ABSTRACT
Ever suffered a gnawing pain called sciatica? Sciatica pain is pretty clear cut, piercing or shooting pain in the lower back, which radiates down buttocks and legs. It is more common in men than women. Homoeopathy is considered as one of the very best alternative system for treating Sciatica pain. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of this gnawing pain.
INTRODUCTION
Sciatica is not a disorder itself but is a general term used to describe the pain that occurs when nerve roots in the lumbosacral spine (low back) become compressed (pinched), irritated, or inflamed, often from a herniated disc or other narrowing of the spinal canal. Sciatica may be accompanied by numbness/tingling and muscle weakness. The sciatic nerve is the longest and thickest (almost finger-width) nerve in the body. True injury to the sciatic nerve “sciatica” is actually rare, but the term “sciatica” is commonly used to describe any pain that originates in the lower back and radiates down the leg.
AETIOLOGY
Sciatica occurs when the sciatic nerve becomes pinched, usually by herniated lumbar disc, Lumbar spinal stenosis, Lumbar degenerative disc disease, general degenerative changes in vertebrae or discs, Spondylolisthesis, Muscle spasm and/or inflammation of the lumbar and/or pelvic muscles, Sacroiliac joint dysfunction
Rarely, tumors, blood clots, or other conditions in the lower spine may cause sciatica.
RISK FACTORS
Risk factors for sciatica include:
· Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
· Obesity. By increasing the stress on spine, excess body weight can contribute to the spinal changes that trigger sciatica.
· Occupation. A job that requires to twist back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there's no conclusive evidence of this link.
· Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
· Diabetes. This condition, which affects the way body uses blood sugar, increases risk of nerve damage.
· Smoking, Mental health issues, such as depression, Tall height in older age groups (50 to 60 years), Vitamin B 12 deficiency
CLINICAL MANIFESTATIONS
The symptoms of sciatica are commonly felt along the path of the large sciatic nerve. Sciatica is often characterized by one or more of the following features:
· Pain. Sciatica pain is typically felt like a constant burning sensation or a shooting pain starting in the lower back or buttock and radiating down the front or back of the thigh and leg and/or feet.
· Numbness. Sciatica pain may be accompanied by numbness in the back of the leg. Sometimes, tingling and/or weakness may also be present.
· One-sided symptoms. Sciatica typically affects one leg. The condition often results in a feeling of heaviness in the affected leg. Rarely, both legs may be affected together.
· Posture induced symptoms. Sciatica symptoms may feel worse while sitting, trying to stand up, bending the spine forward, twisting the spine, lying down, and/or while coughing. The symptoms may be relieved by walking or applying a heat pack over the rear pelvic region.
Certain symptoms of sciatica may indicate a serious medical condition, such as cauda equina syndrome, infection, or spinal tumors. These symptoms may include, but are not limited to: Progressive neurological symptoms, such as leg weakness, Symptoms in both legs, Bowel and/or bladder dysfunction, Sexual dysfunction
Types of Sciatica
Depending on the duration of symptoms and if one or both legs are affected, sciatica can be of different types:
Acute sciatica. Acute sciatica is a recent onset, 4 to 8-week duration of sciatic nerve pain. The pain may be self-managed and may not typically require medical treatment
Chronic sciatica. Chronic sciatica is persistent sciatic nerve pain that lasts for more than 8 weeks and usually does not subside with self-management. Depending on the cause, chronic sciatica may require nonsurgical or surgical treatment.
Alternating sciatica. Alternating sciatica is sciatic nerve pain that affects both legs alternately. This type of sciatica is rare and may result from degenerative problems in the sacroiliac joint
Bilateral sciatica. Bilateral sciatica occurs in both legs together. This type of sciatica is rare and may occur due to degenerative changes in the vertebrae and/or the disc at several spinal levels, or from serious conditions such as cauda equina syndrome.
DIAGNOSIS
A diagnosis of the underlying cause of sciatica is essential in formulating an effective treatment plan and managing sciatica pain.
Physical Examination and Medical History - The goal of conducting a physical exam and review of medical history is to identify the pain pattern in the patient’s leg.
Straight leg raise (SLR) test. This test includes the patient lying on his/her back and lifting one leg at a time with the other leg flat or bent at the knee. A pain encountered while lifting the affected leg usually indicates sciatica.
Slump test. This test includes the patient seated upright with hands behind the back. The patient bends (slumps) forward at the hip. The neck is bent down with the chin touching the chest and one knee is extended to a degree possible. If pain occurs in this position, sciatica may be present.
Medical imaging tests like Magnetic resonance imaging (MRI) & Discogram helps in diagnosing underlying cause
GENERAL MANAGEMENT
Sciatica treatment may include both nonsurgical and surgical methods. Typically, nonsurgical methods are tried first. Surgery may be indicated when the underlying cause is severe and/or progressive neurological deficits such as leg weakness occurs.
