In the human body, the sciatic nerve is one of the longest and most powerful nerves. It originates from the sacral plexus and innervates the lower limb.
According to statistics, usually neuralgia along n. Ischiadicus appears on the right side. This feature is due to the fact that most patients are right-handed. When a person lifts weights, the load occurs on this side.
In this article, we will talk about sciatic nerve neuralgia (lumbar spine): its symptoms and treatment.
- What it is?
- Causes of the disease
- Symptoms and manifestations
- Possible patient complaints
- Problem diagnosis
- What violations can be confused?
- Features of treatment
- Manual therapy
- How to treat folk methods?
- Prognosis and prevention
- Useful video
- Sciatic nerve neuropathy
- Sciatic nerve anatomy
- Causes of sciatic nerve neuropathy
- Symptoms of sciatic nerve neuropathy
- Diagnosis of sciatic nerve neuropathy
- Treatment of sciatic nerve neuropathy
- Inflammation of the sciatic nerve: symptoms, causes and treatment
- What is inflammation of the sciatic nerve?
- Causes of inflammation
- Sciatica Treatment
- Non-steroid drugs
- Vitamins and muscle relaxants
- Massage and spa treatment
- Symptoms and features of the treatment of sciatic nerve inflammation
- Description and reasons
- Symptoms of the disease
- Video “Inflammation of the sciatic nerve”
What it is?
So called a violation in which the process is limited to the perineural membrane, causing irritation syndrome. The roots of the lumbosacral spine are affected. Himself n. Ischiadicus is extremely rare.
Causes of the disease
Neuralgia usually occurs due to damage to the lumbar spine (osteochondrosis, discogenic radiculopathy). It is localized above the nerve, but is manifested by distant pain. Quite rarely, sciatic neuritis leads to pathology.
The main reasons for the violation:
- local and general hypothermia;
- infections and intoxications;
- concomitant diseases in the form of diabetes mellitus, chronic alcoholism;
- occupational hazard – a forced sitting position for a long time. The disease is more common among managers, office workers;
- damaging effects on the intervertebral discs.
Symptoms and manifestations
The main symptom of the pathology is aching, and sometimes tearing, stitching or burning pain. It is localized first along the posterior femoral surface, and then spreads to the lower leg and foot. If the sciatic nerve is affected at a high level, above the folds of the buttock, discomfort is located in the lumbosacral zone. Moreover, the pain extends to the thigh and lower leg.
Usually it develops gradually. Less often appears sharply and intensifies with a sharp turn of the body, lifting weights, walking, standing position or sitting on a hard chair.
In some cases, unpleasant sensations are accompanied by a crawling sensation, numbness. When the patient is standing, he rests on a healthy lower limb. In this case, the sore leg is slightly bent.
The patient determines characteristic pain points with such neuralgia:
- paravertebral region of the lower back;
- under the fold of the buttocks;
- at the location of the transverse processes of the IV – V lumbar vertebrae;
- in the middle of the posterior femoral surface;
- in the popliteal fossa.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Possible patient complaints
The signs of tension of the nerve roots and sciatic nerve are quite intense. These include:
When symptoms of the disease appear, the patient comes for a visit to a neurologist. The doctor interrogates him and conducts a neurological examination. What does the doctor pay attention to:
- the nature of the pain;
- areas of reduced sensitivity;
- decreased muscle strength;
- loss of reflexes.
The neurologist analyzes the data and establishes the topic of the lesion. To confirm the diagnosis, he prescribes additional examination methods:
- electroneurography: allows you to evaluate the peripheral nervous system – the axon and myelin sheath;
- electromyography: performed to determine the functional state of skeletal muscles and the ends of peripheral nerves.
These studies distinguish sciatic neuropathy from radiculopathy of the lumbosacral region and lumbosacral plexopathy.
He also appoints:
What violations can be confused?
Typically, sciatic neuralgia is accompanied by typical symptoms. However, some diseases can give similar manifestations. What disorders can be confused with pathology:
- Inflammation of the vertebrae, including tuberculosis.
- Benign and malignant soft tissue tumors, metastasis to the spinal column and pelvic bones.
- Irradiation of pain in pleurisy, aneurysm of the abdominal aorta and other diseases.
