Ischias: symptomen en de behandeling
Sciatica is called sciatic nerve inflammation of .This nerve trunk begins in the lumbosacral portion of the spinal cord.Then it passes through the buttock, goes to the back of the thigh and descends the foot, giving rise to the smaller nervous branches that innervate the muscles, the skin of the lower limb, the hip and knee joints.In view of these large sizes of the sciatic nerve zone, pain, numbness and other symptoms of sciatica affect not only the lower back, but almost the entire leg from the buttock to the foot.Table of contents: Causes of sciatica Symptoms of sciatica What kind of doctor should I use for sciatica?Complications of sciatica Treatment of sciatica at home
Causes of sciatica
Sciatica can not be considered an independent disease.Inflammation of the sciatic nerve is almost always a sign or consequence of other ailments.Consider them:
- The first group includes spine diseases , in which the compression of the spinal roots forming the sciatic nerve.Nerve roots are jammed by intervertebral hernias and bony outgrowths that appear in the spine with neglected osteochondrosis.In addition, the compression of the nerve structures is accompanied by a narrowing of the spinal canal due to severe curvatures of the spinal column and displacement of the lumbar vertebrae.
- The second group of causes includes injuries, excessive physical exertion of , which lead to overstraining and subsequent inflammation of the musculo-tendon apparatus of the lumbar and pelvic region.In these parts of the body, nerves and blood vessels pass between the layers of different muscles, so if the muscle fibers become strained, the vascular-neural bundle contracts on all sides as "in the fist."However, this stress lasts not for a long time, but if there is damage or inflammation, a persistent muscle spasm appears reflexively.For example, inflammation of the pear-shaped muscle can lead to the development of tunnel syndrome, one of the manifestations of which is sciatic nerve compression.
- Tumors of soft tissues and spine .If the tumor is large, it squeezes everything that is near, whether it is a vessel, muscle fiber or a nervous trunk.
- Infectious processes .Most often, the defeat of the peripheral nervous system occurs with generalized herpetic infection, severe influenza, infection with enteroviruses.
- General and local subcooling.
Sciatica quite often occurs in expectant mothers in the last months of pregnancy. This is due, first, to the unavailability of the locomotor system of a woman to the load, which is a growing abdomen.And, secondly, with the pressure of the fetal body parts on the nerve roots in the lumbar region and the sacrum.With the approach of birth, the frequency of sciatica increases. To prevent pinch of the sciatic nerve, gynecologists recommend their pregnant patients to engage in special gymnastics, swimming, wearing a bandage, follow the posture, sleep on a comfortable orthopedic mattress.
Symptoms of sciatica
All patients complain of pain , which first localizes in the area of the sacrum, and eventually falls all lower on the back surface of the foot.The intensity of these painful manifestations can be different.Some patients feel pain during movements and at rest.Others notice the appearance of discomfort only when bending, turning the trunk, raising the affected limb, after a long standing, walking or sitting in an uncomfortable position.In the most severe cases, the patient, due to severe pain, can not move at all. The nature of the pain can be pulsating, baking, shooting, stabbing.
In addition to the pain syndrome patients are concerned about numbness of the skin, a feeling of tingling, weakness of the muscles in the leg. There may be impaired mobility of the hip and knee joint.This is due to the fact that the sciatic nerve innervates these structures, as well as the fact that patients reflexively spare their leg.
The described symptoms, as a rule, appear only on one side, that is, where the pinching occurred.But, if the pathology of the spine is not limited only to the right or left side, both legs can be involved in the process simultaneously.
Which doctor should I use for sciatica?
If you have the symptoms described above, you need to contact a neurologist. To diagnose "Sciatica", based on complaints of the patient and the data of a neurologic examination, the doctor will not work.But to determine the cause of the development of this pathology will be much more difficult. This is not without a more extensive survey, including:
- General blood test.If the body develops an infectious-inflammatory process, the blood will necessarily show characteristic changes.
- Radiography of the pelvis and spine in different projections.
- Computer or magnetic resonance imaging - according to indications.
- Electroneuromyography is the determination of the passage of impulses along a nerve fiber.
- Blood tests for rheumatological factors.Rheumatological diseases can mimic sciatica.
Complications of sciatica
Practically for all reasons of sciatica development, doctors can influence and accordingly stop squeezing of the sciatic nerve.The exception is malignant tumors and severe deformities of the spine, which can not always be eliminated with the help of surgical intervention, but fortunately these are rare. Therefore, the main thing for sciatica is to get diagnosed in time and start treatment.Then the forecast will be favorable.If the pathology is triggered, a part of the nerve trunk may die out, which, of course, will affect the zone innervated by these fibers: the skin will become insensitive, the muscles will stop moving and gradually atrophy, etc. The end result of such a development of events is the disability of the patient.
Treatment of sciatica at home
In the acute period, the main task of treatment is the maximum possible elimination of compression of the sciatic nerve and pain sensations.The patient is shown complete rest and bed rest, as well as anti-inflammatory and analgesic therapy. In addition, neuropathologists appoint such patients vitamin complexes and drugs that improve the conduct of nerve impulses.In severe pain syndrome, blockade of the sciatic nerve with novocaine or other anesthetics is performed.
As anti-inflammatory and analgesic therapy apply:
- Non-steroidal anti-inflammatory drugs of local and systemic action.If the pain is severe, intramuscular injection is preferred.
- Ointments and gels with irritating and anesthetic efficacy.
- Muscle relaxants.These drugs reduce the tension of the muscles and thereby reduce the compression of the nerve trunk and the intensity of pain.
- Hormonal drugs( in severe cases).
The physiotherapy is an integral part of the treatment for patients with sciatica.It promotes an early resolution of the inflammatory process, reduces the severity of pain and muscle spasm.To relieve the sciatic nerve from pinching, patients are shown courses of manual therapy and massage .After the extinction of acute symptoms, the exercise therapy will not be superfluous.
If the pinching of the nerve can not be eliminated by conservative methods, patients undergo surgery - remove the tumor, cover the hernia, etc.After such surgical interventions patients need a long rehabilitation, which allows to fix the results of treatment.In addition, so that the disease does not return, patients should listen to the recommendations of doctors and change their lifestyle, habits, attitude to physical activity.Movements are the best medicine for the spine.
Remember: if the sciatic nerve is at least once pinched, this can happen again, so you should always see a doctor and get a diagnosis.Self-medication with sciatica can only give an imaginary positive effect, but you can really heal only under the guidance of a qualified neurologist.
Zubkova Olga Sergeevna, medical reviewer, epidemiologist-doctor