Sciatica

BY
KAGOGA ROGER
ECN-DNE
PHNC
SCIATICA
Monday, June 8, 2015TAKE CARE OF YOUR LIFE1

OBJECTIVES
 Overview of sciatic nerve.
 Define sciatica.
 Etiology of sciatica.
 Risk factors for sciatica.
 Pathophysiology .
 Clinical manifestations.
 Diagnosis
 Management.
 Complications
 Prevention.
 ADVICEs.

OVERVIEW OF SCIATICA
 The sciatic nerve is the largest nerve in the body.
It originates in a bundle of nerves in the lower
back (called the sacral plexus), and passes
through the pelvis and down the back of each
thigh. In the back of the thigh, the sciatic nerve
branches into two smaller nerves called the tibial
nerve and the peroneal nerve.
 The sciatic nerve carries impulses between
nerve roots in the lower back and the muscles
and nerves of the buttocks, thighs, and lower
legs.

Overview……………….
 Nerve roots are extensions of the spinal nerves.
They emerge from the spinal cord through spaces on
both sides of the bony segments (vertebrae) in the
backbone (spine).
There are 31 pairs of nerve roots.
 Eight pair originate in the neck (called the cervical
spine)
 12 pair originate in the upper back (called the
thoracic spine)
 5 pair originate in the lower back (called the lumbar
spine)
 5 pair originate in the lowest area of the back (called
the sacral spine)
 1 pair originate in the tailbone (coccyx)
 Pressure or irritation in one of the nerve roots in the

SCIATICA
 Is a term used to describe the symptoms of low
back pain that spreads (radiates) through the hip,
to the back of the thigh, and down the inside of
back the leg via the sciatic nerve, characterized
by pain, tingling, numbness, or weakness.
 Sciatica (sometimes known as radiculopathy) is a
description of symptoms of inflammation or
compression of the sciatic nerve , not a
diagnosis. A herniated disc, spinal stenosis,
degenerative disc disease, and
spondylolisthesis can all cause sciatica.

AETIOLOGY OF SCIATICA
 Sciatica occurs when the sciatic nerve, which
runs from your back to your feet, becomes
compressed or irritated.
 There are many reasons why this may happen,
although the vast majority of cases are caused by
a herniated or "slipped" disc.

Herniated ('slipped') disc
 Your spine is made up of
vertebrae, discs and nerves.
Vertebrae are the blocks of bone
that make up the structure of your
spine and protect the nerves.
 The vertebrae are supported and
cushioned by discs. These discs
are made from a tough, fibrous
case that contains a softer, gel-like
substance. A herniated disc occurs
when the outer part of the disc
ruptures (splits), allowing the gel
inside to bulge and protrude
outwards between the vertebrae.
When this presses against the

Spinal stenosis
 Spinal stenosis is the narrowing of the passage
where the spinal cord travels down the spine.
 It occurs when the ligaments become overgrown,
but bulging of spinal discs and bony spurs from
the vertebrae can also contribute.
 Spinal stenosis is usually caused by age-related
changes in the spine, but can also be down to
degenerative disease of the spinal joints, which
causes the vertebrae to lose their correct
alignment.

Spondylolisthesis
 Spondylolisthesis occurs when a vertebra slips
out of position.
 Spondylolisthesis is most commonly caused by
age-related or degenerative wear of the spinal
joints. However, in younger people, it can be
caused by spinal fractures and repeated
excessive bending of the spine.

Piriformis syndrome
 This develops when the piriformis muscle, a small
muscle that lies deep in the buttocks, becomes
tight or spasms, which can put pressure on and
irritate the sciatic nerve.