- Flat feet (rarely manifested by a similar clinical picture).
- Pathology of the hip joint, proceeding with coxalgia.
- Pain of vascular etiology (thrombophlebitis, varicose veins, intermittent claudication).
Features of treatment
The doctor prescribes a comprehensive therapy for neuralgia, including conservative methods, manual therapy, and folk remedies.
The basic principles of drug treatment:
If a patient suffering from neuralgia has no contraindications, the doctor prescribes this method of treating problems with the lower back and sciatic nerve.
In this case, you should choose a competent and experienced specialist, since inept actions can lead to serious complications.
During manual therapy, the doctor gently stretches the lumbosacral region. After the session, the load on the affected area is reduced. Nerves and discs are unloaded, which will lead to improved blood circulation.
How to treat folk methods?
Alternative medicine prescriptions should be used as a complex therapy, and not as an independent treatment. What can be used:
- Grinding from rosemary. Grind the plant. Then put in a container 2 tablespoons of raw materials and add 5 tbsp. l vegetable oil. Put to simmer over low heat for 50-60 minutes. Let it brew for about 6 hours, strain. Apply the medicine to the affected areas before bedtime.
- Herbal infusion compress. Take 1 tbsp. l aspen leaves and pine buds. Add 200 ml of boiling water to the container, put to boil the product for 15 minutes and let it brew for an hour. Moisten gauze in a decoction, after which it is put on a sore spot. Cover with a bag and apply a warm scarf. Leave the compress for half an hour.
- Ointment from burdock roots. Take 1 tbsp. l ingredient. Mix with 100 g of pork fat. Strain until the mass softens. Rub the product on the affected area.
Prognosis and prevention
Basic principles for the prevention of disease:
Sciatic nerve neuralgia (lumbosacral spine) is easier to prevent than to treat. That is why measures should be taken to prevent the ailment.
However, if pathology could not be avoided, the patient must strictly comply with medical prescriptions in order not to provoke a worsening of the condition.
The video will tell about the diagnosis and treatment of sciatic nerve neuralgia:
Sciatic nerve neuropathy
Sciatic Nerve Neuropathy – defeat n. ischiadicus, manifested by acute shooting or burning pain on the back of the thigh, weakness of flexion of the leg at the knee, numbness of the foot and lower leg, paresthesias, paresis of the muscles of the foot, trophic and vasomotor deviations on the lower leg and foot. The disease is diagnosed mainly by the results of a neurological examination, electrophysiological studies, CT, radiography and MRI of the spine. In the treatment of sciatic neuropathy, along with the elimination of its etiological factor, medical and physiotherapeutic treatment is carried out, supplemented by massage and physiotherapy (including post-isometric relaxation).
Sciatic nerve neuropathy is one of the most common mononeuropathies, in its frequency it is second only to the peroneal neuropathy. In most cases, it is one-sided. It is observed mainly in middle-aged people. The incidence among the age group of 40-60 years is 25 cases per 100 thousand population. Equally common in females and males. There are frequent cases when sciatic neuropathy seriously and permanently reduces the patient’s ability to work and even leads to disability. In this regard, the sciatic nerve pathology seems to be a socially significant issue, the resolution of the medical aspects of which is the responsibility of practical neurology and vertebrology.
Sciatic nerve anatomy
The sciatic nerve (n. Ischiadicus) is the largest human peripheral nerve trunk, its diameter reaches 1 cm. It is formed by the ventral branches of the lumbar L4-L5 and sacral S1-S3 spinal nerves. Having passed the pelvis along its inner wall, the sciatic nerve through the eponymous notch goes to the posterior surface of the pelvis. Then it goes between the greater trochanter of the thigh and the sciatic tubercle under the piriformis muscle, goes to the thigh and is divided into the peroneal and tibial nerves above the popliteal fossa. The sciatic nerve does not give sensory branches. He innervates the biceps, semi-membranous and semi-tendon muscles of the thigh, responsible for flexion in the knee joint.
In accordance with the anatomy of n. ischiadicus emit several topical levels of its lesion: in the pelvis, in the piriformis muscle region (the so-called piriformis syndrome) and on the thigh. The pathology of the final branches of the sciatic nerve is described in detail in the articles “Tibial Neuropathy” and “Tibial Neuropathy” and will not be considered in this review.
