Pinched sciatic nerve why symptoms occur, treatment

Sharp pain along the back of the thigh and lower leg is a key manifestation of a condition such as pinching of the sciatic nerve. Injuries, infections, degenerative pathologies and other predisposing factors can lead to compression. An X-ray examination and magnetic resonance imaging will help determine the disease. For treatment, medications, physiotherapy and post-isometric relaxation are prescribed.

Characteristics of pathology

The sciatic nerve is the most massive nerve of the human body, consisting of all the roots of the sacral plexus. It originates under the buttock, runs along the back of the thigh, in the popliteal region it is divided into two branches, descending along the lower leg through the calcaneus to the toes of the foot. In the region of the gluteal muscle, the nerve trunk passes through the piriformis fissure, spasm of which can lead to compression.

Pinched sciatic nerve can form at the level of the lower vertebrae. Compression is manifested by a sharp pain signal. Most often, one limb is affected, a bilateral process occurs, but rarely. Among the sick, the majority are male workers of working age. Such statistics are explained by men’s employment at work with difficult working conditions, which require physical endurance.

Causes

The factors provoking the onset of pathology include a sharp increase in weights, exorbitant loads on the lower back, prolonged inactivity in an unusual position.

Compression can occur against the background of other pathologies:

  • disc herniation due to cartilage degeneration;
  • osteochondrosis – with the deformation of the vertebrae and the formation of osteophytes;
  • spinal injury;
  • specific infectious diseases (gonorrhea, tuberculosis and others);
  • tumor growths and their metastases;
  • spasm of the piriformis muscle;
  • pregnancy – with improper load distribution in the later stages;
  • endocrine pathologies;
  • improper course of metabolic reactions – gout;
  • fibromyalgia;
  • intoxication in contact with heavy metals, arsenic, as well as alcohol poisoning;
  • spondylosis and curvature of the spine;
  • juvenile rheumatoid arthritis.

Often a pinch of the sciatic nerve occurs after hypothermia. At risk are representatives of professions performing labor duties in cold conditions. In this case, low temperature acts as a push for exacerbation of a chronic disease, as the root cause of compression.

Additional risk factors include:

  • increased body weight;
  • herpes zoster type with localization in the sacral region;
  • hormonal restructuring of the female body during menopause;
  • smoking;
  • insufficient intake of vitamins and minerals.

clinical picture

The main sign of pinched nerve is a strong pain syndrome. A sharp, pulsating pain, in nature resembling the passage of an electric current pulse, occurs in the gluteus maximus muscle and spreads along the sciatic nerve up to the foot. The pain can spread over the entire surface of the leg or have a separate localization under the knee or in the thigh.

According to the duration of the course, the pain symptom is more often periodic. An acute attack begins suddenly with piercing pain, which makes a person freeze in place and take a forced position, since any attempt to move causes suffering. Chronic pain symptom is not particularly intense, moderate manifestations cause mild discomfort.

In addition to the standard localization of pain, in some cases there is radiation to the lumbar region. At the same time, the strength of pain increases and is accompanied by burning and tingling with each movement. A pinched sciatic nerve always leads to a violation of innervation and, as a result, the development of neurological symptoms:

  • decrease in Achilles, knee and plantar reflex;
  • the cross nature of the pain (when lifting the affected leg, the pain extends to a healthy limb);
  • sharp pain when clicking on the points of Valle (the place where the sciatic nerve is located close to the surface of the skin).

Violation of sensitivity and motor function are expressed in the following symptoms:

  1. A slight feeling of numbness, a feeling of running “goose bumps” in the foot and calf muscle;
  2. Limitation of flexion in the joints;
  3. Muscle weakness of the lower extremities;
  4. Impaired gait (lameness);
  5. Limit the amount of movement of the body (tilts, turns);
  6. The strengthened work of sweat glands;
  7. Feeling cold in the feet;
  8. Dry skin and brittle nails;
  9. Violation of innervation leads to a violation of the act of urination and defecation.

