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Why did the diagnosis of “sciatica” disappear from the terminology of physicians, the symptoms of which are so colorfully and vividly described by patients who go to the doctor? So, let’s start with the fact that the name “sciatica” comes from the Greek term “radix” – the nerve root. The ending “itis” describes the inflammatory process.
Even 50-70 years ago, doctors believed that pain in the neck, lower back, or other parts of the back was associated with inflammation of the nerve roots extending from the spinal cord. Therefore, the treatment consisted of taking antibiotics in combination with anti-inflammatory therapy. But as the problem was studied, it turned out that the inflammatory process for the roots during the development of back pain is not typical, and all painful and unpleasant sensations are associated with irritation, compression of nerve fibers. Therefore, today the term has been replaced by a more correct one – radiculopathy (or in other words – radicular syndrome). Of course, if the patient complains of “sciatica”, the doctor will understand what it is about, but he will write a completely different diagnosis on the card.
And one more thing: not every back pain is associated with radicular syndrome, other tissues can be the cause – muscles, bones, joints, etc. In this case, we are talking about dorsopathies. This is a group of diseases, the basis of which is degenerative-dystrophic changes in the spine itself and its surrounding structures (soft tissues).
For ease of understanding in the text, we will sometimes use the term “sciatica” to describe changes in tissues.
Causes of sciatica
Radiculopathy is not a disease, but a neurological syndrome, a group of specific human complaints that occur when one or more roots extending from the spinal cord are irritated. The roots strictly correspond to a specific vertebra, located directly next to it. The root departs from the spinal cord in the region of a small intervertebral foramen, which is surrounded by ligaments, choroid plexuses and certain muscles. If there are changes in any of these elements (bone or soft tissue), the root may become irritated or compressed.
Accordingly, radiculopathy of one or another localization and the resulting pain syndrome are associated with the location of a particular root.
Why do symptoms of sciatica occur, what problems can provoke pain and additional complaints? There are a number of factors:
- various injuries in different parts of the back (from the neck to the sacrum);
- muscle weakness from inactivity and lack of training;
- hormonal, metabolic disorders that negatively affect bone and ligamentous elements, muscle tone;
- age-related processes associated with degeneration and dystrophy (progression of osteochondrosis);
- chronic inflammatory processes;
- various types of posture disorders (curvature, both in the form of a hump, and lateral deviations);
- complications in the field of operations on the vertebrae;
- gravity load, heavy physical labor, heavy lifting;
- congenital or acquired anomalies in the structure of the spine;
- tumor lesions in the region of the vertebrae and surrounding tissues;
- a sharp narrowing of the spinal canal and intervertebral due to the fact that the vertebrae are displaced from their usual place;
- the formation of hernias or protrusions in the area of the intervertebral discs.
The most common causes of radiculopathy are considered to be progressive changes against the background of osteochondrosis and changes in the intervertebral discs. Gradually, the discs become thinner, they lose their elasticity, if no measures are taken, they gradually begin to collapse, deform, conditions are created for the formation of hernial protrusions.
Symptoms of sciatica
Usually, the symptoms of sciatica appear as disc protrusions or hernial protrusions form. They are formed in the area of the intervertebral disc, which is most thinned in the area of the annulus fibrosus. Initially, while the ring is intact, protrusions are formed, when the fibrous membrane is ruptured, a hernia is already formed.
The protrusion can put pressure on the nerve roots that run along the sides of the spine to the right and left. Initially, only the sheaths of the nerves are irritated, but if the process is not slowed down, all the nerve roots will gradually be compressed, which leads to the so-called discogenic radiculopathy.
For radicular syndrome, two stages of development are typical, and the symptoms differ in them.
The first, or neurological stage. It is characterized by increased sensitivity of tissues in the area of the affected root, periodic sharp pain, protective muscle tension, which is why people are often forced to take an unnatural posture. With pressure on certain (paravertebral) points, pain is felt.
The second or neurotic stage. For this stage, a violation of sensitivity is typical in the area that the affected root “serves”. Protective muscle tension and pain persist (they even increase). For different types of radiculopathy, there are typical specific symptoms with which a person goes to the doctor.
