Sciatica

Overview of Sciatica

• Pain in the distribution of the either sciatic nerve or its component nerve roots (L5, S1).
• Moreover, The syndrome is now accepted as being caused by lumbar disc prolapse. [2]
• In detail, The delicate nerve fibers themselves are seldom, if ever, affected.
• Besides this, The symptoms of sciatica may be copied by such conditions as arthritis of the hip-joint, or a tumour pressing on the trunk of the nerve, but other signs are present in these conditions by which they may be distinguished from true sciatica.
• However, sciatic nerve lesions can occur due to pressure in the buttock or upper part of thigh.[2]

Causes of Sciatica

1.Firstly, True sciatic neuritis

2. Secondly, Mechanical pressure on nerves or roots or referred pain:

• In the spinal cord: e.g. Tumours, thrombosis, haemorrhage or infection.
• In the vertebral column: e.g. Arthritis, tuberculosis, primary bone tumours, secondary carcinoma.
• In the back: e.g. Fibrositis of ligaments, Compression of nerve.
• In the thigh and buttock: e.g. infection, anticoagulant therapy.
• Lumbosacral spondylosis, intervertebral disk herniation, osteophytes, and narrowing of the spinal canal (in other words; spinal stenosis) [2]
• Injury to the leg
• Rheumatic disorder.[1]
• Intraspinal either tumor or abscess.[4]

Risk factor of Sciatica

• Prolonged standing
• Prolonged sitting
• Prolonged straining
• Prolonged coughing also sneezing
• Twisting
• Lifting [3]

Pathophysiology of Sciatica

• Basically, The altered mechanics of the lumbar spine result in loss of lumbar lordosis also there may be spasm of the paraspinal musculature.
• Furthermore, Root pressure is suggested by limitation of flexion of the hip on the affected side if the straight leg is raised (in other words; Lasègue’s sign).
• All in all, If the third or fourth lumbar root is involved, Lasègue’s sign may be negative, but pain in the back may be induced by hyperextension of the hip (femoral nerve stretch test).[7]

Sign & Symptoms of Sciatica

• A mild ache
• Sharp burning sensations
• Weakness
• Numbness
• Tingling [3]
• Pain radiates along the course of the sciatic nerve; additionally it may occur with or without low back pain.
• Pain radiating down the affected leg when the contralateral leg is lifted (crossed straight leg raising) is more specific for sciatica.[4]

Clinical / Physical Examination For Sciatica

• SLR test: Restriction of straight leg raising, SLR test gives a useful indication of the severity of the sciatica, also increased capacity for painless SLR is objective measure of improvement
• Tenderness of nerves: Tinel’s sign
• Popliteal compression: Radiating pain can often be aggravated especially by pressure over the course of the tibial nerve through the popliteal fossa
• Besides this, Muscle power in the lower limb tested against resistance
• Knee also ankle jerks – When L4 root are involved
• Lastly, Presence of tender nodules: paraspinal muscles also along iliac crest may be found in sciatica due to inflammation of muscular and fascial structures.[2]

Investigation of Sciatica

X-rays i.e.

• For detecting disc narrowing in lumbar spine, or lesion of sacroiliac or hip joint

MRI i.e.

• Of lumbosacral spine

CSF i.e.

• Show increased protein with normal cell count

EMG i.e.

• To confirm presence of denervation in affected muscles Procaine injection test [2]

Diagnosis of Sciatica

• Clinical evaluation.
• Sometimes MRI, electrodiagnostic studies, or both.
• Sciatica is suspected based on the characteristic pain. In detail; If it is suspected, strength, reflexes, and sensation should be tested.
• Structural abnormalities causing sciatica are diagnosed either by MRI or CT.
• Electrodiagnostic studies can confirm the presence also degree of nerve root compression.
• Lastly, abnormalities may not be evident on electrodiagnostic studies for up to a few weeks after symptoms begin. [4]

