Ischialgia is Latin for pain in the pelvis. Sciatica is a pinched sciatic nerve with subsequent inflammation. Pathology is not a separate nosology and is considered a manifestation of diseases of the spine, in which pathological changes occur in tissues, bones and muscles located near the sciatic nerve. They put pressure on the nerve bundle, causing pain. The longer this exposure, the more excruciating the pain will become.
Anatomy excursion
The sciatic nerve is the largest, longest and thickest, reaching 1 cm in diameter in men. It starts in the lumbar region from the sacral nerve plexus, exits the spine, through the coccyx and the pelvic surface down the back surface to the legs. Here, at the lower leg, it is divided into 2 bundles, and each of them goes to one leg to the feet. Thus, its nerve branches touch many areas, and pains during its inflammation are felt in different parts of the body. Its function is to providesensory and motor innervation of the lower extremities.
Causes and factors for the development of sciatica
The most common causes of sciatica are:
- Osteochondrosis, osteoarthritis of the intervertebral joints. In this case, spikes form on the vertebrae, which provoke inflammation.
- Intervertebral hernia. With them, a protrusion of the disc occurs and the roots that make up the nerve are pinched.
- Tunnel neuropathies.
- Piriformis syndrome (it is the muscle responsible for the movement of the hips). We have to talk about it because it is close to the sciatic nerve.
- Stenosis of the spinal canal.
- Tumors and neoplasms.
- Infectious diseases. The nerve is affected by toxins from infections such as TB, typhoid, malaria, syphilis. After that, it becomes inflamed.
- Hypothermia can become a provoking factor when the body's defenses are weakened.
Symptomatic manifestations
Manifestations of pinched sciatic nerve - the appearance of sharp pains along the nerve endings. They start from the lower back, go down to the buttock, and then along the back of the leg to the foot, they intensify with movements and loads of any kind, sneezing, coughing, laughing. At night, a person is forced to wake up to change position. Later, pain can block any movement.
The most characteristic manifestation is the symptom of tension. When bending the leg in the hip joint, tilting the head, torso, the pain increases sharply.
Other signsinflammation:
- Skin numbness and burning, goosebumps on the back of the leg.
- Decrease in tactile sensitivity and increase pain.
- Change in gait (walking on straight legs).
The important thing is that regardless of the cause, the symptoms of sciatica are the same, but the treatment is always different.
Characterization of pain
Pain sensations can be conditionally divided according to the following characteristics:
- Localization. The pain is usually unilateral. The other side only tingles or feels a little numb.
- Intensity. Depends on the degree of inflammation and pinching. At the initial stage, the pain is not strong, it is removed with conventional analgesics. The long course of the disease leads to atrophy of the muscles of the affected side. Left untreated, inflammation spreads to adjacent tissues and affects new nerve fibers.
If you have correctly identified the symptoms of sciatica, and treatment becomes necessary, this should be done by a specialist, since different causes require different treatment.
Diagnostic measures
If the pain does not go away in 2-3 days, but only increases, you should definitely consult a doctor. In sciatica, reflexes become abnormal and weaken.
Neurological symptoms of diagnostic significance:
- Decreased Achilles tendon reflex. When hit in the tendon area above the heel, the foot flexes weakly or does not react at all;
- Knee reductionreflex.
- Decreased or absent plantar reflex.
When lifting the leg up, the pain increases sharply due to muscle tension. Also, severe pain is felt when pressing on some points under the buttock, on the thigh (Valle points).
For a full diagnosis, you need a blood test, X-ray, MRI, CT.
X-ray allows you to determine the condition of the intervertebral joints and the condition of the intervertebral discs. To do this, images are taken in 2 projections - in a vertical position and horizontal. MRI examines pathological changes in soft tissues (this is not visible on an x-ray).
Principles of Therapy
Treatment of sciatica is only complex - general and local. It is complemented by non-drug therapies. It should be noted that the treatment of lumbago and sciatica is almost identical. In doing so, the following goals are pursued:
- Restore mobility and elasticity of affected muscles.
- Pain relief.
- Restoration of the conductivity of the nerve trunks.
- Improve the nutrition of affected neuromuscular tissues.
For the treatment of sciatica, it is better to use injectable drugs, pills are ineffective.
Therapy algorithm
Firstly, the mode is important. It means complete peace. You need to lie on a bed with a hard, even mattress, then the load on the spine and pressure on the nerve bundle is minimal.
In case of exacerbation, non-steroidal and steroidal anti-inflammatory drugs, muscle relaxants are used to treat sciatica. Also shown are antispasmodics, opioid analgesics, epidur altherapy and vitamin complexes.
