Jh Ha Guide to Sciatica

7/31/2019 Jh Ha Guide to Sciatica

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Johns Hopkins Health Alertswww.JohnsHopkinsHealthAlerts.com

Johns Hopkins Guide to Sciatica

Repor

Four out of five adults experience signifi-cant low back pain at some point in theirlives. This figure is not surprising, given the

amount of stress placed on the back throughoutthe day. The back not only supports the weight ofthe body during standing, walking, and lifting, but

it also turns, twists, and bends. These movementsare affected by the strength, flexibility, and align-ment of many body parts. As a result, seeminglysimple movementshow we habitually stand or sit,for instancecan adversely affect our backs, some-times to the point of injury.

Degenerative Changes

Normal Vertebrae

Lumbar Spinal Stenosis

Herniated Disk Vertebral Compression Fracture

Vertebral Spine(side view)

vertebra

intervertebraldisk

spinousprocess

spinal nerve emergingfrom spinal canal

bony

overgrowth

bone spurcompressingnerves inspinal canal

diskcompressingspinal nerve fracture

collapseddisk

cervicalvertebrae

thoracicvertebrae

lumbarvertebrae

sacrum

coccyx

facetarthritis

The Aging Spine


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Repor

Sciatica is a common cause of back pain,affecting approximately 40% of adultsduring their lifetime. It can occur when

lateral spinal stenosis or a herniated disk irri-tates some part of either sciatic nerve.

Each large sciatic nerve is formed by nerveroots that emerge from the lower spine, jointogether in the hip region, and run down theback of each thigh. Near the knee, the sciaticnerves branch into smaller nerves that extendinto the calves, ankles, feet, and toes.

Sciatica results from irritation of one of thenerve roots in the lower back, most often thoseemanating from the fourth lumbar vertebra

(L4), fifth lumbar vertebra (L5), or first sacralvertebra (S1). Pain or numbness developsalong the path of the sciatic nerve; the preciselocation of symptoms depends on which spinalnerve root is affected. Compression of the sci-

atic nerves can also diminish leg strength.After age 50, sciatica is more commonlycaused by spinal stenosis than disk hernia-tion. Most of the time, sciatica from a herni-ated disk resolves within six weeks with littleor no treatment. In up to 50% of cases, sciaticafrom spinal stenosis resolves by itself within amonth, but 25% may have pain for as long asfour months.


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Spinal stenosisa narrowing of the spi-nal canalis usually the result of degen-erative changes in the spine, or it may

develop as a complication of surgery, traumato the spine, or involvement of the spine inPagets disease. It typically affects people intheir 50s and 60s.

As the body ages, gradual deterioration ofthe disks and facet joints in the spine causesthe bones to rub together. This increased fric-tion may eventually lead to the formation ofovergrowths or bone spurs (called osteophytes)at the facet joints and around the rims of thevertebrae.

Spinal stenosis can occur when these over-growths of bone gradually narrow the central

canal of the spine; ligaments may thicken andcause narrowing of the spinal canal as well. Thenarrowing leads to symptoms as the spinal cordor the cauda equina becomes compressed.

Symptoms can vary, ranging from vaguenumbness and weakness in the legs while stand-ing and walking to severe pain and difficultieswith bowel and bladder control. Symptoms ofspinal stenosis usually start slowly and are mildat first. Central stenosis can cause back pain,but usually the pain radiates into both legs.The pain does not follow the distribution ofspecific nerves but rather seems to involve thebuttocks, thighs, calves, and, occasionally, theentire length of both legs.

The pain feels like cramping and may beassociated with weakness, a rubbery feeling,numbness, and a sensation of loss of power inthe legs. As a result of this weakness, peopleare prone to falls. Because the nerves control-

ling the bladder emerge from the lower spine,spinal stenosis may also cause urinary inconti-nence.


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Repor

Over the years, the demand of support-ing the bodys weight causes the outerlayer of the disk to weaken, become

thinner, and develop microscopic tears. At thesame time, the center of the disk slowly loses itswater content, so that it becomes progressivelydrier. These changes make the disk suscepti-ble to herniation (protrusion), in which mildtrauma such as lifting an object or even sneezingcauses the center of the disk to bulge throughthe weakened outer layer.

