Sciatica Syndrome

spinal stenosis

Pain across the low back, mid-back (lumbosacral), or on the low broad bone (sacrum), or in the joints formed by the sacrum and the hip bone (ilium), the sacroiliac joints, can precipitate an acute sciatic attack. This occurs when there is a severe trauma, a wrong movement, or anything that can cause an irritation or pinching of the nerve roots involved. When the low lumbar and the higher sacral roots that form the sciatic nerve are involved, the back, buttocks and the outer border of the thigh and the calf will be extremely painful. If the lesions involve the more numerous nerves of the lower sacral plexus (Cauda Equina), it may produce symptoms bilaterally (both buttocks), and of the lower extremities. The symptoms may also affect the groin, and can also produce sexual dysfunction.

The incidence of sciatica can increase with age and at age 60 can be as high as 50% for those with low back problems. These problems can be of many varieties. The most prevalent causes of low back pain that can result in sciatica are due to degenerative joint disease. Other causes can be; congenital defects (Spina Bifida, a defective closure of the spinal column), bulging or ruptured discs, inflammation, pinched nerve, tumor, forward slippage of a vertebra on the one below (spondylolisthesis), and osteoarthritis are but few of the possible precipitating factors of the onset of sciatica.

If any of the above conditions are present, they may remain dormant until there is a trigger mechanism that will set off an acute attack of sciatica. That trigger can be a trauma, such as a fall, golf or tennis swing, wrongly lifting an object (no matter how light or heavy), reaching for an object above your head, a minor auto accident, or any overexertion of the back that causes a severe sprain/strain. Another less obvious trigger can be such an innocuous thing as keeping a thick wallet in your back pocket and constantly sitting on it. That will cause a pressure on the sciatic nerve where it exits from the spine into the buttock area inflaming the nerve, thus precipitating an acute attack.

Misalignment of the vertebrae of the spine is one of the greatest causes of sciatic syndrome. The misalignment reduces the foramina (opening) between the vertebrae where the sciatic nerve exits the spine, causing a pinching of the nerve. The pinching results in inflaming the nerve and causing an acute attack. Poor posture over the years can also place stress on the spine with the same result. A Chiropractor can generally correct these anomalies with manipulation of the spine.

A severe sciatic attack will also affect deeper lying tissues, such as the paravertebral muscles and ligaments (the muscles and ligaments alongside the spinal column), causing inflammation, pain and muscles spasms. The severity of the muscle spasms will determine the amount of limitation of motion of back movement. In severe cases the patient will be unable to move without eliciting sudden severe, sharp, stabbing pain. The patient will present "Antalgic Posture" (bent over and unable to move). Coughing, straining or sneezing will cause a sudden sharp stabbing pain. Your Doctor will refer to this as the "Valsalva's maneuver. Lifting the leg straight up while lying on your back will increase the pain in the leg and back.

A less common form of sciatica can be due to "Spinal Stenosis" This form of sciatica resembles a circulatory condition in that it will involve the nerve roots and manifests itself by causing pain in the buttocks, thighs and or calves when walking, running or climbing stairs. Here again the causative factors can be pinching of the nerve as it exits the spine. The numbness and tingling may be more pronounced here. At times rest will alleviate the pain, but not the numbness and tingling. Another causative factor can be toxic inflammation due to alcoholism or diabetes. Although rare, diabetes can cause a diabetic neuritis.

Seeing your Chiropractor or Physician can help determine the causative factor of your condition. The Chiropractor, once the condition is diagnosed, can correct any spinal misalignment or imbalance that causes a pinching of the nerve. He will also use several modalities, consisting of physiotherapy that will reduce muscle spasms and reduce the inflammation. There are also many things that you can do to help alleviate the symptoms of sciatica. Sufficient rest is of the utmost importance. Prevent overexertion of the back in any form, such as lifting, excessive bending at work or sports. Over the counter pain relievers can take the edge off the pain. Using analgesic gels will aid in reducing the pain. Taking hot showers and the use of a heating pad can be soothing to the back.

When symptoms permit, the individual can start walking for short distances, but should be using the proper back brace to prevent further muscle injury at this time. The patient with vertebral joint arthritis may also respond to a proper back support. Wearing of a proper back brace will help the muscles that have become spastic to relax and limit motion by splinting them. Mild exercises can be started when symptoms permit. Exercise will help strengthen the back and abdominal muscles that maintain the integrity of the spinal column. Lumbosacral flexion exercises should be avoided if they make you feel uncomfortable, as they can also aggravate the condition. The overweight or seriously obese individual should make every effort to lose weight. The extra pounds place an enormous amount of strain on the spinal column.

In conclusion, the condition of sciatica can be an extremely painful and debilitating as previously stated. Do not ignore it, but make every effort to help yourself. An acute flare-up of sciatica when ignored can easily become a chronic condition that will plague you for life. Follow the previous suggestions and life will be more bearable. And remember, in the final analysis, when symptoms permit start your exercise program to strengthen your back and abdominal muscles, which in the future will help prevent recurrences.