For the treatment of ischialgia of the sciatic nerve and pain relief, local effects are also used: gels, ointments, patches, applications. The therapy is complemented by physiotherapy, homeopathy, exercise therapy, massage.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Their action is based on the fact that the production of prostaglandins, the substances responsible for pain, is blocked.
When symptoms of sciatica appear, many anti-inflammatory drugs are best for treatment. They are divided into fast and slow acting. Some are available at any pharmacy, others are strictly prescription.
The most commonly used: "Ibuprofen", "Voltaren", "Diclofenac", "Aspirin", "Ketoprofen", "Motrin", "Anseid", "Seraktil" and others. All of them have one unpleasant property - irritate the gastric mucosa, so it is better to take them after meals. They also reduce blood clotting.
Contraindications to NSAIDs
NSAIDs are prohibited in the following cases:
- Peptic ulcer.
- Anemia.
- Tendency to bleed.
- High blood pressure.
- Heart, kidney, liver problems.
Steroid Anti-Inflammatory Drugs (SAIDs)
Another category of remedies for symptoms of sciatica is treatment with steroid medications. These hormonal compounds are designed to produce a hormone in the bodyhydrocortisone and well relieve swelling and inflammation. These remedies have side effects:
- Weight gain.
- Stomach ulcer.
- Osteoporosis.
- Edema of the face.
- Increased blood clotting.
- Immune weakening.
The course of treatment of ischialgia of the sciatic nerve with steroid drugs is prescribed for a maximum of 2 weeks. This is done to avoid side effects.
Epidural Therapy
Treatment of sciatica with drugs of different groups is supplemented by epidural injections. They have been used since 1952. Medicines are injected into the spinal canal - the cavity where the roots of nerve branches are located.
The dose may be less than the therapeutic one, because the medicine immediately enters the site of the focus. The risk of side effects is therefore reduced. The pain is relieved quickly, but not for long.
Opioids
Drug treatment of sciatica can be carried out with drugs, which include elements of a narcotic nature. These are the most powerful. They absorb pain, cloud perception.
Opioids can also be used today in the form of patches. Their action is enhanced by this. The most commonly used "Tramadol" or "Ultram". Side effects of opiates are lethargy, delusional disorders, lethargy and drowsiness.
Miorelaxants - Mydocalm, Relanium, Sirdalud, Baclofen.
First aid for sciatica
At the time of an attack, the treatment of sciatic nerve sciatica at home is to completepatient immobility. You need to lie on your back, on a hard mattress. You can't bend your spine. Something should be placed under the knees - this will reduce the level of tension in the sciatic nerve and reduce pain. Do not lift any weights, sit on soft surfaces.
You can drink "Ibuprofen", "Aspirin" and other NSAIDs if the patient did not take blood thinners for treatment. Can help "Pentalgin" or "Analgin". Cold should be applied locally. Ice cubes can be kneading.
For the treatment of sciatic nerve sciatica at home, the following rules should be followed:
- Sit no more than 2 hours.
- Do not wear high heels.
- Eat more foods with B vitamins.
- Sleep with side pain in the fetal position.
- Don't lie on your back.
At home, you can also use anti-inflammatory ointments or gels based on bee or snake venom: Apizartron, Sofya, Nyatoks, Ketoprofen, Voltaren.
From folk remedies, a good effect in the treatment of sciatica at home is given by bear and badger fat, essential oils - fir, camphor, tea tree, red pepper. When stopping pain, you can switch to chondroprotectors. It is important to remember that no treatment for sciatica at home does not cancel a trip to the doctor.
Physiotherapy
She is a must-have supplement to medicines. Physiotherapy is used when acuteperiod. Its action is aimed at relieving swelling and reducing pain, warming up the nerve, improving blood circulation, and relaxing muscles.
The following procedures are usually prescribed:
- Diadynamic currents.
- Magnetotherapy.
- UHF.
- Electrophoresis and phonophoresis.
- Paraffin treatment.
- Ozokerite.
Massage of the lumbar region
Massage can only be done outside of exacerbations of the inflammation process. It is done only by a specialist. Massage can increase the conductivity of the inflamed nerve, improve lymph flow and blood flow, and prevent muscles from hypotrophy. Strong muscles will be able to maintain the strength of the spinal column and support the weight of the body, and this will already unload the vertebrae.
Surgical treatment
Surgery is used only in the most extreme cases, when all conservative therapy has been ineffective. Spine surgeries are considered the most technically complex and should only be performed by experienced surgeons in major centers.