Pinching of the sciatic nerve may not be manifested by the entire symptom complex, but by a combination of several signs in various variations. The severity of the clinic may also vary. At the initial stage, a person may not respond to subtle manifestations for years, exacerbating the situation, and consult a doctor when the disease gains full force.

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When the nerve is compressed, the affected limb acquires metamorphic changes. The appearance of the legs is very different from healthy. The skin changes color to red or painfully pale, becomes dry, peeling is present.

Muscle tissue atrophies and becomes thinner, while the volumes of the thigh and calves of the diseased limb are reduced. A sharp weakness appears not only during movement, but also in a calm state. The leg ceases to bend, at the time of the step it is “transported” in a straightened position, provoking a characteristic lame gait.

Diagnostic measures

The orthopedist and neuropathologist are involved in the detection of pinching. In most cases, the diagnosis does not cause contradictions, thanks to the characteristic clinical picture, which the patient describes as part of complaints. After collecting an anamnesis, specialized tests are performed to confirm the presence of neurological symptoms. Additionally, you may need advice from an endocrinologist, infectious disease specialist, gynecologist, urologist.

A positive symptom of Laseg indirectly confirms the disease: lying on his back on a hard surface, the patient raises a straightened leg with a pinched nerve, while a pain impulse appears along the posterior surface of the femoral muscles and in the gluteus maximus; when the lower limb is bent in the knee joint, the pain impulse completely disappears. If difficulties arise with the reproduction of leg movements, the doctor carries out the manipulation by raising and bending the limb with his own hands (Bonnet symptom).

Pinched sciatic nerve is diagnosed by objective studies:

  • radiography of the leg, lumbosacral spine;
  • electroneuromyography;
  • MRI and CT.

The results will help not only confirm the alleged diagnosis, but also establish the cause of pinching. Additionally, you may need advice from an endocrinologist, infectious disease specialist, gynecologist, urologist.

Further treatment tactics will be based not only on improving the patient’s condition by relieving symptoms, but also on eliminating the disease that led to the development of the pathological condition.

Possible complications

Inaction, improper therapeutic actions or attempts at self-treatment lead to the development of the following complications:

  • non-stopping pain symptom;
  • insomnia;
  • violations of the ovarian-menstrual cycle;
  • exacerbation of chronic pathologies;
  • limitation of motor function;
  • fecal and urinary incontinence;
  • infertility.

Treatment

The medical complex of procedures for pinching is successfully carried out at home. Hospitalization may be required only in extreme cases. The therapeutic regimen consists of several points, including medicines, physiotherapeutic procedures, massage and therapeutic exercises. Compliance with medical prescriptions and recommendations is the main condition for the success of therapeutic actions. Therefore, I should not follow the advice of friends or uncontrolled use of advertised pharmaceuticals.

Mode and dosing load

Reducing physical activity is necessary for any course of compression compression. In the period of acute pain, bed rest is prescribed for several days. To reduce pain, the patient is placed on an orthopedic mattress, and if necessary, getting out of bed, put on a lumbosacral corset of rigid fixation, the orthopedist is engaged in modeling the ribs. Warming bandages for pinching the sciatic nerve are recommended for prevention during a period of persistent remission.

  1. NSAIDs (Ketoprofen, Indomethacin) – to eliminate an attack of pain with a simultaneous effect on a possible inflammatory process. Only your doctor should prescribe drugs. For moderate pain, they are prescribed in the form of tablets or powders for oral administration (Nurofen, Nimesil), intense pain is relieved by the injection method (Diclofenac, Ketorolac), for local exposure – gels or ointments (Voltaren, Quick gel).
  2. With the ineffectiveness of NSAIDs with severe pain, local novocaine blockades are performed.
  3. Muscle relaxants (Midokalm, Sirdalud) to relieve muscle cramps.
  4. Vitamins of group B (Kombilipen, Neuromultivit) in an injectable form to improve the conductivity of nerve impulses.
  5. Chondroprotectors (Honda, Arthra, Teraflex) for a long course with cartilage degeneration.
  6. Complex multivitamin complexes (Doppelherz from A to Zinc, Vitrum, Supradin) to improve metabolic processes and the body’s defenses.
  7. Antibacterial therapy (Azithromycin, Cefatoxime) in the presence of an infectious factor.