Causes of sciatic nerve neuropathy
A large number of sciatic neuropathies are associated with nerve damage. Injury n. ischiadicus is possible with a fracture of the pelvic bones, dislocation and fracture of the hip, gunshot, lacerated or cut wounds of the thigh. There is a tendency to increase the number of compression neuropathies of the sciatic nerve. Compression may be due to a tumor, aneurysm of the iliac artery, hematoma, prolonged immobilization, but most often it is caused by compression of the nerve in the sub-piriform space. The latter is usually associated with vertebral changes occurring in the piriformis muscle according to the reflex muscular-tonic mechanism for various pathologies of the spine, such as scoliosis, lumbar hyperlordosis, osteochondrosis of the spine, lumbar spondylarthrosis, herniation of the intervertebral disc, etc.
According to some reports, approximately 50% of patients with discogenic lumbar radiculitis have a clinic of piriformis syndrome. However, it should be noted that neuropathy of the sciatic nerve of vertebrogenic genesis can be associated with direct compression of nerve fibers when they exit the spinal column in the composition of the spinal roots. In some cases, the pathology of the sciatic nerve at the level of the piriformis muscle is provoked by an unsuccessful injection into the buttock.
Inflammation (neuritis) n. ischiadicus can be observed in infectious diseases (herpetic infections, measles, tuberculosis, scarlet fever, HIV infection). Toxic damage is possible both with exogenous intoxications (arsenic poisoning, drug addiction, alcoholism), and with the accumulation of toxins in connection with dysmetabolic processes in the body (diabetes, gout, dysproteinemia, etc.).
Symptoms of sciatic nerve neuropathy
A pathognomonic symptom of neuropathy n. ischiadicus is pain along the affected nerve trunk, called sciatica. It can be localized in the buttock region, spread from top to bottom along the back of the thigh and irradiate along the back-outer surface of the lower leg and foot, reaching the very tips of the fingers. Patients often characterize sciatica as “burning,” “shooting through,” or “piercing like a dagger.” The pain syndrome can be so intense that it does not allow the patient to move independently. In addition, patients note a feeling of numbness or paresthesia on the posterior lateral surface of the lower leg and some parts of the foot.
Paresis (decrease in muscle strength) of the biceps, semi-membranous and semi-tendon muscles, which leads to difficult knee bending, is objectively detected. In this case, the predominance of the tone of the antagonist muscle, in the role of the quadriceps femoris muscle, leads to the position of the leg in the state of the bent knee joint. Walking with a straightened leg is typical – when moving the leg forward for the next step, it does not bend at the knee. Paresis of the foot and fingers, a decrease or absence of the plantar and Achilles tendon reflexes are also noted. With a sufficiently long course of the disease, atrophy of paretic muscle groups is observed.
Pain sensory disorders cover the lateral and posterior surface of the lower leg and almost the entire foot. In the area of the lateral ankle there is a loss of vibrational sensitivity, in the interphalangeal joints of the foot and ankle – a weakening of the muscular-articular feeling. Soreness is typical when pressing the sacral-buttock point – the exit point n. ischiadicus on the thigh, as well as other trigger points of Valle and Gar. A characteristic sign of sciatic neuropathy is the positive symptoms of Bonnet tension (shooting pain in a patient lying on his back with passive abduction of the leg bent in the hip joint and knee) and Lassega (pain when trying to lift the straight leg from the supine position).
In some cases, sciatic nerve neuropathy is accompanied by trophic and vasomotor changes. The most pronounced trophic disorders are localized on the lateral side of the foot, heel and rear of the fingers. On the sole, hyperkeratosis, anhidrosis or hyperhidrosis is possible. Hypotrichosis is detected on the posterior lateral surface of the lower leg. Due to vasomotor disorders, cyanosis and foot cooling occur.
Diagnosis of sciatic nerve neuropathy
Diagnostic search is carried out mainly in the framework of a neurological examination of the patient. The neurologist pays special attention to the nature of the pain syndrome, hypesthesia zone, decreased muscle strength and loss of reflexes. Analysis of these data allows you to establish the topic of defeat. Its confirmation is carried out using electroneurography and electromyography, which allow us to differentiate sciatic mononeuropathy from lumbosacral plexopathy and radiculopathy of the L5-S2 level.
