Sciatica-

Sciatica is a clinical condition characterized by pain beginning from low back region  radiating downward along the course of sciatic nerve, towards posterior thigh. However it can occur with or without lower limb pain(unilaterally or bilaterally) and may show other symptoms in some individuals such as -muscle weakness, sensory deficit , numbness, urinary bladder dysfunction etc.

Sciatica is caused by sciatic nerve root (L4-S3) compression or irritation caused by vertebral canal disk narrowing or trauma(protrusion, prolapse).

Over the period of time Compression of the spinal nerve root leads to local oedema, ischemia, inflammation that may even cause leakage from the degenerated intervertebral discs.

Some of the common features of sciatica are pain, tenderness to pressure, muscle weakness, reduced sensation, and pain that increases on movement .

 Etiology –common causes of sciatica 

Any activity or condition that structurally impacts or compresses the sciatic nerve may cause sciatica symptoms.

•  One of the most common cause of sciatica is a herniated or bulging lumbar intervertebral disc. In old aged patients lumbar spinal stenosis is another major causative factor of these symptoms.
• Sometimes a relative misalignment of one vertebra with respect to another may also result in sciatic symptoms. 
• lumbar or pelvic muscular spasms or inflammation are also responsible for causing sciatic symptoms.
• A spinal or Para spinal mass (such as malignancy, epidural hematoma, or epidural abscess etc) may also cause compression of sciatic nerve leading to sciatic symptoms.  Etc

 Risk factors for sciatica.

Some of the Risk factors for acute sciatica are as follows:

• Age-  (peak 45-64 years); rarely occurs before age 20 unless it is secondary to trauma or is triggered by physical activities and frequent bad postures.
• Very tall height.
• Obesity.
• Pregnancy
• Smoking
• Mental stress.
• Strenuous physical activity—for example, frequent lifting, especially while bending and twisting
• Excess Driving, activity involving whole body vibrations.
• Prolonged standing or sitting, bending.
• Poor posture.
• Diabetes.
• Regular weight lifting
• Poor general health.
• Low socioeconomic status.
•  Psychological stress etc.

Diagnosis and differential diagnosis of sciatica.

Usually sciatica is diagnosed clinically through detailed history and physical examination.

 Imaging methods such as magnetic resonance imaging can be used to evaluate other suspected conditions such as progressive neurologic deficit, fracture, spondylolisthesis, and cases of persistent  and worsening pain (not responding to conservative management) 

Detailed previous history inquiring about onset and distribution of pain, other associated symptoms such as tingling sensation, numbness, or muscle weakness in the legs must be asked.

Clinically  some of the commonly used tests to confirm the diagnosis of sciatica are - Neural tension tests, such as the femoral nerve, slump, or straight leg raise tests,.

 Some symptoms and signs seen in sciatica include unilateral leg pain which is more severe than low back pain, pain(sharp aching pain) radiating most commonly posteriorly down the leg and below the knee, paraesthesia, numbness in the involved lower leg .The pain might be of sudden or slow onset and differs in severity from person to person. Numbness or tingling sensation and weak muscle strength in the same leg are other suggestive symptoms of nerve root involvement.

Hence, diagnosis of this disease is mainly by clinical diagnosis based on the signs and symptoms and findings on the examination of the patient.

 

Differential diagnosis of sciatica must be made with following :

• Herniated lumbosacral disc.
• Muscle spasm.
• Nerve root impingement.
• Epidural abscess.
• Epidural hematomas.
• Tumors.
• Pott disease(spinal tuberculosis)
• Piriformis syndrome etc. 
•     Management of sciatica through Ayurveda. 

Ayurveda, the ancient Indian system of medicine, employs a holistic protocol in managing sciatica that includes herbal remedies, lifestyle and diet modifications, and several therapeutic techniques

The signs and symptoms found in “Sciatica” in are similar to the condition mentioned in Ayurveda texts -  'Gṛidhrasi’.

The Term ‘Gṛidhrasi’  indicates a typical gait that resembles a vulture.

According to ayurveda  The cardinal symptoms of  Sciatica -

• pain with pricking sensation
• stiffness
•  repeated twitching in the buttocks, low back region, thigh, back of knee, calf, foot

• Drowsiness etc

 

‘Gṛidhrasi’ comes under 80 types of' nanatmaja vyadhi, caused by Vata dosha alone. Ayurvedic treatment for Gṛidhrasi focuses on restoring balance to the Vata dosha, thus reducing inflammation, pain , and holistically strengthening the nervous system.

 

Ayurvedic management is done by using collaborative approach of 'shodhana and shamana chikitsa' namely-

Vasti, agnikarma, siravyadha , snehana, swedana, patra potli therapy etc along with Ayurvedic medicines reduce pain and other symptoms and ultimately improve life of individuals suffering with sciatica.

 

Pathya ahara (good food)-

 

Meals must such that they pacify vata dosha  for example-  warm, nourishing, and easily digestible Foods such as cooked vegetables, whole grains, ghee, and warming spices like ginger and turmeric must be taken on a regular basis .

 

Apathya ahara (food to be avoided) - Cold, dry, and processed foods .

 

Lifestyle modifications-

Pranayama (breathing exercises) and meditation Significantly calm the mind, reduce stress, and promote relaxation, which can alleviate sciatica symptoms specially those caused by tension and anxiety. Yogaasanas such as – bhujangasana, balasana, Ardha Chandrasana,

Salabhasana, Pawanmuktasana etc can be done to strengthen muscles and relieve symptoms of sciatica.