Gymnastics and exercise therapy
Outside of the exacerbation of the process, exercise therapy and gymnastics are applicable. Exercise will help stimulate metabolism and reduce inflammation.
Contraindications for exercise:
- Stage of exacerbation of sciatica.
- Pregnancy.
- Alcohol or drug addiction.
- Cancer diagnosis.
- Internal bleeding.
- Violation of the integrity of the skin.
Hirudotherapy
Leech saliva contains many biologically active substances that can improve blood circulation in the area of inflammation and provide tissues with good nutrition. Their impact is not only local, but also general - the walls of blood vessels are cleared of cholesterol, swelling is removed.
Homeopathy
Homeopathic remedies are slower, but often more effective. In addition, these drugs have a natural composition.
Some homeopathic medicines:
- RhusToxicodendron. It is taken for sciatica in the supine and sitting position.
- Aesculushippocastanum. Prescribed for prolonged dull pain.
- Colocynthis. Discharged with aching, pulling pain, aggravated by touch.
- Nuxvomica. Effective for pain and shooting in the sacral region, with paresthesia.
- Berberis vulgaris. Taken for morning pain.
Traditional medicine
Phytotherapy is the use of compresses, decoctions, mixtures, ointments. Among the recipes:
- Warm wrapping with sheets soaked in a solution of vinegar and s alt, with a woolen blanket on top. Lie wrapped for 1.5 hours.
- Decoction of aspen leaves. 1 st. l. herbs in 200 ml of water, boil and drink 3 times a day.
- Decoction of St. John's wort. Used as compresses and added to the bath. For cooking, 2 tbsp. l. brew herbs in 1 liter of water. You can also add a thick decoction of pine needles to the bath.
- Preparing a healing ointment from honey, vodka and fresh radish juice. All components are taken in equal proportions and mixed. Apply the remedy on the affected side.
- Fir oil, eucalyptus oil is used for rubbing. Sciatica excludes the use of mustard plasters.
- S alt. It is heated to 37.5 degrees and applied in bags to the affected area until it cools down.
- Wax is mixed with propolis 1:10. Apply in the form of a cake for an hour and a half.
- Raw potatoes are rubbed, horseradish is added. This application is kept for 30 minutes.
- Kalanchoe and Aloe. The juices of these plants are added to a mixture of rye flour and honey. Apply in the form of a cake, warm with a woolen cloth on top. Hold for 30 minutes.
- Alcohol tincture of white acacia flowers is also used for rubbing - insist for a week and rub 2 times a day.
- You can make compresses with radish juice and honey - proportion 3:1.
- Application of turpentine and egg white. Hold until discomfort appears. You can repeat the procedure after 6 hours.
- Compresses are also made from scalded leaves of cabbage, burdock or birch.
For oral use, decoctions of aspen leaves, viburnum, Kalanchoe (diluted juice), calendula, horsetail, thyme.
Baths
Baths with a temperature not exceeding 38 degrees Celsius have a good effect. Take them no more than 15 minutes. Young pine branches, a decoction of horsetail, grated horseradish in a bag are added to the bath.
Medical kerosene. Mix 100 ml with horseradish and radish, leave for 9 days, apply in the form of applications for an hour 2 times a day.
Egg white is added to the grated mass of half of the laundry soap. The product should be appliedcompress for 2 hours.
Criteria for the effectiveness of treatment
Efficiency criteria are:
- Reduce the severity of pain, then their disappearance.
- Reduce neurological symptoms.
For symptoms of sciatica, the best treatment (according to patients) are:
- NSAIDs - Ibuprofen and Arcoxia.
- Miorelaxants - "Mydocalm".
- Homeotherapy.
- Defanotherapy.
- As an anesthetic - "Thiodin", vitamin B1, dorsaplast.
Prevention
If sciatica is gone, it is important to prevent it from recurring. To do this, the following rules are observed:
- The bed should be moderately hard and even.
- Don't sit still for a long time.
- The workplace should be equipped with quality furniture.
- If necessary, use orthopedic corsets, it is advisable to wear orthopedic shoes.
It is also important to treat childhood scoliosis, articular pathologies, and strengthen the spine. Periodically, back massage and physiotherapy should be performed to prevent spinal deformity.
Remedial gymnastics should be done regularly. For prevention, take vitamins, immunostimulants. It is advisable to give up bad habits.
When sitting at the computer, you need to get up every hour to warm up and stretch. If necessary, apply to the backspecial pillows. In the cold season, hypothermia should be avoided.