Recently, to assess the condition of the nerve trunk and surrounding anatomical formations, an ultrasound technique is used that can give information about the presence of a nerve tumor, its compression, degenerative changes, etc. The determination of the genesis of neuropathy can be carried out using spinal radiography (in some cases, CT or Spinal cord MRI), pelvic radiography, pelvic ultrasound, ultrasound and hip radiography, CT of the joint, blood sugar analysis, etc.
Treatment of sciatic nerve neuropathy
The primary consideration is the elimination of causal factors. With injuries and injuries, plastic or suture of the nerve is performed, reposition of bone fragments and immobilization, removal of hematomas. With voluminous formations, the question of their removal is resolved, in the presence of a hernia of the disk – about discectomy. In parallel, conservative therapy is carried out aimed at stopping inflammation and pain reaction, improving blood supply and metabolism of the affected nerve.
As a rule, pharmacotherapy includes non-steroidal anti-inflammatory drugs (ibuprofen, lornoxicam, nimesulide, diclofenac), drugs that improve blood circulation (pentoxifylline, nicotinic acid, benzcylan), metabolites (calf blood hydralizate, thioctic acid, vitamins group B). Perhaps the use of therapeutic blockades – local injection of drugs into the trigger points along the sciatic nerve.
Of the methods of non-drug exposure, physiotherapy (SMT, UHF, diadynamic therapy, local ultraviolet radiation), massage, post-isometric relaxation are successfully used; in the recovery period – physiotherapy exercises.
Inflammation of the sciatic nerve: symptoms, causes and treatment
Good day, dear friends! It turns out that inflammation of the sciatic nerve can occur in any person.
The inflammatory process is characterized by soreness in the lower back and lower limb. So, today we will find out how the symptoms and treatment of inflammation of the sciatic nerve manifest.
What is inflammation of the sciatic nerve?
The sciatic nerve is located in the ileo-sacral plexus and stretches down the thigh. Under the knee he is divided.
One part goes to the shin and the other to the foot. A pinched sciatic nerve is also called sciatica as a disease of the peripheral nervous system that occurs when the roots of the lumbosacral spine or spinal nerves are damaged.
Sciatica occurs in women and in men.
Sciatica provokes two types of pain:
- Superficial or dysesthetic occurs with damage to small nerve fibers. In this case, the pain will be stinging, burning and shooting.
- Deep or truncal pain is breaking, cutting and aching.
Consider what signs can accompany sciatica. Pain syndrome occurs on the side where inflammation occurs.
Pain arises in the leg on one side. At the very beginning, pain occurs with sudden movements and physical exertion.
With an intense inflammatory process, a person has insomnia, and then there is complete immobilization due to acute pain.
Causes of inflammation
Before we learn how to relieve pain, let’s find out the causes of their occurrence. Not infrequently, the process of inflammation of the sciatic nerve is formed after the appearance of an intervertebral hernia.
It is worth noting the following common causes of sciatica:
- Traumatic injuries.
- Change in the shape of the vertebrae.
- Infectious diseases.
- Gynecological diseases.
- Displacement of the intervertebral disc.
- Strong physical activity.
How to treat sciatica depends on the exact diagnosis that the doctor must make.
A full examination includes the following methods:
- Methods of biochemical and clinical diagnostics.
- Consultation of a neurologist, rheumatologist and vascular surgeon.
- Tomographic studies.
- Performing radiological images.
Urgent medical attention is required if the temperature rises to 38 degrees, redness and swelling appeared on the code.
Pain sensations appear in new areas of the body. In the pelvic area, legs and hips, numbness and piriformis pain occurs.
When urinating, a burning sensation appears. Research will help determine which drug treatment can be used to eliminate pain.
If symptoms of the inflammatory process appear, treatment should be started as soon as possible.
Then, depending on the results, a certain therapy is carried out:
- Drug therapy. Special pain medications are prescribed, as well as injections and ointments.
- B vitamins stabilize metabolism in nerve cells. During periods of acute exacerbation, drugs are administered intramuscularly, and then an oral dose is prescribed.
