Pain, feature, radiates the buttock to the foot. True sciatica is usually caused by a herniated disc compressing the sciatic nerve. How to overcome? Should we operate? Are infiltrations effective?Contents of this article
- Why sciatica-is also wrong?
- Which treatments for sciatica?
- Are the manual therapies recommended in case of sciatica?
It is common to have pain in the buttock or thigh. And this is often related to back pain. But the real sciatica, which corresponds to compression of the nerve, is rare. It requires a specific treatment.
There is compression of the sciatic nerve
The attack of sciatica is caused by compression of the sciatic nerve roots, between the fourth and fifth lumbar vertebrae, between the fifth lumbar and first sacral vertebrae.
Most of the time, this is a herniated disc that causes it. Compressing the sciatic nerve can also be due to osteoarthritis or a tumor.
What is a herniated disc?
Originally a herniated disc, a problem with the intervertebral disc, which serves as a shock absorber between two vertebrae. This disc consists of an annulus and a nucleus containing a kind of gelatin.
When this ring crack as a result of microtrauma, sometimes the nucleus escapes through the tear. It thus forms a ball, which compresses one of the roots of the sciatic nerve. It is his ignition that hurts. Hernia, meanwhile, eventually dehydrate and regress.
The hernia is very common and often goes unnoticed. "30% of the population has a hernia, without any symptoms, says Dr. Serge Poiraudeau, head of the rehabilitation department-rehabilitation of the musculoskeletal system of the Cochin Hospital in Paris. Some become painful without anyone ever knowing why. "
Sciatica causes a sharp pain that starts in the lower back to irradiate the entire leg. The pain is due to inflammation around the nerve root.
Its intensity is independent of the volume of the hernia. It follows a very characteristic way since it starts in the buttock and down along the thigh and calf to the foot.
Loss of tone in the leg is a warning sign
"If the compression is between the L4 and L5 vertebrae, the pain goes to the big toe. If it is in L5-S1, she went to the outer edge of the foot, "said Dr. Jean-Yves Maigne, responsible for the functional rehabilitation unit at Hotel Dieu Hospital in Paris.
In rare cases, the pain is accompanied by loss of tone in the leg and in the foot that can be a harbinger of paralysis. This is a medical emergency that requires surgery.
Should we make a radio?
If pain persists for more than two or three weeks, scanner or MRI will check for a herniated disc.
"The imagery can help especially if the doctor provides therapy infiltration, or if considering surgery," says Dr. Maigne.
When you have an attack of sciatica, the first thing to do is to spare. Avoid all movement that awaken the pain: do not lean forward too much, do not carry heavy loads, dispense cleaning for a while, no sports ...
This is to rest his back without bedridden. "Neurological pains are accentuated by fatigue and increased by physical activity," says Professor Bernard Fouquet, Head of Physical Medicine and Rehabilitation of the University Hospital of Tours.
The anti-inflammatory drugs may provide some relief. "Indeed, it is the inflammatory component that is the problem more than the compression of the nerve that is not necessarily embarrassing," says Dr. Fouquet.
When the pain is unbearable, the doctor must sometimes prescribe morphine.
Read also: Back pain, pain which solution to choose?
Resort to infiltration
If nothing works after two or three weeks, we can consider cortisone injections around the sciatic nerve to reduce inflammation.
"The efficiency of infiltration is discussed. The injection is given as close to the compression zone. The main risk is that of infection, but it is very weak, "said Dr. Jean-Yves Maigne.
Wearing a corset
Immobilize the spine for six weeks could promote faster healing. But, again, efficiency is not proven.
Should there be an operation of the herniated disc?
Most herniated regress spontaneously, but 4 to 5% of them must be carried out. It is envisaged intervention when, having tried everything, the patient is still not relieved. The surgeon removes using a curette all core fragments that compress the nerve.
Read also: When to operate a herniated disc?
What risk of recurrence?
Since it is not clear what triggers the inflammation of the nerve, it is difficult to measure the risk of recurrence.
Morality, we must continue to lead his life trying to strengthen his back, through physical activity.
Chiropractic and osteopathy are not indicated in the attack of sciatica. In reality, especially we risk failure. "You can try, but spinal manipulation walk in bad sciatica, presumably because they have no action on the nerve irritation" says Dr. Jean-Yves Maigne.
Can we envisage physio sessions against sciatica?
Massage can relieve sciatica during the crisis, but the physiotherapist will not cure. "The pain prevents the patient's active management," says Yvan Aubier, physiotherapist Active Health program of the primary health insurance fund of the Sarthe.
However, the physiotherapist will be very useful in a second step in prevention of recurrence: "The treatment will be based on flexibility exercises, stretching, muscle strengthening and awareness of the mobility of the pelvis" Yvan Aubier accurate.
An exercise for pain
Yvan Aubier offers this stretching exercise to relieve pain.
Read also: What treatment against sciatica?