The most typical symptom for all radiculopathies is pain, but it can be from mild to severe, when it is almost impossible to move your arms or legs, bend your back.
cervical radiculopathy manifested by acute pain in the morning. There is soreness of the neck, radiating to the shoulder and arm, headache, stiffness of the neck muscles and with their soreness, a feeling of numbness, chill or tingling, crawling. The skin in the affected area is dry and cold, and may peel off.
Thoracic radiculopathy characterized by pain behind the sternum, between the shoulder blades along the lower ribs, may have a girdle character. Shooting can be in the armpit or shoulder, the middle finger of the hand. There is also weakness in the shoulder muscles, especially the triceps. Often the pain resembles an attack of angina pectoris or a heart attack.
lumbosacral radiculopathy is described as severe pain in the buttocks, extending down the thigh to the foot. Lower back pain can shoot down the leg to the big toe. Against the background of pain and muscle spasm, mobility is impaired – sudden movements or tilts respond with an acute pain attack. The sensitivity on the leg on the affected side decreases, the muscles weaken.
Treatment of sciatica
When typical symptoms appear, you should not self-medicate, you can only worsen the situation. You need to see a doctor immediately.
Diagnostics
The basis of diagnosis is a detailed conversation with the patient and the clarification of all symptoms, including the most insignificant ones. Be sure to describe to the doctor the type of pain, its severity and duration, as well as all related problems – numbness, crawling, burning skin.
If necessary, the doctor prescribes an x-ray, which determines the deformation of the vertebrae and the severity of the degenerative-dystrophic process, possible displacement of the vertebral bodies.
To detect disc protrusions or hernias, an MRI of the corresponding spine section is indicated, and electromyography is performed to determine muscle tone.
Modern treatments
Treatment methods are selected individually, taking into account why, where and how it hurts, what complications and in what form, at what stage the disease is. In addition, there is a division into the treatment of acute pain syndrome and its chronic form.
We discussed treatment issues with orthopedist-traumatologist, osteopath Maxim Kolinsky, specialist of the clinic of rehabilitation treatment “Quality of Life”.
Treatment of acute pain
If the pain is relatively moderate, it is worth partially restricting movement, and with very severe pain, create complete rest for the affected area for several days.
The affected spine is fixed to limit mobility with the help of special orthoses.
Medications are shown – taking anti-inflammatory drugs, muscle relaxants, diuretics and, if necessary, a short course of corticosteroids. The doctor in the conditions of specially equipped rooms can perform blockades with anesthetic drugs. To prevent the pain from becoming permanent, chondroprotectors (drugs that restore cartilage tissue) may be recommended from this period.
As the pain recedes, after about 5 to 10 days, the treatment is supplemented with non-drug procedures. These include:
- Exercise therapy, in which the loads are selected according to the patient’s condition and exercise tolerance, are carried out systematically and regularly;
- manual therapy, which helps to eliminate blocks in the joints of the spine, muscle spasms, corrects pathological vertebral deformities, improving the general condition;
- traction therapy (or in other words, spinal traction techniques) to anesthetize the lesion, reduce muscle tone and relax them in the affected area, reduce pressure inside the discs, which eliminates compression of the nerve roots;
- physiotherapy as a complex effect for back problems;
- acupuncture to eliminate pain and muscle spasms, stimulate the work of the affected nerves by acting on biologically active points, especially in reflex syndromes (today the technique has been modified and used in the form of pharmacopuncture, with the introduction of drugs into the area of trigger points, so that the effect is maximum) ;
- hirudotherapy – the use of medicinal leeches.
Methods are selected individually, taking into account all possible contraindications, and concomitant factors that may affect the results.
Manual therapy is contraindicated in the presence of severe osteoporosis (sparse bones), spondylosis (disorders in the intervertebral discs with limited mobility); if there is abnormal mobility in the area of individual segments of the spine; there are congenital malformations of the vertebrae or the spinal cord itself.
Treatment for chronic pain syndrome
If the pain is prolonged, antidepressants can be prescribed, drugs with a muscle relaxant (muscle relaxing), sedative effect are preferred. They are combined with the same methods of non-drug treatment as in the acute period, combined at the choice of a doctor. Treatment methods are supplemented with a psychotherapeutic course and treatment in sanatoriums.
