Sciatica: symptoms and treatment of inflammation of the sciatic nerve

29.01.2021

Inflammation of the sciatic nerve is the most common disease of a mononeuropathic nature, when the function of an individual nerve is impaired. Both middle-aged men and women suffer from it equally. The disease can deprive the patient of his ability to work for a long time, and in severe cases can lead to disability.

The sciatic nerve (n. ischiadicus) is the largest nerve column in humans. It is formed by the spinal nerves of the sacral and lumbar regions. It runs along the inner side of the pelvis, continuing between the joints of the thigh, the ischial tuberosity, and, going under the piriformis muscle, is divided into the peroneal and tibial nerves above the popliteal fossa. The sciatic nerve provides sensation to the thigh muscles that allow the knee to bend. The sciatic nerve does not form sensitive nerve branches.

Sciatica (sciatica, neuralgia, neuropathy) is pinching or irritation of the sciatic nerve, which is accompanied by burning, sharp and sharp pain in the back of the thigh, numbness, impaired mobility and sensitivity of the foot and lower leg.

Causes of sciatica

The most common cause of the disease is a pinched nerve, which can be caused by various pathologies of the spine:

• Osteochondrosis is a thinning of the vertebral discs with the subsequent formation of bone growths that compress the nerve roots.
• Displacement of the vertebrae (spondylolisthesis), which causes the sciatic nerve to be pinched.
• Narrowing (stenosis) of the spinal canal.
• Intervertebral disc herniation and other diseases.

Also, neuritis of the sciatic nerve can occur due to hypothermia, against the background of infectious diseases, due to injuries and during pregnancy due to a shift in the center of gravity.

Symptoms of a pinched sciatic nerve

• Effective treatment of symptoms of pinched sciatic nerve.
• Dr. Bobyr’s unique method is defanotherapy.
• Reduction of pain after 2–3 sessions.

The sciatic nerve is the largest in the human body; it emerges from the sacral nerve plexus, which, in turn, is formed by five nerve roots: two lower lumbar and three upper sacral. Typically, symptoms of compression occur when the fourth and fifth lumbar and first sacral roots are affected. In addition, pinching of the sciatic nerve itself can occur with piriformis syndrome - we will talk about the main manifestations of this pathology below.

All symptoms of pinched sciatic nerve can be divided into general and specific - occurring when certain nerve roots are damaged. In this case, different roots can be compressed at the same time, which leads to mixed symptoms.

Common symptoms of a pinched sciatic nerve

In most cases, the lesion is unilateral. Nerve compression and, as a result, symptoms occur only on the right or left. The pain that occurs in the lumbar region, goes down to the buttock, then down the back of the thigh.

A list of the most common symptoms that patients complain about when the sciatic nerve is pinched is presented below.

Pain

may be constant or occur periodically. In most cases, patients describe it as sharp, sharp, shooting, reminiscent of a burning sensation. A characteristic symptom: pain when the sciatic nerve and its roots are damaged in the leg is always much more pronounced than in the lumbar spine. On the legs, pain is most often localized in the lower leg area.

Other (uncommon) areas where sciatic nerve pain may occur include:

• The front surface of the thigh, shin.
• Upper and outer part of the foot.
• Sole.
• The membrane of skin between the first and second toes.

A characteristic feature of pain when the sciatic nerve or its roots are pinched is that it can weaken or intensify, depending on the patient’s body position:

When does leg pain require immediate medical attention?

In rare cases, symptoms may occur that indicate severe damage to the sciatic nerve. They say that the patient needs the help of a doctor as soon as possible:

• Very strong, unbearable pain in the lumbar and sacral area, if it suddenly intensifies.
• Loss of control over rectal and bladder function. It manifests itself in the form of incontinence of stool, urine, imperative urges: when a person experiences an unbearable desire to visit the toilet right now.
• Pain in the lower back and leg is accompanied by nausea, increased body temperature, and causeless weight loss.

These symptoms are dangerous because they may indicate serious conditions such as cauda equina syndrome

(damage to the nerve fibers that extend in the form of a bundle from the end of the spine), infections, benign and malignant tumors of the spinal column.

Muscle weakness

The sciatic nerve is mixed, that is, it contains both sensory and motor fibers. When the latter are involved in the pathological process, movement disorders are observed. Weakness occurs in the thigh muscles, it is felt especially strongly when a person tries to bring his legs together. The patient may have difficulty bending the leg at the knee joint, as well as flexing and extending the foot and its toes.

One of the specific symptoms of movement disorders in certain muscle groups of the legs is stepping

or
"cock walk"
. At the same time, it is difficult for a person to lift his foot; it constantly seems to “fall”. The main manifestations of the step:

• While walking, the patient constantly drags his foot along the ground.
• Severe swaying of the hips, which occurs as a compensatory mechanism: the hip deviates strongly during gait so that the affected foot can rise high enough without touching the ground.
• Climbing stairs and inclined surfaces becomes especially difficult for such people.

