NERVIO CIÁTICO

SCIATIC NERVE

¿Did you know that the sciatic nerve is the longest in the body and gives its name to symptoms? It is responsible for both the mobility and sensitivity of the back and side of your leg to the sole, instep and toes. 

                                   

The sciatic nerve originates from the lumbar roots L4, L5 and S1 to S3 and its territory of action begins in the lumbar spine and gleteal region.

Once these roots are joined to a large nerve trunk in the thickness of the gluteal musculature, the sciatic nerve descends down the leg and at knee height divides into two branches that reach the sole and instep of the foot in addition to the toes.

* What is sciatica?

* Compression zones

* What are the symptoms of sciatica?

* How is sciatica diagnosed?

                                 * What are the causes of sciatica?

                                 * Complications

                                 * Risk factor´s

                                 * How long does sciatica last?

                                 * Treatments for sciatica.

                                 * Physiotherapy 

                                 * Recommended exercises for sciatica. 

                                 * Tips to prevent sciatica.

                                 * Clinic History 

                                 * Test assessment. 

                                 * Physiotherapeutic Diagnosis  

                                 

       ¿What is sciatica?

Sciatica occuts most often when a herniated disc, a bone spur in the spine (spinal canal stenosis) compresses part of the nerve. This causes swelling, pain, and often some numbness in the affected leg.

     Compression zones

• Nerve root: at the level of the spine where there is a hernia or a protrusion that involves the nerve.
• Pyramidal: The nerve passes behind the pyramodal muscle. If it spasms, it undergoes compression of the nerve.
• Squibiotibial fiber breakdown.
• Fracture of the fibula: Since the nervous horn divides the common fibula, and in turn surrounds the fibula, it can cause compression. 
• More distal levels: Involvement of the twins, inflamation, at the level of the ankles, for example, a corner that can force branches that are typical of the common fibula, superficial fibula and the tibial nerve.   

    What are the symptoms of sciatica?

It is very rare that you feel discomfort in both legs at the same time, the most common is to have discomfort only or predominantly in the right or left leg that begins in the lower back and or buttocks, with pain in the back of the leg being much more intense. The painful sensation and numbness can spread to your toes causing you to limp or "drag" your leg. 

• It usually worsens with sudden movement
• Pain getting up from bed or from a seat 
• positions held
• Pain when carrying out physical effort such as weight bearing
• Back pain 
• Pain in the affected leg

   How is sciatica diagnosed?

Each type of injury and its severe location are very differente symptoms that your doctor will know how to assess and interpret.

To locate its origin, it is very likely that you will have to carry out complementary imaging tests.

• Resonance or RMN
• Bone scan
• Tac 

   What are the causes of sciatica?

The most common causes of sciatica are related to age: the injury, pinching or crushing of the sciatica nerve, can be caused by the degeneration of the lumbar discs, the appearance of herniated discs.

In young patients, injuries to the sciatica nerve are associated with being overweight, carrying out an effort, and it is also very frequent during pregnancy (sciatica of the pregnant woman). 

  Complications 

Although most people recover fully from sciatica, usually withoun treatment, this condition can lead to permanent nerve damage, Seek immediate medical attention if you have the following:

• Loss of sensation in the affected leg.
• Weakness in the affected leg.
• Impaired bowel or bladder function.  

  Risk factor´s 

• Age 
• Obesity 
• Profession
• Remain seated for a long time 
• Diabetes 

  How long does sciatica last?

Depends on the damage, the discomforts and limitations caused by scitica con be very disabking, it is one of absenteeism from work, but it is rare that thay persist over time.

After an acute phase in which the pain is intense, most people improve on their own without requiring any medical treatment within a few days. 

• Rest is only recommended in this first phase of less than 3 days of evolution, then we recommend avoiding rest as much as possible.  

  Treatments for sciatica

• Symptomatic treatment to calm the pain, basically analgesic drugs
• The types of medications that could be prescribed to treat sciatica pain are as follows.
• Anti-inflammatory
• Muscle relaxants
• Tranquilizers
• Tricyclin
• Antidepressants
• Seizure medications 
• Rehabilitator treatment, postural education hot and cold therapies, deep massages or the use of transcutaneous nerve stimulation (Tens).