Surgical treatment is also possible, but there must be clear indications for it. Among the absolute indications – compression of the nerve roots with the formation of partial paralysis of the foot, sensory disturbances in the genital area and rectum, a disorder of the pelvic organs. Relative indications for surgery – if conservative therapy does not work for 6-12 months. It is important to understand that the treatment will not end with the operation, it is only one of the links in the long rehabilitation period. After the intervention, patients undergo a long recovery, which depends on the extent of the intervention.
Let’s analyze this on the example of a degenerative-dystrophic process with the formation of a herniated disc, which squeezed the nerve and led to radiculopathy, with all the palette of its clinical symptoms. What is our smart body doing at this moment? It:
- includes protective mechanisms, in the form of local muscle spasm, to temporarily limit mobility in the affected area;
- redistributes the load on other parts of the spine and the entire musculoskeletal system in order to unload the affected segment;
- secretes specific inflammatory enzymes that irritate pain receptors, cause pain, and thereby signal that a breakdown has occurred in the body;
- starts the processes of proliferation and regeneration, i.e. healing.
The implementation of these processes takes time, sometimes quite a long time. Everything is very individual and depends on a combination of many factors, such as age, gender, profession, the presence of concomitant diseases, lifestyle, physical fitness, etc. The success of self-healing of the body depends on this. A person in the modern world does not have time for this, and besides, pain makes him act and he goes to the doctor, and the doctor, with all confidence, responsibility and a true desire to help, begins to apply the entire arsenal of the above tools and methods. And yes, it really helps someone, especially if the person is young, physically prepared and there is enough reserve in his body.
Но часто, и пациенты не дадут мне соврать, проходит полгода и больше, но боль не уходит, многим делают операцию, возникает временное облегчение, но болезнь неизбежно переходит в хроническую форму. И человек живет с периодами ремиссий и обострений, формируется страх перед новым приступом боли, что значительно снижает качество жизни и может приводить к инвалидности.
Почему же так происходит? A потому, что не распознана и не выявлена истинная причина нарушения равновесия в теле, из-за которой произошла перегрузка позвоночно-двигательного сегмента и сформировалась грыжа, а вектор лечения направлен на работу со следствием, т.е. все лечат грыжу, а не причину ее образования, отсюда и неудовлетворительный результат. В то время как, чаще всего, настоящая причина кроется в нарушении постурального равновесия в теле, вследствие:
- dysfunctions of the stomatognotic system (congenital malocclusion, loss of chewing teeth, unsuccessful treatment and prosthetics, dysfunction of the temporomandibular joint, etc.);
- whiplash injury (accident, fall from a bicycle, snowboard, even without visible serious damage);
- malfunctions and overload of the oculomotor muscles, various visual impairments, even with incorrectly selected or broken glasses;
- consequences of damage to ligaments, fractures and dislocations;
- cicatricial adhesive changes after surgeries such as cholecystectomy, appendectomy, caesarean section, etc.
Therefore, for effective treatment, it is necessary to identify the leading problem in the complex chain of events that led to overload and decompensation in the body.
And here the leading place is occupied by osteopathy, which considers a person as a single biomechanical system, the constituent parts of which – bones, muscles, ligaments, internal organs, vessels, nerves, glands – are interdependent, they are in close interaction. This principle of building the body is very strong, this is due to the ability of our body to long-term and lasting compensation. But if the impact factor is powerful or prolonged, leads to local overloads, then the entire system suffers. Therefore, it is very important to find a key dysfunction and eliminate it, which will balance the body and restore health.
Osteopathy has much fewer contraindications and much wider possibilities, unlike manual therapy and other methods of non-drug treatment. Therefore, it can be used at all stages of treatment, starting with the most acute period and severe pain, since the osteopath has many soft techniques in his arsenal that can relieve tension and reduce inflammation without causing additional irritation and pain irritation. This allows from the first days to reduce the drug load and thereby reduce the risk of side effects from drugs, as soon as possible to start the main method of treatment – therapeutic exercises.
Профилактика радикулита в домашних условиях
The basis for the prevention of pain syndromes and exacerbations is constant, regular physical therapy and gymnastics, lifestyle changes and the elimination of all pain provocateurs.
The main role in consolidating the result, in further treatment and prevention belongs to physiotherapy exercises and, especially at the beginning of treatment, only individual lessons.