progressive. Sphincter dysfunction and hyperalgesia in the saddle area are also present. The diagnosis can be confirmed by lumbar puncture with subarachnoid obstruction and significantly increased cerebrospinal fluid protein quantification, or even Froin’s sign (cerebrospinal fluid that is yellow and coagulates on its own after placement), and spinal iodine hydrography or MRI.
Lumbar spinal stenosis
Most often seen in middle-aged men, early on there is often “intermittent claudication”, the pain in the lower extremities is aggravated after walking, but the symptoms are reduced or disappear after walking with bending or rest. When the nerve root or cauda equina is severely compressed, symptoms and signs of sciatica may appear on one or both sides, and the course of the disease is progressively aggravated, and treatment such as bed rest or traction is ineffective. The diagnosis can be confirmed by X-ray or CT of the lumbosacral spine.
Lumbosacral radiculitis
The disease develops due to infection, poisoning, nutritional and metabolic disorders or strain, cold and other factors. The onset is usually acute and the damage often extends beyond the sciatic nerve innervation area, manifesting as weakness, pain, mild muscle atrophy of the entire lower extremity, and the knee tendon reflex is often weakened or absent in addition to the Achilles tendon reflex.
In addition, tuberculosis of the lumbar spine and metastatic cancer of the vertebral body should also be considered. In case of dry sciatica, attention should be paid to the history of cold or infection, as well as lesions of the sacroiliac joint, hip joint, pelvis and hip. If necessary, in addition to lumbosacral spine X-ray, sacroiliac joint X-ray, anal finger, gynecological examination and ultrasound of pelvic organs should be performed to clarify the cause.
Treatment of sciatica
The cause of sciatica should be determined by hospital consultation and active treatment of the primary disease (e.g. lumbar disc herniation) that is causing the nerve compression or irritation. Symptomatic treatment may include antipyretic and analgesic drugs such as ibuprofen and diclofenac.
Adjunctive treatment of sciatica
For painful episodes, apply ice to the affected area for 30-60 minutes several times a day for two to three days, then apply hot water bags to the affected area at the same intervals, or take over-the-counter painkillers such as anti-inflammatory pain. Apply hot towels or cloth-wrapped hot salts to the lower back or buttocks daily before bedtime, the temperature should not be too high and should be comfortable.
Diet for sciatica
The following foods can be eaten regularly.
1. 25 grams of Chuanjian and 30 grams of Eucommia, boiled with 1 pig’s tail and taken with seasoning.
2. 15 grams of mulberry sorrel with 1 egg, boiled and taken.
3. 6 grams of old mulberry branch, stewed with 500 grams of female chicken, and consumed with soup.
Precautions for sciatica
1, board bed rest, can insist on doing bed gymnastics.
2, to combine work and rest, regularize life, and participate in various sports activities appropriately.
3.After exercise, pay attention to the protection of the waist and affected limbs, change underwear in time after sweating to prevent damp clothes from being warmed and dried on the body, and it is not advisable to take a bath immediately after sweating, and wait until after sweating to prevent getting cold and wind.
4, in the acute pain period, do not pick up more than 10 pounds (1 pound = 0.9072 city pounds) of heavy objects and do not use the legs, arms and back to lift heavy objects, can push but do not pull heavy objects.
In order to avoid pulling on the sciatic nerve to reduce pain, patients often have some special pain-reducing positions, such as sleeping on the healthy side, with the hip and knee of the sick side of the lower limb slightly flexed. The hip and knee of the diseased side of the lower limb are slightly flexed. When sitting down, the hip of the healthy side is used to apply pressure. When standing, the weight of the body shifts to the healthy side, and when bending over to pick up something, the knee of the affected limb flexes, causing scoliosis over time, mostly to the side of the lesion. Any test that pulls on the sciatic nerve can induce or aggravate pain. There may be significant pressure pain along the sciatic nerve pathway at various points such as the lumbar paravertebral area, the equivalent of the circumflexion, at the commissioning point, below the small head of the lateral fibula of the ankle, and in the middle of the sole of the foot. In addition to pain, there are sensations of pins and needles on the lateral side of the calf and the dorsum of the foot, and the muscles of the posterior thigh and calf are flaccid and weak, with mild muscle atrophy over time.