Orthopedics-Online

Sciatic Nerve Pinched - What To Do?

causes

Due to the relatively complicated process, serious injuries to the sciatic nerve (sciatic nerve) can occur, especially in connection with accidents:

Pelvic fractures
Femoral fractures and
Dislocations (Dislocations) of the sacrum-iliac joint can lead to paralysis of the sciatic nerve.

Intramuscular injection of vaccines into the buttock also poses a risk of injury to these nerves.

One of the most common diseases of the sciatic nerve is called sciatica (see lumboischialgia), which occurs when the nerve is pinched.

Trapping can occur due to various previous illnesses and, above all, incorrect movement sequences, and strong mechanical pressure can also lead to sciatica.

A special condition called spondylolisthesis (Vortex sliding), cause pinching of the sciatic nerve. In the course of this vertebral slipping, the individual vertebral bodies shift towards one another in such a way that various nerves, including the sciatic nerve, can be pinched.

Furthermore, inflammatory processes or excessive pressure in the area of the nerve roots can lead to a pinched sciatic nerve.

This happens particularly often during an existing pregnancy, because as the child grows, various anatomical structures shift that can pinch the sciatic nerve.

Read more on the subject at: Lumboischialgia in pregnancy such as Pinched nerve

Other possible reasons are fluid retention (edema), fractures of the vertebrae or tumors.

Figure sciatic nerve

Sciatic nerve -
Sciatic nerve
Warping disc
Disc prolapse -
Nucleus pulposus prolapse
Gelatinous core -
Nucleus pulposus

You can find an overview of all Dr-Gumpert images at: medical illustrations

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Symptoms of a pinched sciatic nerve

If the sciatic nerve is pinched, the following typical symptoms occur:

moderate to severe pain, which can be perceived in all supply areas of the nerve.

Usually these are:
- buttocks
- the back of the thigh,
- the lower leg and
- Parts of the foot affected.

Most patients describe the pain associated with a pinched sciatic nerve as stabbing and burning.

The main sign of a pinched sciatic nerve is the often unilateral pain caused by the irritation.
The pain can also radiate into the leg on the same side. Restrictions in movement, hobbling or changes in feeling can occur as side effects. The examining doctor can determine whether this is really an entrapment of the sciatic nerve if the radiation areas match those supplied by the sciatic nerve.

In addition, the clamping of the nerves and the associated disturbance of the transmission of excitation can lead to sensory disturbances and numbness of the supply area of the sciatic nerve.

The first sign is usually a tingling sensation in the foot and leg, similar to a leg that has fallen asleep.
If the sciatic nerve is pinched, back pain occurs in many cases at the same time.

This fact suggests that a herniated disc in the lumbar spine or a protruding disc in the lumbar spine can also pressure the sciatic nerve.

In the worst case, there can also be problems urinating or holding urine or stool.

Leg pain with sciatica

The sciatic nerve is the longest nerve in the human body. It arises from the sacral plexus and supplies the gluteal muscles as well as the muscles of the back of the thigh, the lower leg and the foot. At the same time he also leads sensitive fibers to the back of the thigh and large parts of the lower leg and foot and thereby enables that Touch and temperature sensation in these regions. For this reason, irritation in the course of the sciatic nerve is felt as pain in these skin areas. This is known as the "projection" of the pain. The extent of the irritation of the nerve is reflected in the intensity of the pain.

Painful conditions in the supply area of the sciatic nerve are called sciatica and are characterized by a typical complex of symptoms, which means that sciatica can usually be identified quickly. Next to one mostly as pulling or tearing described pain, which one radiates from the buttocks into the leg, abnormal sensations such as Numbness, tingle or Temperature sensation disorders in the supply area of the nerve. The complaints strengthen each other moreover when sneezing, to cough or that Carry out a belly press.

Pain in the area of Lumbar spine count by the way Not under the concept of Sciaticabecause this region of the body is not supplied by the sciatic nerve. Instead, it is known as lower back pain. If they occur together with sciatica, one of them Lumboischialgia spoken.

You can find more about lumbar irritation at Lumboischalgia cause, Lumboischalgia diagnosis and Therapy of lumbar disease

Deaf leg

If a leg is numb and there may be signs of paralysis, a doctor should be consulted immediately.

Further clarification must be carried out here as soon as possible and permanent damage prevented.

In some cases, numbness in the leg can be accompanied by difficulty holding urine or stool. However, this incontinence is not even noticed by some sufferers because the skin on the legs is numb and does not feel when changes occur.
If you have problems urinating in connection with acute back problems, you should consult a doctor quickly.

Also read our topic: Numbness in the leg

Is that lumbago?