Differential Diagnosis of Sciatica

• Arthritis of the hip
• Sacroiliac arthritis
• Major lesions in the buttock
• Disc lesion
• Spondylolisthesis
• Attrition of disc
• Benign spinal tumour
• Intermittent claudication
• Dissecting aneurysm [2]

Treatment of Sciatica

• Bed rest (brief), analgesics, and sometimes drugs that relieve neuropathic pain.[4]
• NSAIDs
• Analgesics
• Muscle relaxants
• Anti-depressants
• Injections of Epidural, corticosteroid, Transforaminal corticosteroid
• Patient education
• Exercises, staying active
• Physical therapy
• Apply hot/cold packs
• A referral to a physiatrist if symptoms persist [3]
• Surgery for severe cases.

Surgery is indicated only for unequivocal disk herniation plus one of the following i.e.:

• Muscular weakness.
• Progressive neurologic deficit.
• Intolerable, intractable pain that interferes with job or personal functions in an emotionally stable patient also that has not lessened after 6 wk. of conservative treatment. [4]

Homeopathic Treatment of Sciatica

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Sciatica

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

1. Rhus tox:

• Generally, Aching pains in legs must change position every moment.
• Sciatica with tearing, drawing pain also burning pain hip-joint to hamstrings.
• Tingling in feet, stiffness, tension in leg, lameness. Additionally, Cramps buttocks, thighs and calves.
• Worse – cold, damp weather, at night, sleep, lifting, overexertion, during rest, lying on back, lying especially on right side.
• Better – dry, warm weather, warmth, walking, rubbing, change of position.

2. Lycopodium:

• Sometimes most useful in chronic cases where there is fine burning or stinging pains, also tearing, drawing, jerking pains which are aggravation from rest.
• Lameness, cramps in calves and toes in bed at night. Restless limbs preventing sleep.
• Worse – right side, cannot lie specifically on painful side, morning on waking, rising from seat, heat or warmth of a room, bed, before midnight, rest. On the other hand, Better – motion.

3. Colocynthis:

• Typifies the sciatica due to nerve changes with no special inflammatory conditions attending it.
• Contraction of muscles. Cramp-like pain in hip, lies on affected side; pain from hip to knee.
• Pain drawing, tearing. Pain down right thigh, muscles and tendons feel too short.
• Numbness with pains. Pains may come and leave suddenly
• Worse – gentle touch, motion, cold. Whereas, Better – pressure, heat.

4. Mag phos:

• Cramping of muscles with radiating pains. Neuralgic pain Amelioration warmth. Cramps in calves.
• Feet very tender. Spasmodic pain. Sudden pain. Pains in lower limbs on alternate sides.
• Worse – especially right side, cold, touch, night. On the other hand, Better – warmth, bending double, pressure, friction. [1]

5. Ruta:

• Deep-seated pain as if in marrow of bone; worse specifically at rest; pain compels patient to walk about constantly during paroxysm. After injuries, contusions, etc.

6. Dioscorea:

• Pain in right leg from point of exit of sciatic nerve, felt only when moving the limb or when sitting up (rising from lying to sitting posture).
• That means: aggravated by walking or moving the limb and entire relief when sitting still. A few distinct pointers
• Pains radiate downwards
• Frequent shooting pains from one part to another.
• Pains of all sorts which are unbearable.
• Pains dart about (go away suddenly and reappear in a different part of the affected limb)

7. Lachesis:

• Pain constantly changes locality, now in head, now in teeth, now in sciatic nerve, attended with nervousness and palpitation of heart.[5]

Frequently Asked Questions

What is Sciatica?

Sciatica is pain along the sciatic nerve. It usually results from compression of nerve roots in the lower back.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Sciatica?

• Rhus tox
• Lycopodium
• Colocynthis
• Mag phos
• Ruta
• Dioscorea
• Lachesis

What is the main cause of Sciatica?

• True sciatic neuritis
• Mechanical pressure on nerves or roots or referred pain

What are the symptoms of Sciatica?

• A mild ache
• Sharp burning sensations
• Weakness
• Numbness
• Tingling

Give the types of Sciatica?

• Acute Sciatica
• Chronic Sciatica