Pregnancy
 Sciatica may also occur during pregnancy as a
result of the weight of the fetus pressing on the
sciatic nerve during sitting or during leg spasms.
While most cases do not directly harm the fetus
or the mother, indirect harm may come from the
numbing effect on the legs, which can cause loss
of balance and falling. There is no standard
treatment for pregnancy induced sciatica

Other causes
 An infection in the spine
 An injury to the spine, or the surrounding muscles and
ligaments
 A growth within the spine, such as a tumour
 Cauda equina syndrome
The cauda equina is the bundle of nerves that lead out
from the end of the spinal cord. Cauda equina
syndrome occurs when these nerves are compressed
and damaged. It can eventually lead to paralysis if left
untreated.
One of the warning signs of cauda equina syndrome is
suddenly losing control of your bladder or bowels.Monday, June 8, 2015TAKE CARE OF YOUR LIFE14

RISK FACTORS……..
 Age. Age-related changes in the spine, such as
herniated disks and bone spurs, are the most
common causes of sciatica.
 Obesity. By increasing the stress on your spine,
excess body weight may contribute to the spinal
changes that trigger sciatica.
 Diabetes. This condition, which affects the way
your body uses blood sugar, increases your risk
of nerve damage.

Risk factors for sciatica
 Occupation. A job that requires you to twist your
back, carry heavy loads or drive a motor vehicle
for long periods may play a role in sciatica, but
there's no conclusive evidence of this link.
 Prolonged sitting. People who sit for prolonged
periods or have a sedentary lifestyle are more
likely to develop sciatica than active people are.

PATHOPHYSIOLOGY
 Sciatica is generally caused by the compression of
lumbar nerves L4, or L5 or sacral nerves S1, S2, or
S3, or by compression of the sciatic nerve itself.
When sciatica is caused by compression of a dorsal
nerve root (radix), it is considered a lumbar
radiculopathy (or radiculitis when accompanied with
an inflammatory response).
 This can occur as a result of a spinal disk bulge or
spinal disc herniation (a herniated intervertebral disc),
or from roughening, enlarging, or misalignment
(spondylolisthesis) of the vertebrae, or as a result of
degenerated discs that can reduce the diameter of the
lateral foramen (natural hole) through which nerve
roots exit the spine. Monday, June 8, 2015TAKE CARE OF YOUR LIFE17

PATHOPHYSIOLOGY………
 The intervertebral discs consist of an anulus
fibrosus, which forms a ring surrounding the inner
nucleus pulposus. When there is a tear in the
anulus fibrosus, the nucleus pulposus (pulp) may
extrude through the tear and press against spinal
nerves within the spinal cord, cauda equina, or
exiting nerve roots, causing inflammation,
numbness, or excruciating pain.
 Inflammation in the spinal canal can also spread
to adjacent facet joints and cause lower back pain
and/or referred pain in the posterior thigh(s).

PATHOPHYSIOLOGY……..
 Pseudosciatic pain can also be caused by
compression of peripheral sections of the nerve,
usually from soft tissue tension in the piriformis or
related muscles.
 The spinal discs are composed of a tough
spongiform ring of cartilage ("anulus fibrosus")
with a more malleable center ("nucleus
pulposus").
 The discs separate the vertebrae, thereby
allowing room for the nerve roots to properly exit
through the spaces between the vertebrae.
 The discs cushion the spine from compressive
forces, but are weak to pressure applied during
rotational movements. Monday, June 8, 2015TAKE CARE OF YOUR LIFE19

PATHOPHYSIOLOGY………
 That is why a person who bends to one side, at a
bad angle to pick something up, may more likely
herniate a spinal disc than a person jumping from
a ladder and landing on their feet.
 Herniation of a disc occurs when the liquid center
of the disc bulges outwards, tearing the external
ring of fibers, extrudes into the spinal canal, and
compresses a nerve root against the lamina or
pedicle of a vertebra, thus causing sciatica. This
extruded liquid from the "nucleus pulposus" may
cause inflammation and swelling of surrounding
tissue, which may cause further compression of
the nerve root in the confined space in the spinal
canal. Monday, June 8, 2015TAKE CARE OF YOUR LIFE20

Symptoms of Sciatica
 Cramping sensation in the thigh
 Radiating pain from the buttock down the back of
the leg
 Tingling in the legs
 Numbness in the legs
 Burning sensation in legs or thigh area
 Severe cases present with muscle weakness

Symptoms of Sciatica
 Most often the symptoms are seen only on one
side
 If the symptoms are present on both sides the
disc bulge is usually more severe
 Most often the symptoms are continuous
 Literally a pain in the butt!

