Sciatica

Sciatica

Sciatica:It is a set of symtoms including pain that may be caused by ganeral compression and irritation of one of five spinal nerve roots that give rise to each sciatica nerve or irritation of the left or both or both sciatica nerve.The pain is felt in the lower back,buttock and various parts of the foot.In addition to pain,which is some times sever there may be numbness,muscular weakness,pins and needls or tingling and difficulty in moving or controlling the leg.

Causes:

a)      Compression of lumber nerves L4 or L5 or sacral nerve S1,S2,S3.

b)      Sipnal disc herniation.

c)      Degenerated discs.

d)     Damage to fact joint in the lower back.

e)      Swelling of surrounding tissue.

f)       Trauma to the spine.

g)      Dislocation of hip.

Clinical features:

[A]Symtoms:      

    

a)      Pain is felt in lower back,buttock and various parts of the leg and foot.

b)      Numbness and there may be weakness of the lower leg muscle.

[B]Physical signs:

a)      Physical examination of sciatica patients should include observation,palpation, determination of the range of motion of the spine.

b)      The straight leg raising.

c)      Walk on toes.

d)     Bend forwards and back wards.

e)      Rotate your spine.

f)       Sit down and stand up.

g)      Lie down on back and rise one leg at a time.

Comformity tests:

a)      MR neurography.

b)      MRI.

c)      CT scane.

d)     X-ray.

Differential diagnosis:

a)      Trauma causes=Traumatic peripheral neuropathy.

b)      Infected organ,Abscesses=Lumber disk infection.

c)      Neoplastic disorder.

d)     Foreign body,structural disorders.

e)      Metabolic disorders.

Complication:

a)      Complete loss of leg movement.

b)      Complete loss of sensation in the leg.

c)      Unnoticed injury to the leg.

Physiotherapy management:

[A]Aims of treatment:

a)      To relive pain.

b)      To improve muscule power.

c)      To increase ROM.

d)     To prevent ankle and foot contracture.

e)      To prevent edema.

f)       To correction of gait.

g)      Teach the care of gait.

h)      Teach the postural awareness.

[B]Means of treatment:

a)      Relive pain by:

·         Rest.

·         Analgesic.

·         TENS.

·         Interrupted galvanic stimulation over the affected muscle.

b)      Maintain muscle power by:

·         Full range passive movement.

c)      Maintain ROM by:

·         Free active exercise.

·         Resisted exercise.

d)     Prevent contracture by:

·         Stretching for back extensor,hamstring and calve.

·         Night splint.

e)      Correction of gait:

·         Gait re-eudcation exercise.

f)       Postural re-education.

g)      Advice to back care during lifting,sitting,driving etc.

Treatment

PHASE I - Pain Relief & Protection

Managing your pain. Pain is the main reason that you seek treatment for sciatica. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is a normal part of your healing process post-injury. But, excessive inflammation can be the main cause of your sciatica.
Please contact your physiotherapist or doctor for their professional opinion.

PHASE II - Restoring Normal Flexibility, Posture & Strength

As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back joint range of motion and resting muscle tension, lower limb muscle flexibility and posture.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs. They may recommend that you undertake an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor. 
PhysioWorks has developed a Back Pain Core Stabilisation Program to assist their sciatica patients to regain normal core muscle control. Other more advanced programs can include stability exercises and equipment such as a Swiss exercise ball. Please ask your physio for their advice.
Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body-weight in the buoyancy of water. This allows more movement without causing pain.

PHASE III - Restoring Full Function & Dynamic Control

The next stage of your rehabilitation is aimed at safely returning you to your desired activities. Everyone has different demands will determine what specific treatment goals you need to achieve. Your physiotherapist is the best person to guide your rehabilitation.

PHASE IV - Preventing a Recurrence

Sciatica does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation.
Fine tuning your back mobility and core control and learning self-management techniques will ultimately help you to achieve your goal of safely returning to your previous sporting or leisure activities without sciatica.
Exercise is like cleaning your teeth. Exercise prevents problems.