SCIATICA
Definition:
Involves inflammation of the great sciatic nerve and presents as acute or chronic pain down the back or the leg
originating in the buttock and extending to the foot.
Etiology:
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onset is usually gradual as the nerve becomes inflammed
many causes:
a. pressure can originate in the nerve roots as in discopathy or facet syndrome or can be caused by the
gluteal muscles or piriformis tightening over the nerve
b. gluteal muscle spasm is often 2nd to sacroiliac joint dysfunction (SI dysfunction is in turn secondary to
short leg syndrome, sacroiliac sprain, lumbar sprain/strain causing tightening of the entire low back
musculature, etc.)
the nerves are usually irritated by pressure or stretching (use in its investigation)
usually causes splinting spasm of other muscles and may cause favoring of the opposite leg
common scenario:
a. the sacroiliac joint becomes subluxated and the gluteus medius muscle gradually spasm to protect the
joint which the body perceives as injured. The splinting spasms produce pressure on the sciatic nerve as
it exits the pelvis causing irritation
b. additionally, in a common anatomical variant, the sciatic nerve may pass through the piriformis muscle,
which if in spasm, pressure is then placed on the nerve
it is rarely a result of frank trauma although stretch of the nerve can result from an injury to the leg or vertebral
trauma
Chinese medicine: sciatica along the lateral thigh is often associated with a history of gallbladder problems since that
is the path of the associated merdian
Signs and Symptoms:
1. burning along the tract of the sciatic nerve, usually in the buttocks and extending downward in the posterior leg
a. pain increased by direct pressure to the nerve
2. spasm of the gluteal or piriformis muscles
3. straight leg raise: < pain
4. knee may buckle upon loading as long-standing pain causes weakening
Lab Findings:
1. imaging: to rule out disc pathologies
Course/Prognosis:
1. treat the cause, sciatica is rarely a primary diagnosis
2. the practitioner must work to make the person comfortable while seeking the underlying cause
Differential Diagnosis:
1. RULE OUT DISC PATHOLOGIES
2. other nerve irritation in the gluteal region
3. short leg syndrome
4. cauda equina syndrome
5. referred pain from lesions in the pelvis
6. spinal segmental lesion
7. sacroiliac joint dysfunction
8. gluteal strain
9. discopathy (protrusion or prolapse)
10. fracture, infection or tumor involving the low back or pelvis
11. spondylolisthesis (congenital fracture of the pars interarticularis and forward slippage of the body of the vertebrae)
Nutrition:
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increase B complex foods
olives, rye, lima beans, rice bran, bananas, sprouts, watercress, apples
Remedies:
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mix together peeled taro root and ginger into a paste with some flour and water and apply to the affected
area, cover with a cloth, change QD and apply fresh
Avoid:
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meat
hot sauces, spicy, fried, fatty, rich and/or salty foods
sugar and sweet foods
alcohol, coffee, caffeine
Supplements:
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SCIATICA
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vitamin
vitamin
vitamin
vitamin
vitamin
B complex
B-1 (50mg QD) and B-12 (1cc IM QD) [both for 1 week]
B-12
D
E
Hydrotherapy:
1. hot sitz bath
2. hot fomentation: to low back and buttocks
Manipulation:
RULE OUT DISC PATHOLOGIES
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check and align L2-S1, sacro-iliac joints
Physiotherapy:
1. stretching:
a. gluteal muscles, piriformis, hamstrings
b. sciatic nerve (patient on back lift and extend leg with one hand, at same time bear down on ball of foot
with other hand, do gradually may be painful
2. after relief of pain: strengthen gluteus medius, abdominal, lumbar muscles
3. short leg syndrome:
a. lift: 1/4-7/8" lift in heel of shoe of unaffected leg, 1/16-3/16" lift under sole of affected leg
4. belt to stabilize SI joint
5. diathermy: short wave use cable if available instead of condensor pad, tx. 30-45 min. QD
6. sine: constant current, one pad over sciatic notch other pad to sole of foot of affected leg, strength of current to
produce a tonic spasm of leg (to patient's tolerance) tx. for 1 min., may be painful, relief is great
7. Galvanism: for acute sciatica; large (-) pad under small of back, large (+) pad under calf, tx. with mild current
10min.
8. TENS: for analgesia
9. interferential
Botanicals:
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Abies canadensis (oil): locally
Aconitum napellus (toxic): acute pain
Anthoxanthum odoratum: as a pack
Apocynum cannabinum (toxic): severe, intractable cases
Cimicifuga racemosa: anti-spasmodic
Dioscorea villosa: anti-spasmodic
Gaultheria procumbens (oil): locally
Hypericum perforatum: nerve damage, internally and externally, apply with friction
Piscidia erythrina (toxic): overcomes pain, spasm, induces sleep
Thus toxicodendron (toxic): burning pain, stiffness, restlessness
Senecia jacoboea: as lotion
Urtica spp.: externally; counterirritant
Formulas:
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anti-spasmodic: tinctures of Arnica montana [1/4 part], Cimicifuga racemosa [1 part], Humulus lupulus [1
part], Hypericum perforatum [3/4 parts], Valeriana spp. [1 part]; may use with iontophoresis or internally
Homeopathy:
1. Aesculus: with dull backache which makes walking impossible; stooping and rising from stooping very painful
2. Arsenicum album: burning, tearing pain in L hip extending to thighs
3. Chamomilla: mental symptoms "I would rather die than have this pain"
4. Colocynthis: main remedy; dull, stitching pains with sudden onset and shoot to thigh, knee or foot; > heat, < touch,
motion
5. Dioscorea: tearing pains felt on moving or sitting
6. Magnesia phosphorica: lightening pains > warm, esp. R side
7. Rhus tox.: when die to muscular exertion, < in bed, at rest, > with movement, yet not at first, warmth
8. Ruta graveolens: deep radiating pain, , cold and lying down
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