Sciatic nerve irritation (sciatica)

Sciatica is the term used to describe pain and discomfort caused by irritation of the sciatic nerve. Usually the complaints are described as acute dull, pressing or pulling pains in the back area, which extend from the back of the thigh into the leg and seem to come from the sacrum. A distinction must be made here between lumbago (lumbago), in which the pain is expressed exclusively in the back region.

The causes of sciatic nerve irritation can be of various nature, but are mainly due to various diseases, as well as mechanical pressure of the nerves and/or inflammation.

In most cases, the origin can be found directly in the nerve roots in the spinal cord. The sciatic nerve can be particularly irritated by the following factors:

The sciatic nerve irritation can cause different types of complaints, but most of them depend on the location of the nerve irritation, but less on the underlying disease that causes the sciatica.

Another form of sciatic nerve irritation is the irritation of several nerve roots in the area of the spine. Here, the pain in the leg is limited to a strip-shaped area, which is also called radicular pain in medical jargon (Lat.: Radix= root). Mainly this pain runs on the back of the upper and lower leg, as well as on the sole and outside of the foot.

However, pseudoradicular pain often occurs as well. This is the term used to describe pain that cannot be precisely localized. Here, the cause lies in the small vertebral arch joints. These can either have a malposition or show signs of wear (facet syndrome). However, another cause can also be due to a malposition of the pelvic-cruciate joint (sacroiliac joint) or due to tension in the surrounding muscles.

Generally, symptoms of sciatica are related to the type and severity of nerve injury. A sudden onset of pain after movement is often reported.

In mild nerve injury:

• Dull, throbbing pain
• Pain spreads from the lower back to the foot
• Pain often only on one side of the body
• Limited movement when standing up
• Complaints are felt most strongly in the morning and after longer periods of rest
• Sneezing, coughing, lying, sitting or standing increase the feeling of pain
• Walking reduces the feeling of pain

With moderate nerve injury:

• Itching or tingling in the area of the buttocks and the legs
• Feeling of weakness in the affected leg area
• Numbness in the affected leg

In case of severe nerve injury:

• Severe disturbances during urination or defecation with numbness

In case of ischialgia caused by a herniated disc

• Pain that may cause a pulling or tearing sensation
• A pain that is aggravated by coughing, sneezing or pressing and radiates down the leg
• A sensory disturbance occurring in partial portions of the leg, such as numbness or "formication"
• Impairment of some muscle groups due to paralysis - for example, the inability of some patients to stand on their toes

In severe cases:

• Micturition disorders (i.e., disturbance of bladder emptying) or difficulty emptying the rectum.

It should be noted, however, that not every herniated disc is accompanied by sciatic nerve irritation and associated pain. A computed tomography (CT) scan can detect herniated discs in the elderly that are asymptomatic and unnoticed.

For sciatica due to Lyme disease.

• Severe, shooting pain at night
• Paralysis of single or multiple muscle groups of the legs

Rarely:

• Sensory disturbances and associated numbness, as well as burning sensations of discomfort

1. anamnesis

Before a neurological examination is performed, the patient's medical history should first be taken. In this way, a sciatic nerve irritation caused by a herniated disc, for example, can be well diagnosed. Particular emphasis should be placed on body malposition, loss of sensation and signs of paralysis.

2. imaging procedures

X-rays of the spine are taken to obtain a more accurate picture.

To diagnose a herniated disc as the cause, a computed tomography or magnetic resonance imaging is usually performed. In some cases, this can even reveal the location where the herniated disc is pressing on the nerve root. To be on the safe side, a contrast medium image of the spinal canal and the nerve root canals (myelogram or myelo-CT or myelo-MR) can be made.

A rather unusual method today is discography. Here, the contrast medium is administered directly into the area of the intervertebral discs.

3. neurological examinations

An electromyogram (EMG) can be used to determine the location of nerve damage. It can also be used to estimate the duration and extent of nerve damage.

4. blood and nerve fluid diagnostics

If the treating physician suspects an inflammatory disease or an infection with herpes zoster or Borrelia as the cause, a blood test is usually performed. A spinal fluid (CSF) examination may also be necessary in this case.

General measures

The first priority in the treatment of ischialgia is to relieve the current pain. Acute pain can be counteracted with relieving positioning, for example by a stepped bed. By elevating the legs, ideally at a 90-degree angle, the tensile load on the sciatic nerve can be reduced. It is important to remain in regular exercise despite the pain, as complete bed rest has been shown to prevent healing of the pain and is more likely to exacerbate and chronify the pain. Patients should be educated that physical activity is harmless to the course of the disease and should be maintained as much as possible.

In general, the prospects of recovery from sciatic nerve irritation are very good. Conservative therapy for herniated discs usually makes the pain disappear. In case of surgical intervention, the advantages and disadvantages of the operation should be discussed with the patient.

Spontaneous healing of sciatic nerve irritation caused by pressure loads or postoperative procedures is often very good, although it may take several months. Postpartum sciatic nerve irritation also usually heals within a few weeks.

Sciatic nerve irritation caused by borrelia can be treated very well with antibiotics. In this case, the pain can improve after only 5 days. However, many patients still complain about pain half a year later. More rarely, sciatic nerve irritation caused by shingles can occur. The chances of recovery are also very good in this case. If the patient's immune system is unfavorable, a long-lasting pain disorder can also occur. Increasing age is also a risk factor. Patients over the age of 70 often develop postzosteric neuralgia, which is characterized by sudden stabbing pain.

Strengthen back muscles

This can be done through muscle training and physiotherapy , which are offered in a back school, for example.

Ergonomic measures at the workplace

The workplace should be designed to be back-friendly by allowing upright sitting with correct distance to the computer, table and keyboard. Posture should also be corrected repeatedly while working.

Avoid excess weight

Excess weight puts a strain on the back, which is why weight reduction is advisable to prevent back pain.

Correct lifting of heavy loads

• The load should never be lifted with arms outstretched. It should be squatted and the load lifted with bent arms.
• Loads should also never be carried far from the body
• It is advisable to distribute the weight evenly over the body to avoid loading the body only on one side.
• If possible, carrying heavy loads should be generally avoided and should be done only in the most urgent cases.

Strengthening the immune system

The risk of suffering nerve root diseases caused by viruses such as Lyme disease or shingles can be reduced by strengthening the immune system. A balanced diet rich in fruits and vegetables, as well as a balanced mood and endurance sports in the fresh air contribute to this. Vaccination also protects against the chickenpox virus (herpes zoster virus), which causes shingles.