3. INTRODUCTION
Sciatica is a sharp shooting pain
in the lower extremity resulting
from irritation of the sciatic
nerve and aggrevated by
movement of limbs .
The pain of sciatica is typically
felt from the lower back
(lumbar region) to behind the
thigh and radiating down below
the knee and may reach the foot.
4. EPIDEMIOLOGY
The lifetime incidence of sciatica is estimated to be
between 13-40%.
The corresponding annual incidence of an episode of
sciatica ranges from 1-5%.
Clinically significant sciatica is much less common and
occurs in only 4-6% of poeple over the course of their
life time.
True sciatica actually develops in only 35% of patients
with disc herniation.
5. COURSE OF SCIATIC NERVE
ORIGIN : i) lumbosacaral plexus.
TRAVERSE : i) Then enters the gluteal region via greater
Sciatica foramen.
ii) Then it emerges inferiorly to the piriformis
muscle.
iii) It then enters the posterior thigh by passing
Deep to the long head of biceps femoris.
TERMINATION : At the apex of popliteal fossa, it terminates by
bifurcating into the tibial and common fibular nerves.
6.
7. Etiology
Sciatica occurs when the sciatic nerve which runs from
back
to the feet,get compressed or irritated.
1. Disc herniation – In approximately 90% of
cases,sciatica is caused by disc herniation at different
level of lumbosacaral vertebrae. (most common L5 or
S1).
2.Spinal stenosis – i) It is narrowing of passage where the
spinal cord travels down the spine that results in too
much pressure on spinal cord.
ii) Most common cause is age related change in spine.
3.Spondylolisthesis –It occurs when a vertebrae slips out
of position,it is a cause of spinal stenosis. Most
commonly caused by age related or degenerative bear
of spinal joints.
Disc herniation
8. 4.Piriformis syndrome : In most population sciatic nerve
pierces through the piriformis muscle and over contraction
of piriformis will lead to sciatica like symptom.
5. Pregnancy : It may occur during pregnancy as a result of
weight of foetus pressing on the sciatic nerve during sitting
or leg spasms.
OTHER CAUSES
1. Infection in spine
2. Injury to spine or surrounding muscle and ligaments.
3. Tumour within spine
4. Spinal trauma : Forceful impact caused by car accidents ,
falls or other blows cause damage to spine.
9. SYMPTOMS AND SIGN
i. Radiating pain from buttock down the back of leg.
ii. Cramping sensation in the thigh .
iii. Tingling or numbness in legs.
iv. Burning sensation in legs and thigh area.
v. Muscle weakness is present in severe cases.
vi. Most often symptoms are seen only on one side.
vii. If symptoms present in both sides the disc bulge is
more severe.
10. RISK FACTORS
1. Age : age related changes in the spine such as herniated
disc and bone spurs are most common cause of sciatica.
2. Obesity : Excess body weight may contribute to the spinal
changes that trigger sciatica.
3. Diabetes : This condition, which affects the way your body
uses blood sugar increases your risk of nerve damage.
4. Occupation : A job that requires twisting of back ,carry
heavy loads or drive a motor vehicle for long periods may
play a role in sciatica.
5. Prolonged sitting: People who sit for prolonged period or
have sedentery life style are more likely to develop sciatica
than active people.
11. PATHOPHYSIOLOGY
Due to disc herniation, spinal stenosis, and other
causes
Compression of sciatic nerve takes place resulting
in pain in back throughout the leg
Hence resulting in sciatica.
12. TEST AND DIAGNOSIS
1. Straight Leg Raising test
(SLR): if positive (Lasegue’s
sign)
2. X-Ray : for fractures in spine
3. MRI or CT Scan : to create
images of structures of back.
4. Electromyography : to examine
how well electrical impulses
travel through sciatic nerve .
5. Myelogram: Using dye , injected
between vertebra to determine
if vertebra or disc is causing the
pain.
13.
14. COMPLICATIONS
1. Sciatica can potentially cause permanent nerve
damage.
2. Loss of feeling in affected leg.
3. Weakness in affected leg.
4. Loss of bowel or bladder function.
15. MANAGEMENT AND SELF
CARE
1. Admit to medical ward in severe cases .
2. Position patient in suitable assumed position.
3. Self care
- in form of cold packs ,
- hot packs,
-stretching ,
-pain relievers etc. Can be taken
17. गृध्रसी
परिचय:-
इस व्याधि में िोगी धगद् क
े समान एक पैि पि शिीि का भाि
देकि चलता है, इसललए इसे गृध्रसी कहते हैं।
गृध्रसी व्याधि में प्रक
ु पपत वात से स्फिक प्रदेश की वात वाहहननयों का
प्रक्षोभ होता है औि स्फिक प्रदेश से वेदना प्रािंभ होकि कहि, उरू, जानु,
जंघा औि पाद इस मागग से अंगुली तक संचाि किती है।
ननदान :-
सामान्य ननदान
“व्यायामादपतपगणात्प्प्रपतनाद्भंगात्प्क्षयाज्जागिात्।
वेगानां च पविािणादनतशुचः शैत्प्यादनतत्रासतः।।
रुक्षक्षोभकषायनतक्तकिुक
ै िेलभः प्रकोपं व्रजेत्।
वायुवागरिििागमे परिणते चान्हेऽपिाण्हेऽपपच ।। (नतसिाचायग मा.नन.
मिुकोश िीका)
18. आहािज ननदान
रूक्ष, शीत आहाि का सेवन
प्रनतमाशन
अनशन
अध्यशन
असात्प््य आहाि का सेवन
किु, नतक्त, कषाय िस का अत्प्यधिक सेवन
पवषमाशन
पवहािज ननदान
अत्प्यधिक व्यायाम
धगि जाने से
िात्रत्र जागिण से
19. वेग िािण से
हदवाफवप्न
शोक, क्रोि, भय उत्प्पन्न होने से
हाथी आहद की अत्प्यधिक सवािी से
जल में तैिना
पवलशष्ि ननदान
पञ्चकमो का लमथ्यायोग
धचिकािी व्याधि से ग्रफत होना
ममग फथान पि आघात
आघात से अनतमात्रा में िक्तफत्राव
