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Sciatica

Sciatica is a condition in which symptoms of radiating pain are present in one leg, with or without associated neurological impairments on examination. Lumbar disk herniations are the frequent or persistent cause of sciatica in about 70 to 90% of people.

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Sciatica

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  1. Sciatica : Pathophysiology, Examination, Treatment

  2. Introduction Sciatica is a condition in which symptoms of radiating pain are present in one leg, with or without associated neurological impairments on examination. Lumbar disk herniations are the frequent or persistent cause of sciatica in about 70 to 90% of people. Symptoms are usually self-limiting and generally disappear within three months.

  3. Pathophysiology of  Sciatica One can feel the symptoms of sciatica along the course of the sciatic nerve. Sciatic nerve branches from your lower back through your buttocks & hips and runs down the leg. The neurovascular bundles may be subjected to a toxic biochemical environment or mechanical irritation at many different points. Prolonged irritation may result in a decrement of intraneural blood flow. This, in turn, causes local hypoxia in peripheral nerves leading to a decrease in the pH of tissues. This stimulates the release of inflammatory mediators, called “inflammatory soup”. The toxic substance may contribute to the ongoing nociception without causing any visible nerve damage. The application of neural mobilization and specific soft tissue treatment may help decrease sciatic nerve stiffness and also help in decreasing intraneural pressure and/or edema by mobilizing the neural tubes.

  4. Examination for Sciatica An in-depth health history intake can be conducted to collect information regarding the patient’s course of pain, limitations, the prognostic factors for delayed recovery (e.g., fear of movement, inadequate coping strategies, low self-efficacy, fear-avoidance). Perform a physical exam for evaluating muscle strength and mobility. Screen patients to pick out those who are at greater risk of developing the severe condition and/or red flags.

  5. Red flags for serious spinal pathology Red flags are signs & symptoms that gives indication of more serious underlying pathology.for patients suffering from low back pain. There are many serious spinal pathologies that one should be aware of. These are spinal malignancy, spinal fractures, spinal infection & cauda-equina syndrome (0.08 percent of the patients suffering from low back pain presenting to primary care are because of cauda-equina syndrome).

  6. Outcome Measurements Include one or more of the following outcome results when evaluating and monitoring the patient's progress: • Roland-Morris Disability Questionnaire • LEF - Lower Extremity Functional Scale • Patients Specific Functional Scale • Self-Rated Recovery Question • OswestryDisability Index • VAS - Visual Analog Scale • BPI - The Brief Pain Inventory

  7. Physical examination tools used for Sciatica You can perform one or more of the following physical examinations tests and you can interpret results of these physical examinations tests in the context of all clinical exam findings. • McBurney’s Point - For Rebound Tenderness • Piriformis Test • FAIR Test • Kemp’s Test (Lower Quadrant Test) • Kernig or Brudzinski Test • Well Leg Raise • Bowstring Maneuver • Slump Test • Prone Knee Bend Test • Valsalva Maneuver • Straight Leg Raise Test

  8. Treatment for Sciatica Education Educate the patient & offer reassurance regarding the condition and the treatment options & encourage the use of active approaches like physical activity to help manage the symptoms.

  9. Manual Therapy The treatment plan should be developed based on patient-evaluation findings & patient tolerance. The structures to be kept in mind when evaluating & treating sciatica patients could include neurovascular structures & the investing fascia of the following structures: • Piriformis, gemellus superior, externus and internusobturators, gemellus inferior, and quadratusfemoris - External Rotators of The Hip • QuadratusLumborum • Multifidus & Erector Spinae (spinalis, iliocostalis, longissimus) • LatissimusDorsi and Thoracolumbar fascia • Biceps femoris, semitendinosus, and semimembranosus - Hamstring Muscle Group • Gluteus maximus, gluteus medius, gluteus minimus, and tensor fasciae latae - Gluteal Muscles

  10. Self-Management Strategies Massage therapists offer hands-on therapy and can also create self-management programs that assist patients in managing their symptoms. Simple home-care suggestions like stretching & hydrotherapy may be helpful for patients suffering from sciatica.

  11. Prognosis The majority of patients improve over time by conservative treatment, including pain management, manual therapy, and exercise.

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