  Physiotherapy 

Once the acute pain subsides, the physical thetapist can design a rehabilitation program to help you prevent future injuries. Generally, the program includes exercises to correct posture, strengthen the muscles that support the back, and improve flexibility.

Physical therapy exercises which include strengthening, stretching, and aerobic conditioning from the backbone of nearly every sciatica treatment plan.

  Recommended exercises for sciatica

• Strengthening exercises: Many exercises can serve to strengthen the spine, as well asthe supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also on the abdominal, gluteal, and hip muscles.
• Stretching exercises: Stretching exercises are generally recommended to relieve sciatica pain. Stretching exercises for sciatica are designed to exercise pian-producing muscles when they are stiff and inflexible. The hamstring stretch is almost always an important part of an exercise program for sciatica. 
• Low-impact aerobic exercises: Some form of low-impact cardiovascular exercise, such as walking, swimming, or water aerobics, is generally included as a componente of recovery, because aerobic activities promote fluid and nutrient exchange to create a better healing environment. Aerobic conditioning has the unique benefit of releasing endorphins, the body´s natural pain relievers, that help reduce sciatic pain. 

  Tips to prevent sciatica

• Control your weight, being overweight is one of the main reasons for the appearance of sciatica.
• Take care of tour posture when sitting and above all, when making efforts (when lifting weight for example).
• Do regular physical exercise to strengthen your abdomen and the muscles fo your spine.
• Consult your rehabilitator or physical therapist. They will an exercise program that will make your recover soon, preventing the appearance of new injuries to the sciatic nerve.

Clinic History 

The Clinical History is a private document, obligatory and subject to reservation, in which the patient's health conditions are chronologically recorded. 

      Anamnesis

• Surname and full name: Laura Valentina Perez Ortiz   
• Marital status: Single 
• Identification document: 1.084.605.318
• Eps: Famisanar
• Date of birth and place: November 24 1993 Botoga
• Rh: O+
• Age: 26 years 
• Gender: Female
• Schooling: University
• Ocucupation: Student 
• Address: Carrera 107C # 108F-16
• Neighborhood/sidewalk: Garces Navas
• Zone: Urban 
• Telephone: 3156549876
• Religion: Catolic
• Pregnancy: Not
• Accompanying person: Luz Mariana Ortiz Rojas 
• Relationship: Mom
• Companion phone: 3208674378  

    Personal History

• Pathological: Denies
• Surgical: Denies
• Pharmacological: Denies
• Rraumatic: Denies
• Toxic: Denies
• Allergic: Ibuprofen  

   Medical Record

• Procedures made: Denies
• Surgeries: Denies 

  Family Background

• Maternal: Denies
• Paternal: Arterial Hypertension 

• Reason for consultation: Pain in the ridht leg
• Observation Forwarded: Not

   Clinical Case

Patient of 26  years old, female who enters the emergency department of the Mayor Mederi University Hospital in the company of her mather, who reports that she has been with pain in her right leg for 3 hours that radiates to her foot, the mother of the companion informs us that he has only taken acetaminophen for pain.


  Physical Exploration 

• Weight: 60 Kg
• Size: 1,64 Cm

 Functionaliy level:

• Patient presents difficulty in his normal gait development. 
• Patient has a little difficulty doing some chores around the house.
• Patient presents defficulties when performing recreational activities in society, "university"

 Alert in the 3 Spheres

• Consent 
• Oriented 
• Time and person

 Pain

In this case, the type of pain that the patient presents is pain according to her pathology,    which in this case is sciatic nerve, neuropathic pain, since it is produced by direct stimuli from the nervous system or by injury to peripheral nerve pathways. The patient frequently uses unusual terms to describe it. 

