Absenteeism is a global phenomenon and, statistically, illnesses that cannot be verified, such as a cold, headache or backache (sciatica), are the commonest ailments. Seventy per cent of the adult population suffers from backache (the terms backache and sciatica are often used interchangeably) at some point in their lives. The quantum of pain cannot be objectively measured. Most of the time, the pain is not incapacitating and the discomfort clears up on its own in a day or two with or without treatment. The person returns to work, only to have the symptoms flare up again months or years later.
The sciatic nerve is one of the thickest nerves in the body. It functions as an expressway conveying electrical signals from the brain through the spinal cord to the legs. It becomes irritated and painful if there is an impediment at any point along its path. This may be due to an injury (accident), disc problem, spasm of the muscles near the exit point of the nerve or a narrowing of the spinal column. The pain may start in the back, but then can radiate a to any point along the path of the nerve. It may be felt in the buttocks, thighs, along the back of the calf and right up to the toes. There may be tingling, numbness or a feeling like an electric shock. In severe cases the foot or leg muscles may become weak and walking could become difficult. In severe cases, control over bladder and bowel movements may be lost.
Sciatica can occur at any time after the twenties. It is precipitated by weight gain, diabetes and a sedentary lifestyle.
The pain can be tackled by cold compresses (ice) applied several times a day over the affected part. After a few days, this can be alternated with hot fomentations. Topical applications of pain relieving gels followed by cold and hot compresses often offer a great deal of relief. Over the counter (OTC) painkillers such as paracetemol, naproxen or ibubrufen help but remember, do not take more than the recommended dose to prevent toxicity. Stronger analgesics have no proven value. Painkillers are, however, not a permanent or long-term solution. If you still require them after two weeks, consult a doctor.
After the pain has subsided a little (usually in a day or two), an exercise regimen should be started. Prolonged bed rest used to be recommended but it has now been found to have no real benefit. On the contrary, it may be detrimental because it weakens the spinal muscles that help to hold the backbone in place.
Walking, cycling and swimming are ideal. Wear well-cushioned shoes and start slowly. Then build up to 40-60 minutes a day. The endorphins released from your muscles during exercise will reduce any residual inflammation and promote healing.
Add calf and hamstring stretches and core strengthening exercises to your daily routine — such as squats, push-ups and many yoga poses. This, along with 3-6 suryanamaskars a day will help prevent a recurrence of the problem. Try to get back to your normal level of activity within a month.
To prevent recurrences, avoid stretching to reach objects, twisting and turning. Do not sit in one position for more than 30 minutes. If your work requires you to do this, make sure the table and chair are of the correct height. If you need to lift a heavy object or even a toddler, bend at the knees to crouch down and then lift. Do not leap out of bed. Turn to one side, lower your legs to the floor and then get up. Look in a mirror and see if your posture is good with a ramrod straight back. Control diabetes. If your BMI (body mass index, weight divided by height in metre squared) is more than 23-25 try a regimen of diet and exercise to lose weight.
You need to consult a doctor immediately if:
• The symptoms occur after an accident
• The onset is acute and accompanied by weakness of a leg or foot
• There is loss of bladder or bowel control
• There is no relief after two weeks
Doctors may do investigations like X-rays, CT scans or MRI scans. They may advice medication, physiotherapy and graded exercise.
Some patients require steroid injections into the affected area. This reduces inflammation and provides short-term symptom relief. It is not a permanent solution. Surgery may be eventually required to remove a bulging disc or a growth responsible for the pain.
Sciatica may be precipitated by many factors. There is no universal treatment or miracle cure. What worked for someone else may not necessarily work for you. It is important to listen to your body and to your physician.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org