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Sciatica is one of the most common causes of back pain. But how can we recognize if we are in a presence of Sciatica?

CAUSES:

Sciatica is the compression of the sciatic nerve, which is made up of the L4 through S2 nerve roots. The causes of this compression can be different such as herniated or bulging lumbar intervertebral disc (the most common). Lumbar spinal stenosis may cause these symptoms as well. Spondylolisthesis or a relative misalignment of one vertebra relative to another may also result in sciatic symptoms. Additionally, lumbar or pelvic muscular spasm and/or inflammation may impinge a lumbar or sacral nerve root causing sciatic symptoms (1).

EPIDEMIOLOGY:

  • There appears to be no gender predominance
  • Peak incidence occurs in patients in their fourth decade
  • Lifetime incidence reported between 10% to 40%
  • No association with body height has been established except in the age 50 to 60 group.
  • It rarely occurs before age 20 unless secondary to trauma
  • Some studies do suggest a genetic predisposition.
  • Physical activity increases incidence in those with prior sciatic symptoms and decreases in those with no prior symptoms.
  • Occupational predisposition has been shown in machine operators, truck drivers, and jobs where workers are subject to physically awkward positions.

 SYMPTOMS:

  • Unilateral leg pain more severe than low back pain
  • Pain most commonly radiating posteriorly at the leg and below the knee
  • Numbness and/or paraesthesia in the involved lower leg
  • Positive neural tension test with the provocation of pain in the affected leg (straight leg raise test/slump test)
  • Neurological deficit associated with the involved nerve root such as foot and leg motor or sensory functions (2)

  PREVENTION AND TREATMENT:

  • Use of hot or cold packs for comfort and to decrease inflammation
  • Avoid prolonged sitting/standing. Changing posture often
  • Improving the posture
  • Increase core strength
  • Lumbar spine and hamstrings stretching
  • Regular light exercises such as walking, swimming, or aromatherapy
  • Use of proper lifting techniques: flexion of the knee when taking something from the floor e.g.
  • Muscle relaxants
  • Localized corticosteroid injections
  • Spinal manipulation
  • Deep tissue massage
  • Physical therapy consultation
  • Acupuncture

Resources:

  1. Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
  2. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019 Nov 19;367:l6273.

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