- Physiotherapeutic treatment includes electrophoresis, massage, and ultraviolet radiation.
- Non-traditional methods consist of different methods – hirudotherapy, herbal medicine and acupuncture.
- Folk remedies can be effective. Pinching is treated with infusion of bay leaves, compresses of potatoes and tincture of dandelion.
- Diuretic drugs are used to reduce swelling.
- Therapeutic exercises help to improve blood circulation in the affected area, as well as improve the functioning of the spinal cord.
- Surgical treatments. Microdiscatomy and disketomy are carried out, which can defeat sciatica.
The treatment complex is carried out for a long time at home. If the pain does not subside within a few months, then steroid drugs are prescribed that are administered epidurally.
The most effective painkillers include NSAIDs. Home treatment and these drugs give a good effect.
It is worth noting the following anti-inflammatory drugs for inflammation of the sciatic nerve:
- “Piroxicam” is produced in different forms – suppositories, gel, cream or tablets.
- Meloxicam is one of the safest drugs.
- Nimesulide is available in the form of tablets, capsules and powders.
- Ketonal is often used intramuscularly and as an ointment.
With severe pain, the doctor may prescribe steroid hormones that quickly remove the pain. But it should be borne in mind that these drugs do not help get rid of sciatic nerve inflammation.
Vitamins and muscle relaxants
Muscle relaxants help to reduce local muscle tension that occurs as a result of pain. These drugs include Tizalud, Midokalm and Baclofen.
Multivitamin complexes – Milgamma, Trigamma and Neurovitan differ in anti-inflammatory effect against Sciatica.
Massage and spa treatment
As the reviews confirm, various activities of spa treatment help well. He is prescribed when the phase of exacerbation has passed. Hydrotherapy with the use of hydrogen sulfide, radon and pearl baths, mud therapy and underwater traction are used.
Climatotherapy strengthens the immune system and also improves mood. After exacerbation, but not with inflammation, massage can also be used.
How it is performed with sciatica is presented in the video:
This procedure helps to reduce pain, prevent muscle hypotrophy and stimulate blood circulation. The course should include at least 10 sessions.
A good set of exercises offers Dr. Bubnovsky. It will help eliminate discomfort. The essence of the technique is not in the use of medications, but in finding the latent forces of the body and understanding the anatomical features.
This therapy is called kinesitherapy. A special diagnosis is carried out, according to the results of which a treatment program is created.
Selected exercises help to restore full functioning of the joints and spine. The treatment program includes not only exercises for the spine, but also for the joints of the legs.
Be sure to perform an exercise to stretch the muscles and ligaments.
Here is a gymnastics option:
- To relax the lumbar region and relax the back muscles, take a pose on all fours.
- Then bend your back with a breath and bend with a breath. You need to do 20 repetitions.
- In the same position, move in stretching steps. Buttocks advance to the left and right heel. Also do 20 times.
- In the same starting position, reach forward with your hands. Keep emphasis on the knees and palms.
- As you exhale, lower the body to the floor and bend your arms. On the exhale, straighten your arms, and lower the buttocks to the heels.
- In the supine position, place your heels closer to the buttocks. Place your hands under your head, and press your chin to your chest. As you exhale, reach with your elbows to your knees. Then return to the starting position.
- In the same position, lift the pelvic area up and down. The exercise should be repeated 30 times.
Such gymnastic movements not only have a beneficial effect on the spine, but also on the whole organism.
An integrated approach will fully restore health. Of great importance is willpower and regularity of classes.
If you lead a sedentary lifestyle, then the muscles weaken, and it becomes difficult to hold your back. As a result, all kinds of pathologies may appear.
The following preventative measures can be used:
- Strengthening the muscle corset and moderate physical activity.
- Eating foods high in magnesium and calcium.
- The use of manual therapy.
- Stretching the spine by hanging on the horizontal bar.
- Performing exercises such as backbends on all fours.
- Timely posture correction in childhood.
Remember that inflammation of the sciatic nerve is accompanied by severe pain, so it is so important to immediately consult a doctor when the first signs occur.
I hope my advice will benefit you. Goodbye, dear guests! Do not be ill.