In some cases, patients with a pinched sciatic nerve experience difficulty when they try to get up from a sitting position or rise on their tiptoes.

If no treatment is carried out, and compression of the sciatic nerve increases, then muscle strength decreases even more over time. It is worth recalling here that, among other things, nerves perform a trophic function: they influence metabolic processes in muscle tissue. Disruption of innervation leads to the development of atrophy in the muscles: they decrease in volume and “shrink out.” If such a symptom appears, it usually indicates an advanced disease.

Sensory disorders

A decrease in skin sensitivity in the areas of innervation of the sciatic nerve manifests itself in the form of a feeling of numbness. At first it is expressed to a slight extent, and in advanced cases, sensitivity is lost almost completely. As a rule, numbness affects the back surface of the lower leg (in the calf area), heel, sole, and front (dorsal) surface of the foot.

The second type of sensitivity disorders is paresthesia

. This term refers to an unpleasant sensation in the form of tingling, a feeling as if “goosebumps are crawling across the skin.”

Specific symptoms that depend on which roots are compressed

Depending on what symptoms bother the patient, in some cases it is possible to approximately judge in which nerve roots the pathological changes have occurred. Manifestations of sciatica are most often caused by damage to the roots L4, L5 and S1 (two lower lumbar and upper sacral). The table shows common symptoms that occur when each of these three roots is compressed:

Types of clinical course of sciatic nerve compression

Depending on the nature of the primary disease that became the root cause, and some other factors, different types of clinical course of sciatic nerve damage are distinguished:

• Acute sciatica (acute radiculitis).
  This term refers to pain along the sciatic nerve that lasts from 4 to 8 weeks. In most cases, such pain can be managed relatively easily with the help of medications from a home medicine cabinet, or they go away on their own without medical intervention. However, it is still worth seeing a doctor - it is necessary to establish and eliminate the root cause of the disease.
• Chronic sciatica (chronic sciatica)
  is pain along the sciatic nerve, which lasts longer than 8 weeks and does not go away on its own, and remedies from the home medicine cabinet bring only a temporary effect. In such cases, if the pain persists for a long time, it is better not to wait for the symptoms to intensify and complications to develop, but to consult a doctor as soon as possible. If treatment is started promptly, pinched sciatic nerves can be managed with conservative measures. In advanced cases, the risk that the patient will require surgical treatment increases.
• Intermittent radiculitis.
  This condition is quite rare. With it, pain occurs either in the right or in the left sciatic nerve. This picture is most typical for dysfunction of the sacroiliac joint.
• Bilateral sciatica is
  another rare condition in which pain and other symptoms occur on both sides. The main causes of bilateral compression of the sciatic nerve:

• serious degenerative lesions of the spinal column at different levels;
• spondylolisthesis
  - a condition in which the overlying vertebra slips forward in relation to the underlying one, which leads to compression of the spinal cord and sciatic nerve roots;
• Cauda equina syndrome
  is a serious complication of various diseases of the spinal column.

Among Western doctors there is such a figurative term as “sciatica of the wallet.” This phrase refers to the symptoms of sciatica that occur in a person when he sits for a long time while there is a wallet or other item in the back pocket of his trousers.

Signs of sciatic nerve compression in piriformis syndrome

The piriformis muscle is one of the muscles of the pelvis. Outwardly, it resembles a fan: its wide part starts from the outer surface of the sacral bone, then its fibers converge, it passes through the greater sciatic foramen (where, in fact, the sciatic nerve passes in close proximity to it), passes into the tendon and is attached to the greater trochanter of the femur bones.

Piriformis syndrome is thought to occur when the muscle compresses the sciatic nerve, resulting in pain and other symptoms of sciatica. The exact causes of this condition have not been studied in detail at this time. The following factors are believed to lead to the development of piriformis syndrome:

• Spasm in the piriformis muscle as a result of irritation of itself, the sacroiliac joint, or other adjacent structures.
• Reflexive contraction of a muscle in response to injury.
• Swelling, which can also be caused by injuries and spasms.
• If there is a hemorrhage in the area of ​​the piriformis muscle.

The symptoms of piriformis syndrome closely resemble the symptoms of nerve root damage in spinal pathologies, and it can be difficult to distinguish between the two conditions. The doctor must carefully examine the patient and conduct a comprehensive examination. Piriformis syndrome is usually diagnosed in cases where other possible causes of pain in the sciatic nerve have been excluded.

