Published in Panorama
Have you been experiencing sudden pain in your lower back or hip which is radiating down from your bottom to the back of the thigh and into your leg? Then most likely you are suffering from sciatica, says Dr.Jamil Ahmed, Jumeirah Prime Medical Centre, Dubai.
What exactly is sciatica and who are the people prone to it? Dr.Jamil explains, “This pain which originates in your lower back or hip, in most instances, is because of a protruding disc in the lower spinal column pressing on the roots of the sciatic nerve. The condition is more common in younger age groups, in people between the ages of 20 – 30 and is commoner in males than females. The onset of sciatica in most instances is because of disc protrusion which is again commonest in this age group because of the nature of their jobs or work environment. Their disc is put under a lot of pressure as a result of the naturally higher degree of tension in this age group of people. The disc is like a ring with circular fibres all around and a gel-like substance at its centre. When this disc is loaded or off-loaded in unnatural positions, then the disc fibres give way and there’s a protrusion or prolapse which is coming out and pressing on the sciatic nerve. This gives rise to the typical pain associated with the condition. As we age, the fluid within the disc dissolves and the disc becomes more degenerate and such a disc is not easy to prolapse. Hence the problem is more common in younger ages of people, with the incidence being pretty low in older people.”
Does this imply that sciatica is very often associated with bad posture? To a large extent it is so, says Dr.Ahmed. “For instance, if someone is bending down to pick up something, even if the object is not too heavy, if the individual is not bending his knees in the process, he is stressing the disc, making it vulnerable for a protrusion later on. This condition may be common among labourers and constructions workers who, when they are lifting various heavy objects, bend the wrong way. If they are not educated on how to protect their backs, they’ll certainly end up with a disc protrusion. If it is pressing on the nerve root, they would get sciatica.”
A burning kind of pain coming down at the back of the thigh and leg from the lower back is a typical and commonest sciatica symptom. “But if the extent of the pressure goes on to the next level, above the minimum then the individuals can experience areas of numbness in the areas where the nerve is distributed. This could be either on the foot or top of the foot or sole of the foot. If the pressure is even more severe, it could also involve weakness, either in the big toe, or when bending the foot downwards,” explains Dr.Ahmed.
Can sciatica be classified as acute and chronic? Sciatica, when it happens, is acute, responds Dr.Ahmed. However, individuals can have chronic disc protrusions wherein they have symptoms of pain on and off. But if the individuals are engaged in a lot of activity and the nerve is coming close to the protruded disc, then they will have symptoms. Once the persons take sufficient rest and precautions, the swelling on the nerve reduces and the nerve moves away from the disc, leading to the symptoms subsiding. But in most instances, when the pain is there, it is severe, reveals Dr.Ahmed.
What about sports people suffering from sciatica pain? “In fact, sports people generally do not suffer from the condition because their body is better tuned and they have better back muscle structure because they take care of it as a part of their routine exercise regimen. Sciatica is common among the normal population that is not into sporting activities,” says Dr.Ahmed.
How is sciatica diagnosed? First and foremost step in the line of diagnosis is taking history of onset of pain itself and the associated symptoms. In most instances, you will have an episode of back pain after major lifting or bending down, which would have triggered it. Secondly, we reproduce on the examination table in the cline, the symptoms of sciatica, by lifting up and stretching out the affected leg. If the typical pains appear, it is a positive sign of sciatica. Also, we check for the neurological signs to see if there is any weakness in the reflexes, in the muscle power, or if there is an area of sensory loss. There are the clinical steps of evaluation, explains Dr.Ahmed.
MRI investigations are in order to see the disc. Chronic disc can be made out on a plain X Ray by reduced disc space. But if the disc protrusion has to be identified and the degree of protrusion and pressure on the nerve root have to be made out, MRI is a must. This would confirm the level and extent of pressure on the nerve root, says Dr.Ahmed.
How is sciatica treated? Dr.Ahmed lists the steps in treatment of the condition:
• If it is the first episode, then absolute bed rest is advised for about 3 days.
• The patient is put on anti-inflammatory medication, muscle-relaxants, vitamin B complex to help regenerate the damaged nerves.
• Once the symptoms reduce, though they continue to be there, we advise physiotherapy which would involve traction, mainly to ease the pressure on the nerve. This would be the second stage of management of the problem.
• If the symptoms resolve with this, the patients would be taught back exercises to make sure the symptoms don’t come back again.
Is surgery indicated at any point of time? Dr.Ahmed responds, “If the pain is not responding to the conservative management, is not allowing the patient to carry on his daily activities or if during the course of the conservative management, he develops neurological symptoms like numbness, weakness or bladder symptoms, then we go in for surgery.”
As with any surgical procedure, risks include those from anesthesia and infection. “Specific risks are that we are working in a very close area, close to the nerves where we are trying to remove the disc. So there is an element of risk involving nerve damage. But in competent hands, this risk is practically not there.
What can untreated sciatica lead to? If protrusion is there, there is a progression of the condition from pain to numbness and weakness. But it cannot lead to any complete paralysis of a limb, emphasizes Dr.Ahmed. The most troublesome problem is the severity of pain itself.
Can sciatica be prevented? Dr.Ahmed is positive on this issue and enumerates certain preventive measures.
• Proper back education and back care.
• Be aware of what actually constitutes the back.
• Maintain the right posture at work, in the car, at home, particularly when lifting objects.
• The mattress on which you sleep should be firm; it need not be hard, though.
• Sitting upright, back supported, knees and ankle bent at 90 degrees, foot resting on the floor and the computer should be placed at eye level.
• Don’t reach out right or left for things kept further away from your working area.
• Don’t bend down to pick up files, etc from the file racks, without bending your knees.
• While driving, people have a tendency to lean too far back or too far ahead. Here again it is important to maintain the 90 degree posture.