SCIATICA

Many people may not know that sciatica is not a specific diagnosis for a physical disorder. The term "sciatica" usually describes a symptom (pain) along the sciatic nerve pathway; some mean any pain that starts from the lower back to the leg. The pain characteristically travels along the course of the affected nerves, but usually does not involve the sciatic nerve in real cases. The root cause may be due to spinal disc herniation, or the narrowing of the spinal canal which compressed the lumbar and sacral nerve root, causing ischemia or injury. It may be associated with neurological dysfunction, such as weakness, numbness or radiation from buttock to calf and foot.

The causes of sciatica can be divided into two categories: primary and secondary. Primary type refers to internal infections, most of which arise from inflammation of other tissues in the body, but rarely occur clinically. The secondary type is much more common, usually due to the compression of the spinal nerve or sciatic nerve by nearby tissues, such as disc herniation, tumors, trauma, and improper posture.

• Poor sitting posture, including cross leg sitting or side-sitting
• Pregnancy
• People who need to sit or bend for a long time at work
• History of back injury

Sciatica usually begins with buttock pain and spreads to the back of the thigh, if not the lower leg and foot, which is usually accompanied by lower back pain too. In the early stage, one may have backache and cannot stand upright. When the nerve becomes more squeezed, the pain will extend down to the back of the thigh or even to the foot. The pain may also cause "intermittent claudication". The patient needs to sit down and rest for few minutes after walking for a certain distance. For severe cases, one may have symptoms such as leg numbness, muscle atrophy and difficulty in moving the back. Prolonged sitting, sneezing, and coughing often aggravates the symptoms. Clinical examinations may reveal that the muscle strength innervated by the related nerve roots becomes worse, feels dull, and the leg reflexes are abnormal, which seriously affect daily life.

Primarily sciatica should be treated by conservative therapy, that is physiotherapy, including manual therapy, lumbar traction, heat therapy, and interferential therapy, etc. These therapies aim at relaxing muscles and alleviating the symptoms of nerve compression. Therapeutic exercises aim at restoring normal spinal biomechanics and avoiding abnormal irritation of the spinal nerves. During the acute stage, the patient should bed rest for a few days, but it is not advisable to use a soft mattress, nor passively bed rest for more than a week. Those who are in serious condition can temporarily use a soft back brace for support but are advised to wind off as soon as possible to avoid spinal muscle atrophy. If the symptoms remain severe after a few months, it may be necessary to have a detailed assessment to consider the indication of surgical intervention for relieving the compression on the nerves or tissues, such as discectomy, or laminectomy or decompression, etc.

• Maintain a good sitting posture, with both feet on the ground, back straight, or even add a lumbar support for maintaining normal spinal curvature
• When tying shoelaces, raise your feet and avoid bending.
• Avoid sitting or standing for too long; better to switch a position every hour.
• Arrange regular breaks for proper spinal stretching and mobilizing exercises to relax muscles.
• Before doing any exercises, one should do adequate warm-ups to reduce the chance of sprain injury.

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