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Orthopedics and Traumatology

Sciatica

Causes, Symptoms, and Treatment

Sciatica
This terminology refers to the pain that radiates across the sciatic nerve. The sciatic nerve is the longest in the body. It begins in the lower back, going through the hips and glutes towards the legs. Typically, pain affects only one side of the body. The pain is caused when one nerve branch is compressed. 

Causes
 The pain occurs due to a compression in the sciatic nerve caused by a herniated disk in the spine, or an overgrowth bone in the vertebrae. Less frequently, the nerve may be contracted by a tumor or be damaged due to a condition such as diabetes. 

Symptoms
  • Pain that goes from the lower spine towards glutes and legs
  • Discomfort in any part of the sciatic nerve, most commonly in the low area, and the rare part of the thighs and calf
  • Numbness and tingling in the affected leg or foot
 Risk Factors
  • Age
  • Being overweight
  • An occupation that requires carrying heavy loads
  • Being sit for long periods
  • Diabetes
 
Diagnostic
 During diagnosis, the Orthopedist will evaluate the muscle strength and reflects. It may ask the patient to tiptoe or using the heels, squatting and getting up, lie on your back and lift one leg. When doing these exercises, the discomfort caused by sciatica is more intense. 
 
The Orthopedist may ask for imaging tests, such as radiographs or MRI, to discard herniated discs or bone spurs. 
 
Only if the pain increases and the symptoms don't get better over the weeks will the Orthopedist require other types of exams. 

Treatment
 In most cases, sciatica pains are treatable with non-surgical procedures within weeks. Patients who develop severe weakening in the leg, or problems in the intestine or bladder, may be candidates for surgery.
 
The treatments the Orthopedist may suggest are:
 
Over the counter medication
  • anti-inflammatories
  • muscle relaxants
  • tranquilizers 
Physiotherapy 
 If the pain diminishes, the Orthopedist or Physiotherapist may prescribe a rehabilitation plan to help to prevent future injuries. These programs include special exercises to correct the posture, strengthen the back muscles, and improving flexibility.
 
Steroid injections 
 The Orthopedist may suggest applying corticosteroids on the affected nerve to reduce the pain and help reduce inflammation. Generally, this treatment is no longer effective in a few months. The number of injections that can be applied is limited, since using them too often may lead to secondary effects. 
 
Surgery
This alternative is only suitable when the compressed nerve generates considerable weaknesses and loss of intestinal or bladder control. Surgery is also suggested when the pain worse progressively, and therapies are not enough.
 
Living with Sciatica
 In general, sciatica disappears over time. There are alternatives that can help simultaneously, along with the Orthopedist suggestions that can be performed at home to diminish and control the symptoms. Applying cold compresses in the affected zone several times a day for at least 20 min will alleviate the symptoms. After two or three days, applying hot compresses can be very helpful too.
 
Stretchings within the lumbar zone can help to get better. It is suggested to hold the same position for at least 30 seconds.
 
Over the counter medications such as Ibuprofen, naproxen sodium can alleviate symptoms.
 
Alternative medicine can be an excellent parallel alley along with other treatments previously described by the specialist. Acupuncture and chiropractic are some alternative therapies that may alleviate the pain in the lower part of the back.





When should I visit the Doctor?

 

If the pain doesn't get better in about a week or gets worse, you should reach out to your Orthopedist to get a proper diagnosis and to help alleviate the symptoms with the right treatment.

 

When visiting the Orthopedist, it is highly suggested to keep track of the dates when the discomfort and pain started to show and have a detailed description of the symptoms, duration, and possible causes that might have led to developing it. If you are already under treatment, it is crucial to let the specialist know. Sciatica symptoms can be controlled, and learning how to prevent them is the first step to learn how to live without pain. 




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