In this case we would use the verbal scale that consits of 4 points: 

• 1= Absent
• 2= Light 
• 3= Moderate 
• 4= Intense 

 Systems Review 

 Cardio Pulmonary Domain

• F.C: 80 Ppm 
• F.R: 30 Rpm
• T.A: 120/70 mmHg 
• Saturation: 95 Po2

 Integumentary Domain 

 Skin integrity

• Texture: The skin is hydrated, soft, smooth, uniforme to the touch and not hairy.
• Scars: Does not present
• Skin color: White skin without the presence of bruises. 

 Skeletal muscle Domain

• Symmetry: Asymmetry  of posture
• Rom: The patient undergoes goniometry to measure joint width and muscular performance to determine the force that creates a muscular tension in the muscles to be evaluated in this case in the sciatic nerve because weakness in the muscles, the hamstring muscles. Adductor major, gluteus maximus, pyramidal located on the back of the thigh, and the muscles of the lower leg and feet.
• Weight: 60 Kg
• Size: 1,64 Cm

 Neuromuscular Domain

• March: This altered due to walking has pain in the leg that radiates to the foot, it also has compensation for the unaffected side, in this case the pain is in the right leg, all its weight will be unloaded in the left leg, the phases of the march are affected.

• Locomotion: Not evaluable because the patient can move from one side to the other.
• Balance: Not evaluable. 
• Motor function: Dermatomas 

  Test assessment 

• Leg elevation test: Consists of the patient lying on the table and passively raising the straight leg without bending the knee.

  

• Slump test: Consists of the patient being seated, with tha hands behind the back in a collapsed or crouching position, the physiotherapist will lift the leg and check if it produces the symptoms.

• Faber test: To assess the state of the adductor musculature of the iliac and hip joint. Physiotherapist: Standing next to the patient at the thigh level,flex the knee, bringing the external malleolus obove the kneecap of the extended leg.                                                    One of the physiothrrapist's hands goes to the patient's pelvis and the other on the patient's flexed knee, exerting pressure in the direction of the stretcher, it is assessed by measuring the distance from the knee to the edge of the stretcher. 

• Fair test: Detect if there is irritation of the sciatic nerve, patient in lateral decubitus opposite to the side to assess the examiner stabilizes the hip while passively mobilizing it to a flexion of 60-90° adduction and internal rotation, in this position, in this position the stretching of the pyramidal muscle theoretically compresses the sciatic nerve, so if pain occurs in the gluteal or sciatic region, the test is evaluated as positive. It is a test with high sensitivity and specificity. 

• Lasenge test: Objective is to determine the presence of an irritation of the sciatic nerve, patient in supine position, a passive hip flexion plus knee extension is performed, the positivity of the test is to reduce pain between 30-70° of flexion. the diagnostic precision is sensitivity at 91% and specificity at 26%. The roots come out from L5 and S1.

• Bragard maneuver: It is performed after the lasegue maneuver and consists of the same movement, but when the point when the point where the pain appeared is reached, we stop raising the leg further and push the sole of the foot flexing the ankle. If pain appears it suspicion the suspicion of sciatic.

• Muscle strength tests: To see if strength has been lost in muscles that have motor connectivity to the sciatica nerve.

• Diagnostic test: The electromyography that will ask for the ability of the electrical conduction of the nerve in different areas to check if there is good signal.

   Physiotherapeutic Diagnosis

24-year-old user with medical Diagnosis sciatica, affected musculoskeletal domain with affected pattern (B) posture deficiency, (C) muscular performance deficiency, (E) joint mobility deficiency, motor function, muscular performance and range of motion associated with localized inflation. Restrict recreation. 

  Bibliographic References

• Madariaga, M. (2017). Nervio ciatico y ciatica; causas, síntomas y tratamientos [Blog]. Retrieved from https://www.tuvidasindolor.es/nervio-ciatico-y-ciatica-sintomas-tratamientos/.
• Olmarker K., Myers R., Kikuchi S., Rydevik B. Pathophysiology of Nerve Root Pain in Disc Herniation and Spinal Stenosis Herkowitz H., Dvorak J., Bell G. The lumbar Spine, third edition, Philadelphia, Lippincott Williams, 2004, 11- 30.