TESTS AND DIAGNOSIS
 Proper History taking on how the illness began till
present complaint.
 During the physical exam, your doctor may check
your muscle strength and reflexes. For example, you
may be asked to walk on your toes or heels, rise from
a squatting position and, while lying on your back, lift
your legs one at a time straight in the air. Pain that
results from sciatica will usually become worse during
these activities.
 Nerve conduction velocity studies/electromyography
to examine how well electrical impulses travel through
the sciatic nerve
 Myelogram using dye injected between the vertebrae
to determine if a vertebra or disc is causing the pain

Imaging tests
 X-ray. An X-ray of your spine may reveal an
overgrowth of bone (bone spur) that may be pressing
on a nerve.
 Magnetic resonance imaging (MRI). This procedure
uses a powerful magnet and radio waves to produce
cross-sectional images of your back. MRI produces
detailed images of bone and soft tissues such as
herniated disks. During the test, you lie on a movable
table inside the MRI machine.
 Computerized tomography (CT) scan. When CT is
used to image the spine, you may have a contrast dye
injected into your spinal canal before the X-rays are
taken — a procedure called a CT myelogram. The
dye then circulates around your spinal cord and spinal
nerves, which appear white on the scan. Monday, June 8, 2015TAKE CARE OF YOUR LIFE24

MANAGEMENT
AIMS
 To relieve pain.
 To promote recovery.
 To prevent further complications.
Admit to Medical ward if in severe cases ,OR
manage as out patient.
Position patient in suitable assumed position.
Observations
ADVICE mainly on self care and conservative
management

Self-care treatments
 Cold packs. Initially, you may get relief from a cold
pack placed on the painful area for up 20 minutes
several times a day. Use an ice pack or a package of
frozen peas wrapped in a clean towel.
 Hot packs. After two to three days, apply heat to the
areas that hurt. Use hot packs, a heat lamp or a
heating pad on the lowest setting. If you continue to
have pain, try alternating warm and cold packs.
 Stretching. Stretching exercises for your low back
can help you feel better and may help relieve nerve
root compression. Avoid jerking, bouncing or twisting
during the stretch and try to hold the stretch at least
30 seconds.
 Over-the-counter medications. Pain relievers such
as ibuprofen (Advil, Motrin, others) and naproxen
(Aleve) are sometimes helpful for sciatica.

Treatments and drugs
 If your pain doesn't improve with self-care
measures, the following treatments .
 Medications
The types of drugs that might be prescribed for
sciatica pain include:
 Anti-inflammatories
 Muscle relaxants
 Narcotics
 Tricyclic antidepressants
 Anti-seizure medications

 Physical therapy
Once your acute pain improves, a physical therapist can
design a rehabilitation program to help you prevent
recurrent injuries. This typically includes exercises to
help correct your posture, strengthen the muscles
supporting your back and improve your flexibility.
 Steroid injections
Corticosteroids help reduce pain by suppressing
inflammation around the irritated nerve. The effects
usually wear off in a few months. The number of steroid
injections you can receive is limited because the risk of
serious side effects increases when the injections occur
too frequently. Monday, June 8, 2015TAKE CARE OF YOUR LIFE28

 Surgery
Surgery might be needed for people who do not
respond to conservative treatment, who have
progressing symptoms, and are experiencing
severe pain.
Surgical options include:
 Microdiscectomy — This is a procedure used to
remove fragments of a herniated disc.
 Laminectomy — The bone that curves around
and covers the spinal cord (lamina), and the
tissue that is causing pressure on the sciatic
nerve are removed. Monday, June 8, 2015TAKE CARE OF YOUR LIFE29

Alternative therapies
 Acupuncture. In acupuncture, the practitioner
inserts hair-thin needles into your skin at specific
points on your body. Some studies have
suggested that acupuncture can help back pain.
 Chiropractic. Spinal adjustment (manipulation) is
one form of therapy chiropractors use to treat
restricted spinal mobility. The goal is to restore
spinal movement and, as a result, improve
function and decrease pain. Spinal manipulation
appears to be as effective and safe as standard
treatments for low back pain.

