The sciatic nerve arises from the lumbar region of the spinal cord and runs down the lower limbs. It is the largest nerve in the body. It descends down the buttock area and sends nerve endings down the lower limb. The pain caused by injury to this nerve is termed as sciatic nerve pain. The most common cause of pain is disc bulge or protrusion at the level of the lumbar spine. The intervertebral discs between the lumbar vertebrae herniate and press on the nerve root of the sciatic nerve. A nerve root that is pinched causes radiculopathy. The nerve root gets irritated and inflamed. Other causes of injury to the nerve root may be due to adjacent causes from the bone, a fall, or direct trauma, certain tumours pressing onto it, a haematoma pressing onto the nerve root, internal bleeding, Infections. Increased abdominal pressure due to any cause like straining, chronic cough, pregnancy etc can cause or worsen disc herniation and protrusion.
Symptoms of sciatic nerve pain: The symptoms caused due to sciatic nerve impingement are burning sensation, numbness, and tingling, severe pain radiating from the lower back to the buttocks and further down the back of the thigh and up to the lower leg. In some cases the pain may radiate up to the hip and thigh also. The patient also complains of lower back pain. The pain is usually increased on standing, walking, coughing, sneezing, straining, bending at the waist and is usually relieved by lying down.
Diagnosis of sciatic nerve pain: It can be diagnosed on physical examination and medical history. Locally there may be tenderness at the level of disc protrusion and over the sciatic notch. There may be paraspinal muscle spasm. The straight leg raising test is restricted passively and Lasegue’s sign is positive. Gait may be antalgic depending on the degree of pain the patient is experiencing. The lumbar spine range of motion is restricted and painful. The deep tendon reflexes and sensations on the lower limbs may be altered depending on the level of nerve root compression. For further confirmation a radiograph of the lumbar spine may be taken. And other tests such as CT scan and MRI scan and Electromyogram and nerve conduction studies may be performed.
Treatment of sciatic nerve pain: In most cases of lumbar disc herniation, the patients respond and will go into remission without any intervention. If there is any other cause of sciatic nerve pain, that must first be treated. In cases where the pain is acute, the patient is advised complete bed rest for a few days, until the pain is relieved. Analgesics, muscle relaxants may be prescribed in order to relieve the pain and decrease the inflammation of the compressed nerve root. Short wave diathermy and traction has been of significant use in reducing the pain. Once the pain has subsided the patient must continue to do back stretching and strengthening exercises, in order to prevent further attacks of pain. Most patients respond to this regimen in about 6 weeks and become pain and symptom free for a long time. In some cases however patients may benefit from epidural injections. If not surgery is the final option.
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