Anatomically, sciatic pain (or sciatica) is the compression of the anterior motor root of the sciatic nerve. How can they be treated? Can we really relieve them? Doctissimo tells you all the treatments of sciatica.
Any phenomenon that causes compression or inflammation of the sciatic nerve can cause sciatica. The main cause of sciatica is herniated discs (85% of cases). Sciatica is then caused by the compression and inflammation of one of the roots of the sciatic nerve, a phenomenon referred by specialists as a discoracular conflict L4-L5 (if the hernia is located between the lumbar vertebrae 4 and 5) or L5-S1 (if the hernia is located between the lumbar vertebrae 5 and the sacred vertebrae 1). However, not all herniated discs cause sciatica.
Other, less frequent causes can cause sciatica:
- Osteoarthritis of the lumbar vertebrae;
- A trauma (fall or accident that affected the back);
- A vertebral compression due to osteoporosis;
- Inflammatory spinal disease, such as ankylosing spondylitis or psoriatic arthritis;
- An infection in the spine, such as Pott’s disease (bone tuberculosis);
- A tumour or metastases in or near the spine.
In addition, a particular form of sciatica affects women during pregnancy. Posture disorders associated with weight gain in pregnant women cause pinching of the sciatic nerve and subsequent pain.
Half of the sciatica heals spontaneously
Most sportsmen’s sciatica is benign and only justifies rest, accompanied by a simple analgesic and anti-inflammatory treatment. More than half of sciatica heals spontaneously, on average 4 to 5 months.
Medical treatment of sciatica
The pain symptom is in the forefront: analgesics are effective, whether they are anti-inflammatory and relaxing or class III analgesics (morphine and opium derivatives).
Corticosteroid infiltration is a frequently successful adjunct, as are mechanical techniques, used in combination. Lumbar restraint, hydrotherapy and traction are effective in nearly 70% of cases.
The old dogma of absolute rest is currently being discussed by specialists. It seems to be a given that a certain freedom of movement, with a very cautious resumption of activities, does not change the prognosis of sciatica.
Physiotherapy to relieve sciatic pain
If the patient has been suffering from pain for several weeks (4 to 6 weeks), a consultation with a physiotherapist can relieve sciatica-related pain. In addition, physiotherapy allows you to recover your physical capacities gently. The physiotherapist sets up stretching and muscle strengthening exercises, corrects the patient’s posture and performs massages to relieve painful areas. He sometimes uses warm wraps and electrotherapy to relieve pain.
Sciatica: the treatment of ponytail syndrome
When sciatica is accompanied by ponytail syndrome, the urgency is primarily surgical. This syndrome corresponds to the compression of the last nerve roots of the spine and is manifested by one or more of the following signs: signs of paralysis of the lower limbs, loss of sphincter control (urinary or fecal incontinence), loss of muscle mass in the legs, perinea or genital pain, loss of reflexes in the lower limbs or insensitivity in the perinea skin. Only emergency surgery can cure these forms of sciatica.
The consequences of sciatica treatment
Post-operative rehabilitation will be an essential part of the healing process. It must be progressive and sufficiently prolonged.
Resumption of physical activity is possible, on a selective basis, through activities such as swimming. It must also be very progressive and done under strict medical supervision until complete consolidation.
In any case, patience is essential: it is only after a few months that the healing of a sciatica by herniated disc can be confirmed.