COMPLICATIONS
 Although most people recover fully from sciatica,
often without any specific treatment, sciatica can
potentially cause permanent nerve damage. Seek
immediate medical attention if you experience:
 Loss of feeling in the affected leg
 Weakness in the affected leg
 Loss of bowel or bladder function

PREVENTION
It's not always possible to prevent sciatica, and the
condition may recur. The following suggestions can
play a key role in protecting your back:
 Avoid/ stop cigarette smoking, which promotes
disc degeneration.
 Exercise regularly to strengthen the muscles of
your back and abdomen, which work to support
your spine.
 Use good posture when sitting, standing, and
sleeping. Good posture helps to relieve the
pressure on your lower back.
 Avoid sitting for long periods. Monday, June 8, 2015TAKE CARE OF YOUR LIFE33

PREVENTION……….
 Use good body mechanics. If you stand for long
periods, rest one foot on a stool or small box from
time to time. When you lift something heavy, let
your lower extremities do the work. Move straight
up and down. Keep your back straight and bend
only at the knees. Hold the load close to your
body. Avoid lifting and twisting simultaneously.
Find a lifting partner if the object is heavy or
awkward.

ADVICE on Lifting and handling
 One of the biggest causes of back injury,
particularly at work, is lifting or handling objects
incorrectly. Learning and following the correct
method for lifting and handling objects can help
prevent sciatica:
 Think before you lift – can you manage the lift?
Are there any handling aids you can use?
 Start in a good position – your feet should be
apart, with one leg slightly forward to maintain
balance. When lifting, let your legs take the strain
– bend your back, knees and hips slightly, but do
not stoop or squat. Tighten your stomach
muscles. Do not straighten your legs before
lifting, as you may strain your back on the wayMonday, June 8, 2015TAKE CARE OF YOUR LIFE35

ADVICE…………
 Keep the load close to your waist – keep the load as
close to your body for as long as possible, with the
heaviest end nearest to you.
 Avoid twisting your back or leaning sideways –
especially when your back is bent. Your shoulders should
be level and facing in the same direction as your hips.
Turning by moving your feet is better than lifting and
twisting at the same time.
 Keep your head up – once you have the load secure look
ahead, not down, at the load.
 Know your limits – there is a big difference between what
you can lift and what you can safely lift. If in doubt, get
help.
 Push, don't pull – if you have to move a heavy object
across the floor, it's better to push rather than pull it.
 Distribute the weight evenly – if you are carrying
shopping bags or luggage, try to distribute the weight
evenly on both sides of your body.

ADVICE on Postures
 How you sit, stand and lie down can also have an
important effect on your back. The following tips should
help you maintain a good posture:
Standing
 Stand upright, with your head facing forward and your back
straight. Balance your weight evenly on both feet, and
keep your legs straight.
Sitting
 You should be able sit upright, with support in the small of
your back. Your knees and hips should be level, and your
feet should be flat on the floor (use a footstool if
necessary). Some people find it useful to use a small
cushion or rolled-up towel to support the small of the back.
 If you use a keyboard, make sure that your forearms are
horizontal and your elbows are at right angles.

ADVICE…………..
Driving
 Make sure that your lower back is properly supported.
Correctly positioning your wing mirrors will prevent
you from having to twist around.
 Foot controls should be squarely in front of your feet.
If driving long distances, take regular breaks so that
you can stretch your legs.
Sleeping
 Your mattress should be firm enough to support your
body while supporting the weight of your shoulders
and buttocks, keeping your spine straight.
 If your mattress is too soft, place a firm board under
the mattress. Support your head with a pillow, but
make sure that your neck is not forced up at a steep
angle.

ADVICE………
Exercise
 Regular exercise can help reduce your risk of
developing a herniated disc by slowing down the
age-related deterioration of the discs in your
back.
 It can also help keep your supporting back
muscles strong and supple.
 You should warm up and cool down properly
before and after any workout or sports activity.
Your warm up and cool down should incorporate
stretching exercises.

THANKS
GOD BLESS YOU
REFERRENCES ;
WIKIPIDIA
MEDICINE BY E. AMAYO
WEB MEDICINE
WHO

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