OVERVIEW

Sciatic Nerve
The Sciatic Nerve is the longest nerve in our body, it runs from the pelvis through the hip area and buttocks and down each leg. It divides into the tibial and peroneal nerves at the level of the knees. The sciatic nerve controls many of the muscles in lower legs and provides feeling to thighs, legs and feet.

Definition
Definition: The term sciatica refers to pain that radiates along the path of this nerve from the back into the buttock and leg. The discomfort can range from mild to incapacitating, and may be accompanied by tingling, numbness or muscle weakness. Rather than a disorder in and of itself sciatica is a symptom of another problem, such as a herniated disk, that puts pressure on the nerve.

Signs and Symptoms

~Pain that radiates from lower (lumbar) spine to the buttock and down the back of leg is the hallmark of sciatica.
~The patients may feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow one of these routes: From the lower back to the knee From the midbuttock to the outside of the calf, the top of foot and into the space between the last two toes From the inside of calf to the inner ankle and sole

~The pain can very widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. ~Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It's likely to be worse when they sit, cough or sneeze. Usually only one lower extremity is affected.

1. Numbness or muscle weakness along the nerve pathway in leg or foot.

2. In some cases, they may have pain in one part of leg and numbness in another.
3. Tingling or a pins-and-needles feeling. This occurs most commonly in the toes or part of their foot. 4. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a rare but serious condition that require emergency care.

CAUSES
Sciatica usually results from compression of a nerve root in the lower (lumbar) spine a condition called a radiculopathy. By far the most

common cause of this compression is a herniated disk in the lower back.

 The herniated disk then often presses on a nerve root, causing pain which can be excruciating in back, leg or both. If the damaged disk is in the middle or lower part of the back, patient may also experience numbness, tingling or weakness in the buttock, leg or foot

CAUSES
Other conditions that may put pressure on the sciatic nerve include:
1. Lumbar spinal stenosis.

In spinal stenosis, one or more areas in the spinal canal narrow, putting pressure on the spinal cord or on the roots of these branching nerves. When the narrowing occurs in the lower spine, the lumbar and sacral nerve roots may be affected.

2. Spondylolisthesis. This condition, often

the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves the spine.

3. Piriformis syndrome.

Piriformis muscle running directly above the sciatic nerve, starts at the lower spine and connects to each femur. Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the sciatic nerve. Active women runners and serious walkers, for example are especially likely to develop the condition. Prolonged sitting, car accidents and falls also may contribute to piriformis syndrome.

4. Spinal tumors.

The spinal tumors growth inside the spinal cord, within the meninges that cover the spinal, or in the space between the spinal cord and the vertebrae the most common site. As it grows, a tumor compresses the cord itself or the nerve roots.

This can cause : severe back pain that may extend to the hips, legs or feet muscle weakness loss of sensation especially in legs difficulty walking and sometimes loss of bladder or bowel function.

5. Trauma. Trauma can injure the lumbar or sacral nerve roots. 6. Sciatic nerve tumor or injury. Although uncommon, the sciatic nerve itself may be affected by a tumor or injury, leading to sciatic pain. 7. Other causes. In some cases, doctor may not be able to find a cause for sciatica. A number of problems can affect

the bones, joints and muscles, all of which could potentially result in sciatic pain.

RISK FACTORS
Major risk factors for sciatica include:
Age.

Age-related changes in the spine are the most common cause of sciatica. Deterioration in the disks on the back often occur by the age of 30, and most people who develop herniated disks are in their 30s and 40s. Spinal stenosis, another leading cause of sciatica, primarily strikes people in their 50s and beyond.

 Occupation.

- A job that requires us to twist our back - Carry heavy loads - Drive a motor vehicle for long periods

 Physical activity.

People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are. Researchers have identified two genes that may predispose some people to disk problems.

Genetic factors.

Diabetes.

Diagnosis

Medical history Neurological Examination, paying special attention to spine and legs:

the muscle strength physiological and pathological reflexes. Laseques sign.

3. Radiological Examination.

Spinal X-ray. Ordinary X-rays can't

detect herniated disk problems or nerve damage, they're not usually helpful for pinpointing the cause of sciatica. However, a spinal X-ray can show narrowed disks and spondylolisthesis.

 Magnetic resonance

imaging (MRI). This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI can detect damage to the disks and ligaments as well as the presence of tumors. MRI is noninvasive and has no harmful side effects.

COMPLICATIONS
In some cases, sciatica can result in permanent nerve damage, although this is uncommon. Depending on what's causing the nerve to be compressed, other complications may occur, including loss of feeling or movement in the affected leg and loss of bowel or bladder function.

TREATMENT
NSAID They are the most helpful for sciatica. Although they can provide real relief, NSAIDs have a "ceiling effect" that is, there's a limit to how much pain they can control. If the patient have moderate to severe pain, exceeding the recommended dosage won't provide additional benefits. In addition, periodically re-evaluate whether patient still need NSAIDs. .

Muscle relaxant, such as Eperisone

Tricyclic antidepressants, such as nortriptyline or amitriptyline Anticonvulsant drugs, such as gabapentin. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, our body's natural painkillers

TREATMENT
Physical therapy.

Physical therapy for the patient with a herniated disk, can play a vital role in their recovery. Once acute pain improves, the doctor or a physical therapist can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct the posture, strengthen the muscles supporting their back and improve their flexibility.
Regular exercise.

It may seem counterintuitive to exercise when we're in pain, but the fact is that regular exercise is one of the best ways to combat chronic discomfort. Exercise prompts our body to release endorphins chemicals that prevent pain signals from reaching our brain. Endorphins also help alleviate anxiety and depression.

It's not always possible to prevent sciatica, but the following suggestions can play a key role in protecting the back: 1. Exercise regularly. 2. Maintain proper posture when sitting. 3. Use good body mechanics.