The most common manifestations of piriformis syndrome

Most often, such patients complain of acute pain in the buttocks, as well as sciatica-like pain along the back of the thigh and lower leg. The list of typical symptoms of this condition includes:

• dull pain in the buttocks;
• pain that spreads down the back of the leg, in the thigh, leg, foot;
• the occurrence or intensification of pain while walking on stairs and inclined surfaces;
• increased pain during prolonged sitting;
• reduced range of motion in the hip joint;
• increased pain after running;
• improvement and reduction of symptoms in the supine position.

What symptoms can a doctor detect during an examination if the sciatic nerve is pinched?

Research shows that all nerves in the human body normally have a reserve of stretch. In other words, if a person bends or extends a limb as much as possible in various joints, excessive stretching of the nerve passing in this area does not occur, pain or other unpleasant sensations do not occur.

But the situation changes with a number of musculoskeletal diseases, in particular with pathologies of the spinal column and conditions accompanied by pinching of the sciatic nerve. In certain positions of the lower limb, the pressure inside the intervertebral discs increases, and the receptors located in the affected tissues are irritated. As a result, certain muscle groups reflexively, subconsciously tense, and myofication occurs. The patient is in pain. This is the basis for the definition of so-called tension symptoms - the doctor can identify them during an examination.

With lesions of the sciatic nerve, the following symptoms of tension are detected:

• Bonnet–Bobrovnikova symptom
  . The patient lies on his back, the doctor takes his leg, passively adducts the hip and rotates it inward. This causes tension in the piriformis muscle and pain.
• Lasègue's symptom
  . The patient lies on his back, the doctor takes his leg and lifts it, while flexion occurs only at the hip joint, that is, the straight leg is raised. There are three degrees of severity of Lasegue's symptom:

• I degree
  - mild pain occurs when the leg is raised approximately 60 degrees. In this case, there is a slight reflexive protective tension in the muscles of the lower back, abdomen, and pelvic area.
• II degree
  – moderate pain when raising the leg at an angle of 45 degrees. In this case, a pronounced, clearly visible protective tension in the muscles of the lower back, abdominals and pelvis occurs.
• III degree
  – severe pain when raising the leg up to 30 degrees, sharp tension occurs in many muscle groups.

• Variations of Lasegue's symptom.
  Sometimes they are used in emergency situations:

• The patient lies on the couch on his stomach with his legs hanging over the edge. In this case, lowering the leg leads to pain.
• Lasègue's sign can be assessed with the patient in a standing position.
• Vengerov's maneuver: when performing the Lasègue test, contraction of the abdominal muscles can be noted. At the same time, in order to obtain a reliable result, the patient’s attention must be diverted while checking the symptom.

• Bekhterev's symptom
  . It is also called Lasegue's cross sign. When the doctor lifts the patient's healthy leg, pain occurs in the affected leg.
• Landing symptom
  . Pain occurs when the patient tries to sit on a chair or couch with his legs straight.
• Dejerine's symptom, or cough impulse symptom
  . When the patient coughs, strains or sneezes, he experiences lower back pain.
• Sicard's sign
  . The patient lies on the couch, the doctor takes his feet and performs strong plantar flexion. This leads to pain along the sciatic nerve.
• Turin's symptom
  - pain along the sciatic nerve occurs with strong dorsal extension of the big toe.
• Razdolsky's symptom or bell symptom
  . If you press on the top of the spinous process of the vertebra or on the sides of it, pain occurs that radiates to the leg.
• Panov–Lobzin–Churilov marching test
  . The patient is asked to march in place while the muscles in the lumbar region are felt. In this case, protective muscle tension is noted.

Symptoms of pinched sciatic nerve in osteopathy

Soft manipulation specialists have some specific approaches to assessing the symptoms of sciatic nerve compression. The doctor always strives to identify the root cause of the disorder, which may be caused by very subtle disorders in the musculoskeletal system.

The task of a specialist in soft manual techniques is not just to relieve the patient of unpleasant symptoms, but to eliminate the disorders that triggered the entire chain of pathological changes that caused these symptoms. For example, it has been established that the cause of sciatica in this particular case is osteochondrosis. But it did not arise on its own. Much earlier, deeper processes began in the body, which provoked degenerative changes in the spine. This may be poor posture, improper muscle tone, impaired blood circulation, lymph outflow, pelvic distortion and excessive tension of the ligaments in certain places, flat feet, changes in the joints of the lower extremities. The doctor must find and work through all these causative factors, this helps to achieve a pronounced and long-term effect.

For doctors practicing defanotherapy - a unique proprietary method developed by Dr. Bobyr - areas of tension in certain muscle groups and ligaments are primarily important. Long-term practice shows that it is excess, pathological stress that often triggers all subsequent pathological changes in the musculoskeletal system.

Treatment of symptoms of sciatic nerve compression

If you are experiencing symptoms of sciatica, you can try to manage them with some home remedies. The first thing that comes to mind is over-the-counter painkillers, which are available in almost every home medicine cabinet. But there are other measures.

