Lumbosciatalgia arises as a result of a compression or irritation of the sciatic nerve (or sciatic nerve). This important nervous structure originates between the lumbar area and the sacral area of the spine, crosses the buttock and runs throughout the lower limb. up to the foot.
This explains why the pain that characterizes lumbosciatalgia has the location and irradiation referred to above.
An accurate diagnosis of lumbosciatalgia always begins with the "physical examination and" the medical history.
Treatment depends on the severity of the symptoms and the underlying causes.
Lumbosciatalgia is also known as sciatica or lumbar sciatica.
By sciatica or sciatica, doctors mean a painful sensation that radiates along the entire sciatic nerve, from its roots to its extremities.
BRIEF ANATOMICAL RECALL OF THE SCIATIC NERVE
The sciatic nerve, or ischial nerve, is the largest and longest nerve in the human body.
It begins in the lower back and runs through the entire lower limb, ending at the foot.
Belonging to the category of mixed nerves, it is a derivation of the last two lumbar spinal nerves (L4 and L5) and of the first three sacral nerves (S1, S2 and S3): these nervous structures unite to form the sciatic nerve at approximately the same level of the piriformis and gluteus muscle.
From the piriformis muscle and the gluteus, the ischial nerve descends along the back of the thigh and, after passing the knee, branches into various branches.
The branches of the sciatic nerve are distributed between the back of the leg, the front of the leg, the back of the foot, and the sole of the foot.
MEANING OF THE WORD LUMBOSCIATALGIA
The word lumbosciatalgia recalls all the main characteristics of the condition to which it refers.
In fact, "-algia" in medicine means "pain"; "-sciat-" refers to the involvement of the sciatic nerve; finally, "lumbo-" refers to the involvement of the lumbar area of the back.
Typically, the piriformis muscle causes compression / irritation of the sciatic nerve after suffering a trauma or contracture.
RISK FACTORS AND EPIDEMIOLOGY
According to experts, the risk factors for sciatica are:
- Advanced age. The aging of the human body involves a change in the shape of the spinal column. In some situations, this change is so profound that the spine could develop a "herniated disc."
- Obesity. Excessive body weight can be excessive stress on the spine, which can change its own anatomy and that of the connected spinal nerves.
- Work activities during which it is common to lift weights or twist the back. The researchers noted that those who carry out this type of work are particularly prone to sciatica, lumbosciatalgia in particular.
It is necessary, however, to specify that, for the moment, no scientific evidence has shown the existence of a consequential link between the aforementioned work activities and the appearance of lumbosciatalgia. - The sedentary lifestyle. Statistical incidence studies have shown that those who lead a sedentary lifestyle tend to develop lumbosciatica more frequently than those who lead an active life.
- Diabetes. This metabolic disease can have a variety of complications, including so-called diabetic neuropathy. Diabetic neuropathy is a form of peripheral neuropathy, in which a deterioration of the peripheral nerves takes place (N.B: the sciatic nerve is a peripheral nerve).
To learn more about "diabetes complications", readers can click here. - Arthritis.
- Pathologies of the spine.
- Trauma to the buttocks or thighs.
Typically, lumbosciatica is unilateral. This means that the pain affects only one side of the body (for example, right lower back, right buttock and right lower limb).
In a generic case of lumbosciatalgia, the pain along the anatomical area covered by the sciatic nerve starts from the lumbar area of the back (root of the sciatic nerve) and can radiate along the entire lower limb, up to the foot.
OTHER SYMPTOMS
In addition to pain, lumbosciatica can cause a strange tingling sensation, numbness (like an "altered sensation), and muscle weakness on the side of the body.
It is quite infrequent that the aforementioned pain and symptoms (when present) all localize in the same spot: usually, in fact, patients feel pain in one spot, tingling in another, muscle weakness in yet another, etc.
WHEN TO SEE THE DOCTOR?
Lumbosciatalgia deserves a doctor's attention when:
- Symptoms, instead of improving, tend to get worse.
- The patient experienced a sudden worsening of symptoms, with a sharp worsening of back pain, tingling and / or a sense of muscle weakness.
- The patient developed symptoms after a violent impact, for example after a car accident.
- The patient has poor control of bowel and bladder functions.
COMPLICATIONS
Lumbosciatalgia can give rise to complications if its origin is a serious alteration / lesion of the sciatic nerve.
In such circumstances, complications can consist of:
- Inability to walk
- Total loss of sensation in the affected leg
- Severe weakness in the affected leg
- Loss of control of bowel and / or bladder functions
The use of diagnostic instrumental procedures occurs only in the presence of severe pain or when the data collected during the physical examination and the anamnesis suggest serious triggering conditions (severe herniated disc, spinal tumor, etc.).
INSTRUMENTAL EXAMINATIONS: WHAT ARE THEY?
The instrumental tests that help diagnose the causes of a low back pain are:
- X-rays of the spine
- Nuclear magnetic resonance imaging (MRI) of the spine
- CT scan (or Computed Axial Tomography) of the spine
- Electromyography, for the evaluation of nerve impulses along the sciatic nerve
- Anti-inflammatories of the NSAID type (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen.
- Muscle relaxants, such as Muscoril for example.
- Tricyclic antidepressants or, alternatively, anticonvulsants. Usually indicated for other purposes (respectively, depression and epilepsy), these medicines have also been shown to be effective on peripheral neuropathy pain (or neuropathic pain)
- Intravenous corticosteroids. They are very powerful anti-inflammatories, which doctors prefer to use only in extreme cases, due to their severe side effects.
PHYSIOTHERAPY
Physiotherapy treatment for lumbosciatalgia consists of a rehabilitation program, which helps the patient to improve their posture, strengthen the back muscles and increase trunk flexibility.
SURGICAL INTERVENTION
Surgery is reserved for the most severe cases of lumbosciatica which do not improve with the above treatments.
The surgical procedure is very delicate - for this reason doctors use it only as a last resort - and it consists in freeing the nerve from what causes compression or irritation.
The causes that most frequently require surgery are spinal disc herniation and changes in the lumbo-sacral tract of the spine.
HOMEMADE TIPS AND REMEDIES
Lumbosciatalgia experts recommend taking a short rest period from heavy or sporting activities, but not to overdo it, because long-term physical inactivity often leads to worsening of symptoms.
In addition, they find particularly useful:
- The application of cold compresses, alternating with hot compresses, at the level of the painful area or areas.
- L "daily muscle stretching, ie the so-called stretching. There are exercises for stretching the back, capable of effectively relieving the compression of the sciatic nerve.
