The lumbosciatica corresponds to pain from the lumbar region following the path of the sciatic nerve. It is different from lumbago, limited to the lower back. While lumbago is caused by muscle contraction, lumbosciatica includes compression pain of the sciatic.
It is a condition that involves both bones and joints - lumbar spine - as well as the soft parts of the region. The nerve roots that make up the sciatic nerve are also affected, and together they determine the characteristic symptoms..
The sciatic is the thickest and longest nerve in the human body. It is born from the union of the nerve roots L4 and L5 -in the lumbar region- as well as S1, S2 and S3 (posterior pelvis) running through the waist, buttock and back of the thigh. Its function is to give the sensitivity of the posterior aspect of the lower limb, in addition to the lateral aspect of the leg and foot..
Low back pain affects a large part of the world's population at least once in their life. Sciatic nerve compression is less common and yet represents one of the most common causes of absence from work.
On many occasions, the symptoms of lumbosciatica produce inability for the patient's daily activity, including work. That is why this condition has an impact on the economic activity of a country. Knowing, diagnosing and treating lumbosciatica is important because it is a disabling disease.
Article index
Lumbociatalgia is a condition that affects the lumbar spine and involves the sciatic nerve. It is a condition whose cardinal symptom is pain, the reason for the disability that is observed. Other symptoms observed are derived from compression of the nerve roots coming from the lumbar spine.
The structures involved in lumbosciatica are the dorsal and paravertebral muscles, and the roots of the sciatic nerve. For this reason, pain is both somatic and neuritic..
It corresponds to the symptom caused by reactive and sustained muscle contracture. This is usually the initial symptom of the disease and is related to trauma, improper posture or physical exertion..
Muscle pain receptors are capable of responding to mechanical stress, pressure, stab injuries, and stretching. Extreme physical exertion and trauma are the leading cause of muscle pain.
The intervertebral disc, a structure that separates two contiguous vertebrae, also has pain receptors. Direct compression of the disc due to herniation or displacement is a cause of pain at this level.
The sacro-iliac joint is exposed to damage caused by physical effort, stretching and trauma, in addition to the pathologies of the joints. For this reason, it is possible the appearance of pain at this level due to damage to this region.
First of all, it must be considered that the structure of the nerve is sensitive to pain. Taking into account that lumbosciatica is the product of nerve compression, pain of nervous origin occurs for this reason.
The mechanism of production of neuropathic pain by compression is not yet clear. The existence of receptors for harmful stimuli capable of triggering the release of substances that cause inflammation and, consequently, pain is suggested..
An important characteristic of sciatic pain is its radiation to the gluteus and thigh on the side corresponding to the affected nerve. The nerve is formed by the union of the nerve roots that come out of the intervertebral spaces of the lumbar spine (L) and the sacrum (S).
From the intervertebral spaces L4 - L5, L5 - S1 and S1 - S2 emerge the main roots that form the sciatic. The radiation of pain depends on the affected root. If the affected portion, for example, is L4 - L5, the pain will radiate from the buttock to the posterior and outer thigh, even reaching the first toe..
Any aggression, trauma, or noxious stimulus received by a tissue produces inflammation. Inflammation involves the release of substances produced by the body that produce vasodilation and, in this way, inflammatory manifestations: edema, local heat and pain.
In lumbosciatica, the causative factor induces a localized inflammatory response that produces changes in the tissues and their consequent symptoms. It is a symptom capable of producing pain
As with inflammation, limitation of movement or activity is related to pain. Functional limitation implies a reduction in activities that can lead to functional impotence.
The limitation of movements has the consequence of the decrease or cessation of the normal activities of the individual.
Tingling, tingling, itching, burning sensation, or the sensation of passing current are symptoms of paresthesia. When the sensory fibers of the peripheral nerves are affected, paresthesias appear as a manifestation of neurological alteration.
The areas where paresthesia are observed correspond to those innervated by the branches of the affected sciatic nerve..
Sensitivity is the ability to perceive different external stimuli, such as temperature, touch, pressure, and pain. This property can be altered as a result of compression of the nerve. It can manifest as numbness in a specific area of the affected lower limb.
When the motor fibers of a nerve are compressed by an external agent, there is a limitation for muscle contraction, reducing normal mobility. This alteration is called paresis, and is interpreted as weakness or "heaviness" of the affected limb..
The compression of the roots that form the sciatic nerve is the determining factor that causes lumbociatalgia. Various causes, mechanical or non-mechanical, act on the nerve causing inflammatory changes that lead to alteration of its function. Inflammation of a nerve root is called radiculopathy.
The most common cause of lumbosciatica is herniated disc, a structural alteration of the disc that separates two vertebrae. The intervertebral disc consists of a nucleus pulposus contained within a fibrous capsule. If the capsule wears out or weakens the nucleus pulposus comes out through the weakness producing the herniated disc.
Once the hernia occurs, the root compression mechanism can be both by the pressure exerted by the approximation of the two contiguous vertebrae and by the mechanical effect of the same hernia.