Additional methods that enhance the therapeutic effect of pharmacotherapy are physiotherapeutic procedures. Magnetotherapy, phonophoresis, ultraviolet and laser irradiation are recommended to be carried out in a painless period of the pathology. The physiotherapeutic effect improves blood circulation, restores muscle tissue and tones them, starts the regeneration of damaged tissues, and prevents the formation of pain impulses.

Contraindications for physiotherapy:

  • heart failure in the decompensation stage;
  • pustular skin diseases;
  • acute inflammatory processes;
  • malignant neoplasms;
  • tendency to bleeding;
  • pregnancy.

After the onset of the remission period, pinching of the sciatic nerve is eliminated using therapeutic massage. The correct technique for performing by a qualified specialist remains the main criterion for the appointment of recovery procedures, since one awkward movement can lead to a second exacerbation. To improve tissue trophism, enhance hemodynamics, restore muscle tissue strength, a course of ten sessions is sufficient.

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In practice, two massage methods are used:

  • Classic – includes the stage of warming up the muscles with stroking and light rubbing movements, after which the affected limb is massaged without affecting the painful areas.
  • Point – consists in acupuncture when you click on special points on the human body.

The method of light manual exposure allows you to relieve tension and restore muscle elasticity, eliminate pain, improve the motor ability of joints and spine. The method is based on a two-stage effect on a tense muscle:

  1. Short-term (6-10 seconds) muscle tension performed by a patient holding his breath.
  2. Smooth muscle stretching by the masseur during exhalation and relaxation of the patient.

The procedure allows you to “fix” the muscle in the correct position, achieving maximum relaxation. This measure allows you to remove and prevent pain. To achieve the optimal effect when pinching the sciatic nerve, 3-4 receptions will be required in one session.

Contraindications to the use of this technique:

  • hernias of the intervertebral disc, reappearing after surgery;
  • inflammatory diseases (spondylitis, arachno >

The gymnastic complex of exercise therapy is compiled and appointed by a medical specialist after a detailed examination of the patient. Exercises are selected taking into account the functionality and associated pathologies. Classes should be held regularly. The movements are performed smoothly, without jerking, if an unpleasant or painful sensation occurs, it is recommended to stop gymnastics and inform the doctor who will correct the load.

Two effective exercises for pinching the sciatic nerve:

  1. Lying on your back, pull the affected leg, bent at the knee, to the chest. Feeling the maximum stretch, stay in this position, slowly counting to sixty.
  2. Without changing the starting position, bend both legs. Without extending the affected leg, put it on a healthy limb. With both hands, grab a healthy limb in the popliteal region, and pull the crossed legs as close to the chest as possible, then fix the position and count to sixty.

Operative intervention

Some pathologies that precede sciatic nerve compression require surgical intervention.

Indications for surgery are:

  • spondylolisthesis;
  • intervertebral hernia;
  • destructive changes in the lower vertebrae;
  • spinal stenosis;
  • increasing neurological symptoms;
  • urinary or fecal incontinence.

There are several methods of surgical treatment, the choice of which depends on the pathological condition of the spinal tissue. After surgery, the patient expects a long recovery period under the supervision of a rehabilitologist.

Prevention

To avoid one of the most painful pathologies, such as pinching of the sciatic nerve, it is necessary to eat properly, engage in active physical activity. Intensive overloads have a detrimental effect on the joints and spine, so it is recommended to avoid lifting heavy objects, to engage in power sports. For prevention, wear an orthopedic corset on the lumbar.

Swimming, regular walks in the fresh air, rest on an orthopedic mattress, timely treatment of chronic pathologies and correction of deformation changes in the spine and feet will help to forget about painful discomfort forever. If pain or unpleasant discomfort in the sciatic nerve occurs, it is advisable to consult a doctor for early diagnosis and treatment of the disease.

Shishkevich Vladimir
Shishkevich Vladimir
Orthopedic doctor, traumatologist
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