Symptoms and features of the treatment of sciatic nerve inflammation
Description and reasons
The sciatic nerve is responsible for the innervation of the entire lower limb. It comes out of the piriformis fissure, runs along the midline between the sciatic tubercle and the greater trochanter of the femur, where it is then divided into several branches.
Due to some factors, pinching of sensitive fibers or the entire nerve is possible, causing inflammation when a person’s lower back and leg begin to hurt.
There are many reasons why a nerve can become inflamed. Some of them are:
- hypothermia of the lower back;
- hernias and protrusions;
- injuries of the muscles of the pelvis and spine;
- piriformis syndrome;
- pregnancy, trauma during childbirth, gynecological diseases;
- weight lifting, awkward movements, stress during physical exertion.
Symptoms of the disease
Symptoms of pinching of the sciatic nerve most often manifest in the form of pain, with which the patient, as a rule, seeks medical help. However, the disease can manifest itself with a number of symptoms.
Some signs by which you can find out about the presence of infringement:
- the pain penetrates the back surface of the leg to the buttocks, the lower back can ache, there are cases when the pain covers only one limb, where the lesion is localized;
- in rare cases, there may be a slight increase in body temperature;
- the presence of paresthesia, often the patient complains that the leg can be pulled or pricked, some areas may go numb;
- the inability to lift and hold the leg for 30 seconds (Laseg symptom);
- pain may increase with flexion of the foot (Sikar symptom);
- impaired motor function can be manifested in impaired gait, and with prolonged absence of treatment can threaten lameness;
- dysfunction of the pelvic organs is quite rare, but can occur in the form of urinary incontinence, contribute to the development of constipation.
Sciatica can sometimes be masked by other similar diseases, such as osteochondrosis. To confirm the diagnosis, a neurological examination of the patient is performed, revealing a positive symptom of Laseg. The patient is offered to lie on the couch and raise his leg, without bending at the knee, up. If pain in this position penetrates the leg along the nerve, and when lowering the limbs subsides, then the doctor has reason to assume sciatica. This test is not the only method for determining pathology.
Instrumental research methods allow using visualization to determine the level of nerve clamp, to understand why pinching occurred. Usually, the doctor prescribes an ultrasound scan (ultrasound) and MRI.
After the diagnosis is confirmed, you can proceed to treatment. It is strictly forbidden to engage in self-medication, only a specialist doctor (in this case, a neurologist or neuropathologist) can be entrusted with treatment for pinching of the sciatic nerve. Only a competent doctor will be able to:
- eliminate pain by prescribing pain medication;
- stop the development of the inflammatory process by using anti-inflammatory drugs;
- identify the cause that caused the inflammation.
If the cause of the pathology is of infectious origin, antiviral and antibacterial therapy is prescribed. In the case when a hernia or protrusion was able to pinch a nerve – do not avoid examination in the surgical department.
Without fail, the patient is prescribed bed rest throughout the acute period of the disease.
Consider how to treat the sciatic nerve with the help of drug therapy:
How to provide first aid at home or on the street to such a patient before the ambulance arrives? It is necessary to put a person on his stomach on any hard surface, placing a roller from what is at hand under his stomach. You must be in this position before the doctor arrives. Warming the focus of inflammation with warm heaters, applying and rubbing ointments on your own is prohibited.
Massage is considered an effective way to treat sciatic nerve pinches during the entire course (minimum visit to the masseur is 10–11 sessions). The patient is allowed to undergo massage therapy exclusively during the period of remission. How many sessions are needed for a full recovery – the doctor decides.
Acupressure can relax muscles, improve blood flow in the affected area, relieve cramping and pain. Correct manual exposure over a long period of time will allow to release the pinched nerve and remove the residual effects of the disease.
Among the physiotherapeutic methods for the treatment of a pinched, inflamed nerve are used:
- dynamic currents;
- magnetic therapy;
- laser therapy;
These methods can eliminate the causes that can “pinch” the sciatic nerve.
Video “Inflammation of the sciatic nerve”
In this video, the expert will talk about the symptoms and treatment of sciatic nerve inflammation.
Neurologists give due weight to preventive measures. They strongly advise:
Be careful, take care of your health, and at the first signs of the symptoms described above, immediately contact a medical institution for help.
Remember that the disease is easier to prevent than to cure.