Other causes of sciatic radiculopathy act in a similar way: constant and sustained extrinsic pressure on the root and, consequently, neurological injury.
- Herniated disc.
- Muscle contracture.
- Myofasciitis
- Disc degeneration
- Osteoarthritis or facet osteoarthritis.
- Vertebral stenosis.
- Lumbar trauma.
- Vertebral fracture.
- Spondylolisthesis or abnormal displacement of the vertebrae
- Spinal, extramedullary, or vertebral body tumors.
- Abnormal scarring or fibrosis after lumbar puncture.
- Infections, such as vertebral osteomyelitis.
- Pregnancy.
- Obesity.
- Piriformis muscle syndrome.
- Sacroiliitis or sacroiliac joint dysfunction.
- Peripheral neuropathy
- Myositis and other myopathies.
- Neurological syndromes.
- Multiple myeloma.
- Metastasis.
- Ankylosing spondylitis.
- Osteopenia and osteoporosis.
- Hip defects or diseases.
- Psychogenic pain, in addition to other psychiatric or psychological disorders.
Medication contributes to symptom relief and is sometimes sufficient as part of conservative treatment. The most commonly used medications include treatment of pain, inflammation and neuropathies.
Non-steroidal anti-inflammatory pain relievers - such as ibuprofen, ketoprofen, diclofenac, ketorolac, or naproxen - are renowned for their effects on pain. In addition, they have an effect on soft tissue inflammation.
This group includes dexamethasone, betamethasone, methylprednisolone. They act as anti-inflammatories and, for this reason, have effects on pain.
Its effect is as a medium to high potency pain reliever, but without effects on inflammation. Opioid medications are codeine, nalbuphine, tramadol, buprenorphine, meperidine, and morphine. Its use is reserved in case of severe pain.
Thiocolchicoside is one of the most widely used muscle relaxants. Acts on skeletal muscle providing relief by reducing muscle contracture.
First used as antiepileptic drugs, gabapentin and pregabalin are drugs used for the treatment of neuropathic pain..
They are synthetic forms with a structure similar to Gamma-amino-butyric acid (GABA). The mechanism of action is not precise but it is postulated that they intervene on calcium channels.
The vitamins that make up the B complex (B1, B6 and B12) have been used in the treatment of neuropathies. Its efficacy and mechanism of action is still under study..
Physical therapy includes exercises aimed at improving the symptoms of radiculopathy, as well as preventing disability. They must be indicated by specialists. It is a conservative therapeutic measure.
Surgical intervention is used in severe cases of radiculopathy. When conservative therapy, medications and physical therapy do not provide relief to the patient and he is incapacitated, surgery is performed.
The goal of surgery is to remove the cause of the nerve root compression. Release of nerve fibers suppresses symptoms and restores nerve function.
In vertebral disc disease, this treatment repairs the damaged disc, replaces it with a prosthesis, or fixes the vertebrae to stabilize the joint. It is also used for the excision of tumors or correction of other causes.
Physical exercise and physical therapy provide relief for low back pain, while helping to improve mobility. All physical activity or exercise must be indicated and supervised by a physiotherapist and physical doctor. They will only be indicated and allowed when exercise does not worsen a pre-existing condition.
The considerations for opting for physical therapy and rehabilitation depend on the correct diagnosis of the cause of lumbosciatica. Some pathologies such as tumorous, infectious, severe trauma, or systemic disease require immediate medical attention in the first place..
The objectives of the exercise are based on three premises: stretching, strengthening the abdominal and paravertebral muscles, as well as adequate aerobic conditioning. It is important to note that physical therapy can be performed before or after the surgery or treatment indicated..
There are countless types of exercises, however, the most common are based on the three premises mentioned..
They are the first exercises that must be performed due to their simplicity. The best known is that of the cobra position, which consists of lifting the trunk with the arms from a lying position (prone or prone position) keeping the hips resting on the ground..
A variant of this exercise is performed while standing and pushing the trunk back with the hands resting on the hips. The activity should start with little effort and gradually increase.
To strengthen the lower back, the patient is placed in the prone position and begins by simultaneously raising the arm on one side and the leg on the opposite side with the knee extended..
The abdominal muscles are strengthened in groups. For the upper abdominals, the patient is placed in a supine position (face up) and the head and shoulders are raised, maintaining the position for a certain time.
The lower abdominals require that, starting from the same position, the extended lower limbs are raised. This is done while keeping the lower abdomen contracted..
They are all those whose purpose is to improve physical condition, resistance and cardiovascular work. Aerobic exercises include light jogging, stationary or conventional cycling, and swimming. Activities that involve aerobic conditioning must be allowed, indicated and supervised by specialists.
Well-used physical activity is a benefit for pathologies that produce lumbosciatica or chronic lumbago. There are specific exercises for each pathology separately, executed by indication or specialized guide.
Yet No Comments