ALL you need to know about Sciatica – Causes, treatment, exercises, and symptoms + 10 piriformis stretches
NordenBladet – Sciatica is the name given to pain caused by irritation of the sciatic nerve. Anything that irritates this nerve can cause pain, ranging from mild to severe. Sciatica is usually caused by a compressed nerve in the lower spine. Often, the term “sciatica” is confused with general back pain. However, sciatica is not just limited to the back. The sciatic nerve is the longest and widest nerve in the human body. It runs from the lower back, through the buttocks, and down the legs, ending just below the knee.
This nerve controls several muscles in the lower legs and supplies sensation to the skin of the foot and the majority of the lower leg. Sciatica is not a condition, but rather a symptom of another problem involving the sciatic nerve. Some experts estimate that up to 40 percent of people will experience sciatica at least once in their life.
Causes of sciatica
Sciatica is a common symptom of several different medical conditions; however, an estimated 90 percent of cases are due to a herniated (slipped) disk. The spinal column is made up of three parts:
– vertebra (individual bones in the spine that protect underlying nerves)
– nerves
– disks
Disks are made of cartilage, which is a strong and resilient material; the cartilage acts as a cushion between each vertebra and allows the spine to be flexible. A herniated disk occurs when a disk is pushed out of place, putting pressure on the sciatic nerve.
Other causes of sciatica include:
– Lumbar spinal stenosis – narrowing of the spinal cord in the lower back.
– Spondylolisthesis – a condition where a disk slips forward over the vertebra below it.
– Tumors within the spine – these may compress the root of the sciatic nerve.
– Infection – ultimately affecting the spine.
– Other causes – for instance, injury within the spine.
– Cauda equina syndrome – a rare but serious condition that affects the nerves in the lower part of the spinal cord; it requires immediate medical attention.
In many cases of sciatica, there is no single obvious cause.
Symptoms of sciatica
The main symptom is a shooting pain anywhere along the sciatic nerve; from the lower back, through the buttock, and down the back of either leg.
Other common symptoms of sciatica include:
a) numbness in the leg along the nerve
b) tingling sensation (pins and needles) in the feet and toes
This pain can range in severity and may be aggravated by sitting for long periods.
Treatment
Sciatica can be managed with a number of different treatments with the goal of restoring a person’s normal functional status and quality of life. When the cause of sciatica is lumbar disc herniation (90% of cases), most cases resolve spontaneously over weeks to months. Initially treatment in the first 6–8 weeks should be conservative. More than 75% of sciatica cases are managed without surgery. Physical activity is often recommended for the conservative management of sciatica for persons that are physically able. However, the difference in outcomes between physical activity compared to bed rest have not been fully elucidated. In persons that smoke who also suffer from sciatica, smoking cessation should be strongly considered. Treatment of the underlying cause of nerve compression is needed in cases of epidural abscess, epidural tumors, and cauda equina syndrome.
Medication
There is no one medication regimen used to treat sciatica. Evidence supporting the use of opioids and muscle relaxants is poor. Low-quality evidence indicates that NSAIDs do not appear to improve immediate pain and all NSAIDs appear about equivalent in their ability to relieve sciatica. Nevertheless, NSAIDs are commonly recommended as a first-line treatment for sciatica. In those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and function. While there is little evidence supporting the use of epidural or systemic steroids, systemic steroids may be offered to individuals with confirmed disc herniation if there is a contraindication to NSAID use. Low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica. Anticonvulsants and biologics have not been shown to improve acute or chronic sciatica. Antidepressants have demonstrated some efficacy in treating chronic sciatica and may be offered to individuals who are not amenable to NSAIDs or who have failed NSAID therapy.
Surgery
If sciatica is caused by a herniated disc, the disc’s partial or complete removal, known as a discectomy, has tentative evidence of benefit in the short term. If the cause is spondylolisthesis or spinal stenosis, surgery appears to provide pain relief for up to two years.
Alternative medicine
Acupuncture has been shown to improve sciatica-related pain, though the supporting evidence is limited by small study samples. Low to moderate-quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica. For chronic sciatica, the evidence supporting spinal manipulation as treatment is poor. Spinal manipulation has been found generally safe for the treatment of disc-related pain; however, case reports have found an association with cauda equina syndrome, and it is contraindicated when there are progressive neurological deficits.
Piriformis syndrome occurs when the sciatic nerve goes through the muscle, leading to pain in the hips and the lower back. As the pain is intolerable, most people reach for muscle relaxants, aspirin, and ketoprofen. Trying some specific exercises that can alleviate the pain without any side effects is the best approach, though.
Check out these 10 piriformis stretches:
1. Standing Piriformis Stretch
Stand up, with the hurt leg over the knee of the other leg. Lower the hip at 45 degrees, tilt the torso, and extend the arms at the same line with the ground. Stay in this position for half a minute and repeat with the other leg.
2. Supine Piriformis Stretch
Lie down on the floor and tilt the knees. Then, cross one leg towards the chest and use your hands to hold the knee and ankle, respectively. Draw the leg to the front and keep it at the same angle with the ankle. Hold for about half a minute.
3. Outer Hip Piriformis Stretch
Lie down, bend the hurt leg, and keep the foot near to the other knee. Tilt the leg to the opposite side as you touch the floor with the knee. Extend your left leg, place the right hand on the knee, and lift the left hand. As you try to feel the ground with the shoulder, lower the arm on the opposite side of the knee. Stay in this position for twenty seconds and repeat with the other leg.
4. Piriformis Side Stretch
Lie down, keeping the back straight and the legs flat. Tilt the hurt leg and put the foot on the outside of the other leg. The knee of the hurt leg should be place in the middle line of the body. Stay in this position for thirty seconds and repeat with the other leg.
5. Short Adductor Stretch
Sit down and place the feet upfront. Hold the right ankle with the left hand and the left hand with the right one. Push down the knees and hold for about thirty seconds.
6. Side-Lying Clam
Lie on the side of the hurt hip, with the legs in an L shape. Keep one foot on the other and the legs parallel. Lift the top knee and hold for a couple of seconds. Repeat fifteen times.
7. Hip Extension
Put the hands and knees on the floor, making sure the hands are on the same line with the shoulders. Keep the knee tilt and lift the hurt leg. Lower the leg and repeat fifteen times.
8. Long Abductor Stretch
Sit on the floor, keeping the legs extended out and far apart. Tilt the torso and place the hands on the floor in front of the body. Hold twenty seconds.
9. Seated Stretch
Take a chair, sit, and cross the hurt leg over the other leg. The chest should be kept upfront and the back straight. Take a deep breath twice and bend slowly. Hold for thirty seconds and repeat with the other leg.
10. Bottom Stretch for the Piriformis Muscle
Stay on all four and put the foot of the hurt leg under the belly. Bend it toward the opposite side near to the hip, keeping the knee directed toward the shoulder.
Touch the floor with the forehead and extend the other leg. The pelvis should be kept straight and the hips pushed to the floor. Stay in this posture for thirty seconds and repeat three times.
Note: Please do take into consideration that this site is for information only. You are still supposed to consult your doctor for further medical advice/treatment.
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