Physiotherapy management of sciatica.............................................. Sciatica:It is a set of symtoms including pain that may be caused by ganeral compression and irritation of one of five spinal nerve roots that give rise to each sciatica nerve or irritation of the left or both or both sciatica nerve.The pain is felt in the lower back,buttock and various parts of the foot.In addition to pain,which is some times sever there may be numbness,muscular weakness,pins and needls or tingling and difficulty in moving or controlling the leg. Or, The term sciatica describes a symptom rather than a specific disease. Some use it to mean any pain starting in the lower back and going down the leg. Others use the term more specifically to mean a nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. Pain typically occurs in the distribution of a dermatome and goes below the knee to the foot. It may be associated with neurological dysfunction, such as weakness. The pain is characteristically of shooting type, quickly traveling along the course of the nerve. Causes: Pressure on the sciatic nerve from a herniated disc usually causes sciatica. Otherwise joint inflammation, compression of the nerve from bony arthritic growths or a locked facet joint in the lower spine can commonly cause sciatica. Leg pain can have various sources. Pain can be a local leg injury or it may even be referred from your lower back and travel along the sciatic nerve. The main nerve that travels from your lower back to your leg is your sciatic nerve. Injury that irritates or pinching of your sciatic nerve can cause severe leg pain known as sciatica. Youre most likely to get sciatica when youre 30 to 50 years old. It may happen due to the effects of general wear and tear, plus any sudden pressure on the discs that cushion the vertebrae of your lower (lumbar) spine. While there are numerous causes of sciatica, the most common are: • lumbar bulging disc • spine degeneration • facet joint injuries Other sources include: • piriformis syndrome • spinal stenosis • spondylolisthesis • sacroiliac dysfunction Youre most likely to get sciatica when youre 30 to 50 years old. It may happen due to the effects of general spine wear and tear (spondylosis) or a traumatic injury that sudden pressure on the lumbar discs eg lifting, bending or sneezing. Clinical features: [A]Symptoms: a) Pain is felt in lower back,buttock and various parts of the leg and foot. b) Numbness and there may be weakness of the lower leg muscle. [B]Physical signs: a) Physical examination of sciatica patients should include observation,palpation, determination of the range of motion of the spine. b) The straight leg raising. c) Walk on toes. d) Bend forwards and back wards. e) Rotate your spine. f) Sit down and stand up. g) Lie down on back and rise one leg at a time. Comformity tests: a) MR neurography. b) MRI. c) CT scane. d) X-ray. Pathophysiology: Sciatica is generally caused by the compression of lumbar nerves L3, L4, or L5 or sacral nerves S1, S2, or S3, or by compression of the sciatic nerve itself. When sciatica is caused by compression of a dorsal nerve root (radix), it is considered a lumbar radiculopathy (or radiculitis when accompanied with an inflammatory response). This can occur as a result of a spinal disk bulge or spinal disc herniation (a herniated intervertebral disc), or from roughening, enlarging, or misalignment (spondylolisthesis) of the vertebrae, or as a result of degenerated discs that can reduce the diameter of the lateral foramen (natural hole) through which nerve roots exit the spine. The intervertebral discs consist of an annulus fibrosus, which forms a ring surrounding the inner nucleus pulposus. When there is a tear in the annulus fibrosus, the nucleus pulposus (pulp) may extrude through the tear and press against spinal nerves within the spinal cord, cauda equina, or exiting nerve roots, causing inflammation, numbness, or excruciating pain. Inflammation in the spinal canal can also spread to adjacent facet joints and cause lower back pain and/or referred pain in the posterior thigh(s). Pseudosciatic pain can also be caused by compression of peripheral sections of the nerve, usually from soft tissue tension in the piriformis or related muscles. The spinal discs are composed of a tough spongiform ring of cartilage (annulus fibrosus) with a more malleable center (nucleus pulposus). The discs separate the vertebrae, thereby allowing room for the nerve roots to properly exit through the spaces between the vertebrae. The discs cushion the spine from compressive forces, but are weak to pressure applied during rotational movements. That is why a person who bends to one side, at a bad angle to pick something up, may more likely herniate a spinal disc than a person jumping from a ladder and landing on their feet. Herniation of a disc occurs when the liquid center of the disc bulges outwards, tearing the external ring of fibers, extrudes into the spinal