Massage Therapy
Certain forms of massage therapy, such as deep tissue massage, may have benefits for pain relief. The benefits of massage therapy include:
· Improving blood circulation, which in turn creates a better healing response in the body
· Relaxing tight muscles, which may be contributing to the pain
· Releasing endorphins, which are hormones in the body that function as natural pain relievers
Physical Therapy
The goals of physical therapy and exercises for sciatica include:
· Strengthen the spine and muscles of the lower back, abdomen, buttocks, and hip.
· Increase core strength
· Stretch tight and inflexible muscles, such as hamstrings
· Encourage the exchange of fluids and nutrients in the body by light aerobic exercises such as walking, swimming, or pool therapy
Hot and cold compresses
· A hot pack on your lower back and spine area can help to relax the tense muscles and improves the circulation. Either use a steamed towel or simply sit in a tub of warm water for 15-20 minutes. Do this twice a day and will be able to feel the pain ease away sooner than normal.
· Ice packs on the affected area for 10-15 minutes helps in decreasing the swelling around the nerve and also numbs the pain.
Chiropractic care
The core of chiropractic care are spinal adjustments. Manipulation of the spine frees restricted movement and helps to restore misaligned vertebral bodies to their proper position in the spinal column. Spinal manipulations help to calm the agitated and inflamed nerves, and in turn relax the muscle spasm. Ideally, spinal manipulations are not painful and are definitely effective.
YOGA
Yoga can help strengthen and stabilize core muscles, increase flexibility in hip and spine, and reduce lower back pain and sciatica
While yoga can be complex and difficult to perform, here are some easy and effective yoga stretches that can do at home using a yoga mat or a thick towel.
· Half Moon Pose (Ardha Chandrasana)
· Knees-to-Chest Pose/Wind-Relieving Pose (Pawanmuktasana)
· Reclined Pigeon Pose (Supta Kapotasana)
· Bridge Pose (Setu Bandha Sarvangasana)
· Legs-Up-the-Wall pose (Viparita Karani)
HOMOEOPATHIC MANAGEMENT
Homeopathy is an effective option to treat sciatica. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. Homoeopathy medicines are effective in treating. It is true that this method takes a longer time, but it is also the best one because not only the haemorroids are cured but also the patient.
Indicated Remedies | Indications |
Aesculus | Pain in the very low back (the sacral or sacroiliac areas) that feels worse when standing up from a sitting position, and worse from stooping, may be eased with this remedy. Aesculus is especially indicated for people with low back pain who also have a tendency toward venous congestion and hemorrhoids. |
Arnica montana | This remedy relieves lower back aches and stiffness from overexertion or minor trauma. |
Bryonia | This remedy is indicated when back pain is worse from even the slightest motion. Changing position, coughing, turning, or walking may bring on sharp, excruciating pain. This remedy can be helpful for back pain after injury and backaches during illness. |
Calcarea carbonica | This is often useful for low back pain and muscle weakness, especially in a person who is chilly, flabby or overweight, and easily tired by exertion. Chronic low back pain and muscle weakness may lead to inflammation and soreness that are aggravated by dampness and cold. |
Calcarea phosphorica | Stiffness and soreness of the spinal muscles and joints, especially in the neck and upper back, may be relieved by this remedy. The person feels worse from drafts and cold, as well as from exertion. Aching in the bones and feelings of weariness and dissatisfaction are often seen in people who need this remedy. |
Natrum muriaticum | Back pain that improves from lying on something hard or pressing a hard object (such as a block or book) against the painful area suggests a need for this remedy. The person often seems reserved or formal, but has strong emotions that are kept from others. Back pain from suppressed emotions, especially hurt or anger, may respond to Natrum muriaticum. |
Nux vomica | This remedy is indicated for muscle cramps or constricting pains in the back. Discomfort is made worse by cold and relieved by warmth. Pain usually is worse night, and the person may have to sit up in bed to turn over. Backache is also worse during constipation, and the pain is aggravated when the person feels the urge to move the bowels. |
Rhus toxicodendron | This remedy can be useful for pain in the neck and shoulders as well as the lower back, when the pain is worse on initial movement and improves with continued motion. Even though in pain, the person finds it hard to lie down or stay still for very long, and often restlessly paces about. Aching and stiffness are aggravated in cold damp weather and relieved by warm applications, baths or showers, and massage. |
Sulphur | This remedy is often indicated when a person with back pain has a slouching posture. The back is weak and the person feels much worse from standing up for any length of time. Pain is also worse from stooping. Warmth may aggravate the pain and inflammation |
Hypericum perforatum | This homeopathic remedy relieves lower back pain with sharp throbbing pain.
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Ruta graveolens | This is used to relieve lower back pain caused or worsened by staying immobile. |
Cimicifuga | Severe aching and stiffness in the upper back and neck, as well as the lower back—with pains that extend down the thighs or across the hips — may be eased with this remedy. It is often helpful for back pain during menstrual periods, with cramping, heaviness, and soreness. A person who needs this remedy typically is talkative and energetic, becoming agitated or depressed when ill. |
CONCLUSION
Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. It is true that this method takes a longer time, but it is also the best one because not only the haemorroids are cured but also the patient.
Deep-acting medicines are required to treat the constitution and bring about lasting relief.
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