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Sciatica

Sciatica is a pain in the leg due to irritation of the sciatic nerve. The pain generally goes from the front of the thigh to the back of the calf, and may also extend upward to the hip and down to the foot. more...

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In addition to pain, there may be numbness and difficulty moving or controlling the leg.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the nerve root and causing the pain.

Causes of sciatica

Sciatica is generally caused by compression of the sciatic nerve. It is sometimes divided into two main categories. "True" sciatica is caused by compression at the nerve root from a "slipped disc" (a herniated disc in the spine), roughening and enlarging and/or misalignment of the vertebrae. "Pseudo-sciatica" is caused by compression of more peripheral sections of the nerve, usually from soft tissue tension in the piriformis or other related muscles. Unhealthy postural habits such as excessive sitting in chairs and sleeping in the fetal position, along with insufficient stretching and exercise of the relevant myofascial areas, can lead to both the vertebral and soft tissue problems associated with sciatica.

Other causes of sciatica include infections and tumors.

Sciatica may also be experienced in late pregnancy either as the result of the uterus pressing on the sciatic nerve, or secondarily from muscular tension or vertebral compression associated with the extra weight and postural changes inherent in pregnancy.

Pelvic entrapment of the sciatic nerve can also generate symptoms resembling spinal compression of the nerves. The most predominant form of this condition is known as piriformis syndrome. With this condition the piriformis muscle, which is located beneath the gluteal muscles, contracts in spasm and strangles the sciatic nerve, which is located beneath the muscle.

Yet another source of sciatica symptoms is caused by active trigger points in the lower back or gluteal muscles. In this case, the referred pain is not, in fact, coming from compression of the sciatic nerve, though the pain distribution down the buttocks and leg can be quite similar. Trigger points occur when muscles become ischemic (low blood flow) due to injury or chronic muscular contraction. The muscles most commonly associated with trigger points causing sciatica symptoms are the quadratus lumborum, the gluteus medius and minimus, and the deep hip rotators.

Treatment

Because of the many conditions that can compress nerve roots and cause sciatica, treatment options often differ from patient to patient. A combination of treatment options is often the most effective course.

Most cases of sciatica can be effectively treated by physical therapy or massage therapy (specifically neuromuscular therapy), and appropriate changes in behavior and environment (for example cushioning, chair and desk height, exercise, stretching, self treatment of trigger points). Other conservative treatment options include Somatic Movement Education, anti-inflammatory medications (i.e. NSAIDs or oral steroids), pain medications, and epidural steroid injections. Chiropractic manipulation often helps. In approximately 10-20% of cases, surgery is required to correct the problem.

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Bed rest is bad for back pain, ineffective for sciatica
From American Family Physician, 7/15/05 by Henry Barry

Clinical Question: Is bed rest effective in the short-term treatment of patients with back pain and sciatica?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: In this update of a 1999 Cochrane Review of trials on bed rest for short-term (12 weeks) relief of low back pain or sciatica, authors searched multiple databases for published and unpublished randomized or quasi-randomized studies in any language. Two reviewers independently assessed the methodologic quality of each study and extracted the data. They assessed the quality using four criteria: (1) concealment of allocation; (2) cointervention; (3) intention-to-treat analysis or losses to follow-up; and (4) outcome assessment.

Since the 1999 review, the authors found only two new trials. Six trials consistently demonstrated that for patients with uncomplicated low back pain, bed rest was slightly worse than staying active for pain relief and return to functional status. For patients with sciatica, the data were less clear, but bed rest had little or no effect on pain or return to function.

Bottom Line: When studied for three months, bed rest in patients with uncomplicated low back pain causes more pain and slows return to function. Similarly, patients with sciatica experience, at best, no benefit with bed rest. (Level of Evidence: 1a)

Study reference: Hagen KB, et al. The updated Cochrane review of bed rest for low back pain and sciatica. Spine March 1, 2005;30:542-6.

Used with permission from Barry H. Bed rest bad for back pain, ineffective for sciatica. Accessed online April 27, 2005, at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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