Symptoms usually occur when the protrudingdisk presses on one or more of the spinal nervesemerging from the spinal column. In some peo-ple, the disk presses on the spinal cord itself oron the cauda equina. This causes pain not only

in the back, but also in the part of the bodyserved by the compressed and inflamed nerve.In some cases, disk fragments may break free, acondition referred to as sequestration. Althoughany disk can herniate, about 90 to 95% of casesoccur in the two lowest disks, which bear thegreatest weight.

When a disk herniates, both the site andextent of the rupture determine the location

and severity of the symptoms. For example, aherniated lumbar disk may cause pain, numb-ness, or weakness in one leg (sciatica). However,a herniated cervical disk may produce similarsymptoms in one arm or hand (less commonly,both sides can be affected). In general, a spasmof the back muscles plus difficulty walking orstanding straight indicate a herniated disk; thespasm creates a recognizable leaning to one sidein about half of those affected.

Pain due to a herniated disk usually strikessuddenly. The person may feel somethingsnap before the pain beginsand the painmay start as a mild tingling or a pins and nee-dles sensation before increasing in severity. Ifthe herniated disk compresses the sciatic nerve,

pain later radiates into a specific area of one leg.A decrease in back pain may be accompanied byincreasingly severe pain, numbness, and weak-ness in one leg, along with changes in reflexes.In fact, a herniated lumbar disk is the most com-mon cause of sciatica. If a ruptured disk com-presses nerves in the neck, pain may radiatedown the arms and be accompanied by weak-ness and numbness in the arms and hands.


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Repor

Fewer than 5% of people with back painhave a major medical problem thatrequires intensive care or therapy. Many

back-pain sufferers self treat with rest, ice, heat,or another therapy. In most cases, back painresolves quickly, regardless of the type of treat-ment. However, you can take the following stepson your own to help ease your back pain:

Back relaxation exercises, whichinvolve gentle stretching to relax back muscles,lengthen the spine, and relieve compression ofthe vertebrae, are effective for alleviating stressand strain on the back. Ask your doctor for areferral to a physical therapist or for printedinstructions on how to safely perform the exer-

cises.

Lying down takes pressure off the spineand usually lessens back pain. The best posturesin bed are lying in the fetal position with a pil-low between the knees, or on your back withknees flexed, using a pillow to support the legs.Most experts advise limiting bed rest to one ortwo days, however. The inactivity associated with

longer periods of bed rest may do more harmthan good by weakening muscles. It is better toget out of bed and move around as soon as youcan.

After a sudden back injury immediatelyapplying ice can be therapeutic. In addition torelieving back pain, ice reduces internal bleed-ing and swelling by decreasing blood flow. Anice bag, commercial cold pack, or even a pack-age of frozen vegetables should be used for1020 minutes every two hours for the first 48hours after injury (while youre awake). The20-minute limit is important to avoid the risk offrostbite. Another approach to relieving backpain is to massage the painful area with an ice

cube.

Its best to wait for 48 hours after anacute back injury before you apply heat. How-ever, chronic back pain or a more widespreadbackache that starts some time after a backinjury may be eased by relaxing muscles with ahot bath or shower, a heating pad, a heat lamp,or hot, moist compresses.


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Traveling by car or plane can be a painin the neck, literally, as well as a pain inthe back. Sitting for prolonged periods

adds strain to the structures of the lower backand neck, and poor posture while sitting putseven more stress on your spine. Here are sixsimple, yet effective stretches to help you can doanywhere, without a lot of fancy equipment:

left and maintain this position for about five sec-onds. Turn your head forward again; then turnto the right and hold for five seconds. Repeatfive times.

shoulders up while holding your arms at yoursides. Stay in this position for about five seconds,then return to a resting position. Repeat fivetimes.

gradually lower your torso toward your knees.

Let your arms drop down and then wrap themaround your thighs. Hold this position for about20 seconds while breathing deeply, then returnto your normal, seated position. Repeat fivetimes.

back and slowly stretch backward from the waist.Hold for 10 seconds, then relax and straightenup. Repeat five times.

the left. Maintain this position for five seconds.Return to an upright position, then bend tothe right and hold for five seconds. Repeat fivetimes.

the floor and raise your heels. Hold for 10 sec-onds. Lower your heels back down, and repeat10 times. Although this is really a calf stretchexercise, youll feel the stretch all the way upinto your lower back.


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Disclaimer


Johns Hopkins Guide to Crohns Disease

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This Special Report is not intended to provide advice on personalmedical matters or to substitute for consultation with a physician.

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Jh Ha Guide to Sciatica

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