canal, and compresses a nerve root against the lamina or pedicle of a vertebra, thus causing sciatica. This extruded liquid from the nucleus pulposus may cause inflammation and swelling of surrounding tissue, which may cause further compression of the nerve root in the confined space in the spinal canal. Diagnosing: Since sciatica is, itself, a symptom that can vary from condition to condition and person to person, your doctor will first want to get your full medical background. This includes whether or not you have had any recent injuries, where you feel the pain, and how the pain feels. The next step is a physical exam that will include testing your muscle strength and reflexes. Your doctor might also have you do some stretching and moving exercises to determine which ones bring about more pain. The next round of diagnosis is for individuals who have dealt with sciatica for longer than a month or have a major illness such as cancer. Nerve tests will allow your doctor to examine the way nerve impulses are being conducted by the nerve and see if there are any abnormalities. Imaging tests will allow a doctor to get a look at your spine, which will help him or her to determine the sciatica’s cause. The most common imaging tests used to diagnose sciatica and to find its cause are: • X-ray of spine: Normal X-rays will not be able to provide a view of sciatic nerve damage, but a spinal X-ray can reveal herniated disks and other nerve damage. • magnetic resonance imaging (MRI): An MRI uses a magnet and radio waves to create detailed images of your back. • computed tomography (CT) scan: A CT scan uses radiation to create detailed images of your body. Your doctor will more than likely inject a special dye into your spine (in a process called a CT myelogram) to help produce clearer pictures of your spinal cord and nerves. (Mayo Clinic, 2010) Differential diagnosis: a) Trauma causes=Traumatic peripheral neuropathy. b) Infected organ,Abscesses=Lumber disk infection. c) Neoplastic disorder. d) Foreign body,structural disorders. e) Metabolic disorders. Risk Factors for Developing Sciatica Certain behaviors or factors can make sciatica more likely. The most common factors for developing sciatica include: • age: As your body ages, it becomes more likely that parts will wear out or break down. • occupation: Certain careers place a lot of strain on your back, especially those that involve lifting heavy objects, sitting for extended periods, or twisting movement. • diabetes: This condition can increase the risk of nerve damage. • smoking: Smoking can cause the outer layer of your spinal disks to break down. Prevention: The following steps can assist you in preventing sciatica or from keeping it from reoccurring: • Exercise often. Strengthening your back muscles and your stomach or core muscles is the key to maintaining a healthy back. • Mind your posture. Make sure your chairs offer proper support for your back. You should be able to place your feet on the floor, and make sure to use your armrests. • Mind how you move. Take care of yourself. Lift heavy objects the proper way by bending at the knees and keeping your back straight. Complication: a) Complete loss of leg movement. b) Complete loss of sensation in the leg. c) Unnoticed injury to the leg. Physiotherapy management: [A]Aims of treatment: a) To relive pain. b) To improve muscule power. c) To increase ROM. d) To prevent ankle and foot contracture. e) To prevent edema. f) To correction of gait. g) Teach the care of gait. h) Teach the postural awareness. [B]Means of treatment: a) Relive pain by: • Rest. • Analgesic. • TENS. • Interrupted galvanic stimulation over the affected muscle. b) Maintain muscle power by: • Full range passive movement. c) Maintain ROM by: • Free active exercise. • Resisted exercise. d) Prevent contracture by: • Stretching for back extensor,hamstring and calve. • Night splint. e) Correction of gait: • Gait re-eudcation exercise. f) Postural re-education. g) Advice to back care during lifting,sitting,driving etc. Common Sciatica Treatment Techniques • Bed Rest • Early Injury Treatment • Avoid the HARM Factors • What to do after a Muscle Strain or Ligament Sprain • Acupuncture and Dry Needling • What is Sub-Acute Soft Tissue Injury Treatment? • Core Exercises • Closed Kinetic Chain Exercises • Active Foot Posture Correction Exercises • Gait Re-Education • Biomechanical Analysis • Balance Enhancement Exercises • Proprioception & Balance Exercises • Medications? • Glucosamine • Orthotics • Real-Time Ultrasound Physiotherapy • Soft Tissue Massage • Brace or Support • Electrotherapy & Local Modalities • Heating Pads • Joint Pain Relief Techniques • Kinesiology Taping • Neurodynamics / Neuro Mobilisation • Physiotherapy Instrument Mobilisation (PIM) • Prehabilitation • Strength Exercises • Stretching Exercises • Supportive Taping & Strapping • TENS Machines • Yoga
Posted on: Sun, 02 Feb 2014 03:03:36 +0000
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