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The Unbearable Pain of Sciatica

Dr. Nidhi Luthra

Pain is the major reason of distress in nearly all the diseases. Pain is a symptom which renders the patient immobile and incapable of performing his day to day activities. Sciatica is one such syndrome in which a person suffers from unbearable pain.


Sciatica is characterised by pain that starts in the back and radiates down, one or both the lower limbs along the course of the sciatic nerve.

Sciatic nerve is one of the main nerves of the lower limb. It is the largest nerve of the body with a breath of 2 cms. The course of the nerve extends from the buttocks along the posterior aspect of the thigh to the foot. Anatomically, the sciatic nerve is represented by a line 2 cm broad, drawn from the mid-point between the ischial tuberosity and the greater trochanter upto the beginning of the popliteal fossa where it divides into 2 branches.

  • Tibial nerve
  • Common peroneal nerve
Causes of Sciatica
Sciatic Neuritis
  • Diabetes
  • Leprosy
  • Nerve injury due to injections or trauma
  • Alcoholism
  • Poisoning
Mechanical Pressure on the Nerve
  • Lumbar disc protrusion
  • Arthritis
  • Infection of prostate or female genital tract
  • Tumours
  • Tuberculosis
Causes
Sciatica can be due to simple neuritis, the causes of which could be alcoholism, arsenic or lead poisoning or diabetes. Sciatica could also be due to the compre-ssion of the nerve arising from any of a variety of causes such as prolapsed disc, caries of spine and tumours of the vertebral column.

Lumbar disc protru-sion accounts for most attacks of acute low back pain and sciatica. The age group that is most likely to suffer is between 25 to 50 years. In lumbar spondylosis, there is a degeneration of the spine wherein osteophytes are formed. This can result in direct nerve root compression causing sciatic pain.

Other reasons for sciatica could be tumours, lumbar canal stenosis,spondylolisthers, tuberculosis etc. The cause for sciatica can be differentiated by the signs and symptoms, the neurological signs and modern diagnostic techniques such as X-Ray and MRI.

It is important to consult a specialist in the field to get a proper diagnosis.

Management
In case of symptomatic sciatica, that is not related to any underlying lesion, corrective measures shall help relieve the pain.
  • Bed rest
  • Heat fomentation
  • In case of pain due to disc protrusion, complete bed rest in supine position straight with only one pillow for 3-6 weeks. Complete immobilisation of the spine.
  • Massage, if the cause is muscular. The treatment of sciatica which is due to any underlying lesion aims at curing that particular lesion, for which consulting a physicianis important.
Prognosis
In mild cases, stages of severe pain lasts for 2-3 weeks and the patient recovers in a month or two except that he may from time to time experience aching in the course of the nerve and stooping may excite the pain in the affected leg.

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