Warm compresses and ice packs help a lot. Try applying heat and cold alternately to the affected area for an hour for 20 minutes, after which it will become clear what helps best in your case.

It is a common belief that if a person experiences symptoms of a pinched sciatic nerve or lower back pain, complete rest is indicated. Actually this is not true. You should try to remain physically active within reasonable limits. Stretching exercises can help reduce symptoms of the disease. Ask your doctor how to perform them correctly.

Often, these simple methods help to successfully cope with the symptoms of sciatica and return to a full, active life.
But even after the pain has passed, it is worth visiting a doctor. It is not enough to just eliminate the symptoms. If the cause of the disease is not treated, the pain may return, and even stronger than before. The Bobyr clinic employs experienced specialists who will help identify the disease that causes pinching of the sciatic nerve and prescribe effective treatment. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Diagnostics

In most cases, a simple examination is sufficient to determine whether a patient has a pinching. The patient is checked for reflexes and the evenness of his gait.

However, in order to develop the correct method for treating sciatica in the future, the doctor may need to carry out a number of special procedures. They are aimed at identifying the very cause of the painful condition, for its subsequent elimination.

One of the most common procedures performed to diagnose this disease is MRI and ultrasound. Computed tomography and radiography are also used. Among these methods, magnetic resonance imaging is the most popular. It allows you to get a clear and accurate picture of the patient’s body condition.

Types of lumboischialgia

According to the method of progression, lumboischialgia is divided into 2 forms:

• acute – characterized by acute lumbago that occurs for the first time;
• chronic - pain (they are nagging and dull) appears periodically and systematically, periods of exacerbation are replaced by remission.

Depending on the affected area, lumbago with sciatica occurs:

• unilateral – pathology covers the right or left side of the body;
• bilateral, or bilateral - inflammation spreads to both sides.

Depending on the cause, lumbar sciatica is distinguished:

• vertibral, or vertebrogenic – caused by diseases of the spine:
• discogenic – develops with intervertebral hernia;
• spondylogenic – caused by osteochondrosis;
• nonvertebrogenic – not associated with diseases of the spine:
• angiopathic - provoked by disruptions in the blood circulation of the lower back and lower extremities;
• myofascial – a consequence of damage to muscles and fascia;
• caused by pathologies of the peritoneal organs;
• caused by problems in the hip joints;
• idiopathic - the cause cannot be determined.

What to do in case of an attack of pain?

At the first stage, first of all, you should observe bed rest, limit any movements, it is better to take a pose with support on your healthy leg. When lying on your back, it is recommended to place a small pillow under your lower back and knees. If you cannot lie down, you should shift your weight from one leg to the other alternately and move more often. With light dynamic movements, the muscles relax faster. Take pain medication as prescribed by your doctor.

At the second stage, you can use dry heating (a warm heating pad, a heat-retaining blanket) or a compress with herbal tinctures on the affected area. It is not recommended to use heat at elevated temperatures. In the absence of contraindications, you can perform a massage with rubbing and kneading of the lumbar region and limbs.

To prevent relapses, it will be useful to wear a fixing corset, and for pregnant women, a prenatal bandage if there is a noticeable increase in the abdomen. All intramuscular injections should be performed by trained medical personnel and placed only in the unaffected leg.

Preventive actions

As with any pathology, it is much easier to prevent the occurrence than to treat a pinched sciatic nerve. To avoid the onset of disease, it is important to be careful about your health and follow a number of preventive measures. First of all, you need to strengthen your back muscles. To do this, special physical exercises should be carried out (they are selected by the attending physician).

It is necessary to keep your back straight if possible (do not hunch over while walking, do not sit leaning forward). If a person has a sedentary (office) job, he should take breaks - get up and walk around the room for several minutes. Lifting heavy objects is prohibited and only moderate exercise is allowed. Experts do not recommend exposing the spine to heavy physical activity. Girls with problems in the lumbar spine are not recommended to constantly wear high heels. It is important to keep your lower back warm at all times (to avoid hypothermia).

Treatment

In medical practice, treatment of inflammation of the sciatic nerve is carried out in several stages. At the first stage, the doctor is faced with the need to relieve pain, so analgesics are used. In addition, medications that help reduce inflammation can also be used.

After the primary symptoms have been eliminated, it is time for active treatment. In order to prevent the appearance of pain, the patient may be prescribed physiotherapy, massage, and acupuncture. Pay attention to the fact that achieving a positive effect largely depends on the patient himself. He will have to reconsider his lifestyle, start eating right, following a regimen, and doing physical therapy. Of course, lifting heavy weights is completely limited. Treatment of sciatica is largely related to identifying the causes of its occurrence, so a lot depends on correct diagnosis.