28/06/2022
🔊 SCIATICA
WHAT IS SCIATICA?
💡 Sciatica is the result of a neurological problem in the back or an entrapped nerve in the pelvis or buttock. There are a set of neurological symptoms such as:
➡️ Pain (intense pain in the buttock)
➡️ Lumbosacral radicular leg pain
➡️ Numbness
➡️ Muscular weakness
➡️ Gait dysfunction
➡️ Sensory impairment
➡️ Sensory disturbance
➡️ Hot and cold or tinglings or burning sensations in the legs
➡️ Reflex impairment
➡️ Paresthesias or dysesthesias and oedema in the lower extremity that can be caused by the irritation of the sciatic nerves (the lumbar nerve L4 and L5 and the sacral nerves S1,S2 and S3)
CAUSES OF PAIN
💡 Pain is a result of irritation of the sciatic nerve. it can be constant or intermittend. The pain may be worsened by certain movements like coughing or sneezing (these movements increase the intra abdominal pressure). Sitting, bending, prolonged standing or rising from a sitting position can aggravate or increase the pain.
PAIN PATTERNS
💡 In regards to relief the pain, the supine position decreases the pressure on the herniated disc and will subsequently decrease pain. Pain is located along the distribution of the nerve and can be felt in the back, buttocks, knee and leg. It only radiates to one side of the leg and can result in reduced power, reflexes and sensation in the nerve root. Also gait dysfunction (toe walking, foot drop and knee buckling), paresthesias or dysesthesias are frequent neurological symptoms.
SYMPTOMS BASED ON NERVE COMPRESSION
💡 Sciatica can be caused by the compression or irritation of nerve L4, L5, S1, S2 and S3. The sciatica symptoms depend on which nerve is compressed or irritated.
◾ L4: When the L4 nerve is compressed or irritated the patient feels pain, tingling and numbnessiIn the thigh. The patient also feels weak when straightening the leg and may have a diminished knee jerk reflex.
◾ L5: When the L5 nerve is compressed or irritated the pain, tingling and numbness may extend to the foot and big toes.
◾ S1: When the S1 nerve is compressed or irritated the patient feels pain, tingling and numbness on the outer part of the foot. The patient also experiences weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.
source: B.W Koes, M.W Van Tulder, W.C Peul. Diagnosis and treatment of sciatica. BMJ.
