Sciatica is a debilitating disease due to the sciatic nerve or sciatic nerve root pathology. Affected patients experience pain and paresthesia in the distribution of the sciatic nerve or an associated lumbosacral nerve root. Sciatica is specific to the pain that is a direct result of sciatic nerve or sciatic nerve root pathology. The sciatic nerve is made up of the L4 through S2 nerve roots which coalesce at the pelvis to form the sciatic nerve. At up to 2 cm in diameter, the sciatic nerve is easily the largest nerve in the body. Sciatica pain often is worsened with flexion of the lumbar spine, twisting, bending, or coughing.
SIGNS AND SYMPTOMS
Low backache radiating through the backside of the thigh to the foot
Pain in the lumbar spine mostly in either side
Pain or burning sensation deep in the buttocks
Paraesthesia that accompanies the pain
Associated ipsilateral leg weakness
Affected leg feeling heavy
CAUSES
Any condition that may structurally compress the sciatic nerve like a herniated or bulging lumbar intervertebral disc.
In the elderly population, lumbar spinal stenosis may cause these symptoms as well.
Spondylolisthesis
Lumbar or pelvic muscular spasm and/or inflammation
A spinal or paraspinal mass including malignancy, epidural hematoma, or epidural abscess
PATHOPHYSIOLOGY
The sciatic nerve is made up of the L4 through S2 nerve roots. These nerve roots fuse to create the large sciatic nerve in the pelvic cavity. The sciatic nerve then exits the pelvis through the sciatic foramen posteriorly. After exiting the pelvis, the nerve courses inferior and anterior to the piriformis and posterior to gemellus superior, gemellus inferior, obturator internus, and quadratus femoris. Next, the sciatic nerve enters posterior thigh and courses through biceps femoris. Finally, the sciatic nerve terminates at the knee posteriorly in the popliteal fossa giving rise to the tibial and common fibular nerves. Sciatica symptoms occur when there is pathology anywhere along this course of the nerve.
DIAGNOSIS
Clinical evaluation including straight-leg raise
X-Ray
CT
MRI
TREATMENTS
- A short course of oral NSAIDs
- Opioid and non-opioid analgesics
- Muscle relaxants
- Anticonvulsants for neurogenic pain
- Oral corticosteroids
- Localized corticosteroid injections
- Deep tissue massage may be helpful
- Physical therapy consultation
- Surgical evaluation and correction of any structural abnormalities such as disc herniation, epidural hematoma, epidural abscess or tumor
PROGNOSIS
majority of patients with sciatica tend to have residual or recurrent pain in the long term.
COMPLICATIONS
Epidural abscess
Disease & Ayurveda
Khallwi/grdhrasi
Nidana
Dhaatukshaya (degeneration of tissues)
Aavarana (obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the lower limbs, especially nerves & muscles, causing the signs & symptoms.
Lakshana
Severe pain in the lower limb
Difficulty to raise the lower limb
Divisions
Not mentioned
Prognosis
Saadhya when the disease is new
Krichrasadhya when the disease is chronic
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with warm soolahara-sothahara dravyas
Upanaha with Vaataharadravyas
Sirodhara, kateevasti, kateepichu with Vaatahara taila(once there is no aama)
Sodhana
Sneha (Abhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Daahakarma
Commonly used medicines
Maharasnadi kashayam
Sahacharadi kashayam
Rasnerandadi kashayam
Yogarajaguggulu
Balaatailam
Nimbamruthadi Erandam
Sahacharadi Tailam
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Medical professionals suggest the following to ease pain & other disturbances in the legs:
- Stop the activity that caused the pain.
- Stretch and massage the muscle.
- Hold the leg in the stretched position until the pain is relieved.
- Apply heat to muscles that are tight or tense.
- Use cold packs on tender muscles.
Diet
- To be avoided
Drink enough liquids. Ensure enough hydration.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
A randomized, double-blind, placebo-controlled trial of pregabalin in patients with sciatica was conducted in 209 patients. In this study, treatment with pregabalin did not significantly reduce the intensity of leg pain associated with sciatica and did not significantly improve other outcomes, as compared with placebo, over the course of 8 weeks. The incidence of adverse events was significantly higher in the pregabalin group.
DOI: 10.1001/jamaneurol.2018.3077
A preplanned interim analysis of a randomized, double-blind, double-dummy crossover trial of PGB vs GBP for management of CS at half the estimated final sample size was performed in a single-center, tertiary referral public hospital. A total of 20 patients were chosen for study. Pregabalin and gabapentin were both significantly efficacious. However, GBP was superior with fewer and less severe adverse events. Gabapentin should be commenced before PGB to permit optimal crossover of medicines.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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