By definition, a pinched sciatic nerve is equivalent to lumbago.
Hardened muscles and the associated bad posture can, for example, pinch the sciatic nerve and trigger the typical symptoms of lumbago.

These consist of sudden, extreme pain at one point along the spine.
This can last up to 2 days and occur together with a movement restriction.
After this time there should be an improvement if the symptoms persist for another two days in a weakened form.

Would you like to find out more about the symptoms of lumbago? Also read our article:

Lumbago

Pinched sciatic nerve or herniated disc - these are the differences

The sciatic nerve can be pinched due to several causes.
A herniated disc is not always responsible.
And not every herniated disc causes an entrapment of the sciatic nerve.

Instabilities and loss of elasticity of the intervertebral disc fiber rings can occur along the spine. Inside these rings is what is known as a gelatinous core, which can emerge when the fiber ring tears and can press on emerging nerves.
This creates the symptoms of a herniated disc.

If the gelatinous nucleus emerges at the level of the course of the sciatic nerve, it can irritate it and lead to pain, symptoms of paralysis or abnormal sensations.
You may also have problems urinating or holding urine or stool.

A herniated disc doesn't always have to be painful. Whether it is a herniated disc or some other cause of sciatic nerve entrapment can be determined by diagnostic imaging or clinical examination.

Other reasons for a pinched sciatic nerve include inflammation, osteoarthritis, narrowing of the spinal canal, or muscle swelling.

For more information, also read the article:

How can you recognize a herniated disc?

therapy

Should the Sciatic nerve be trapped, it is necessary to treat the precise determination of the underlying cause.

The symptoms of nerve entrapment cannot always be completely eliminated, because if the nerve is severely and / or for a long time the nerve tissue cannot regenerate completely.

What needs to be done in each individual case is directed against the respective cause.

One of the most common causes of sciatica, i.e. nerve pain in the sciatic nerve, is herniated discs. In almost all cases, these can be treated conservatively, i.e. non-surgically. Especially Back training and Movement therapies are important cornerstones of an effective treatment. In addition, the Pain therapy always an important role. This depends on the subjectively perceived severity of the symptoms by the patient and can vary from over-the-counter drugs such as Ibuprofen about stronger non-opioid pain relievers how Novaminsulfone to weak opiates pass. In severe cases, the affected nerve root can also be infiltrated with a Local anesthetic, such as Glucocorticoids which, on the one hand, inhibit the inflammation of the nerves and surrounding tissue and, on the other hand, enable pain to be effectively eliminated in most cases. This so-called "periradicular therapy"takes place with the help of imaging proceduresto prevent damage to the neural structures.

In the acute situation, measures such as drug therapy with painkillers and muscle relaxants are primarily targeted Stretching and movement exercises significant. Bed rest is not recommended these days.
However, physical measures, especially in combination with physiotherapy, can make a decisive contribution to alleviating the symptoms.
Especially warmth can be helpful here, as it stimulates blood circulation and therefore relaxes the muscles. The heat can be applied in various ways. Especially Hot water bottles and compresses, but also heat lamps and heat baths are often used.

When is an injection necessary?

Whether this therapy is actually necessary for the treatment of sciatica depends above all on how well other conservative treatment methods work and how much a patient feels restricted by his sciatica. In any case, a syringe should not be used lightly. Even if the procedure can usually be used by experienced doctors without problems, there is still a problem compared to taking pain medication in tablet or drop form greater risk of side effects to suffer. Ultimately, however, no website in the world can make the decision for or against an injection for you. Discuss Instead, share their complaints and reflections with your treating doctor or get a second opinion if you have major concerns. This is the only way to get a comprehensive picture of the necessity and risks of periradicular therapy.

Exercise if you have a pinched sciatic nerve

The practice of adapted sports exercises with the pinched sciatic nerve has been proven to promote the further healing process.
Bed rest should be avoided if possible and physical activity should be attempted again and again.

We recommend starting with easy walks. People who are otherwise very fit find jogging very pleasant.
Swimming can also be very helpful in some cases.
Yoga and special stretching exercises help relax certain muscle groups around the pain point.

Through back training, the sciatic nerve can be relieved and the correct posture is more practiced.

Exercise for a pinched sciatic nerve

If the sciatic nerve is trapped, first exercises can relieve the pain. If the pain suddenly shoots in, it is a good idea to lie on your back, bend your legs and raise your lower leg. This results in a stretch and thus relief.

Above all, it is important to relieve the back immediately, as this also relieves the pressure on the sciatic nerve.

The acute pain can be relieved by walking lightly, whereby care should be taken not to overuse yourself. To completely forego movement and instead to sit is less advisable, as the pain of sciatica is increased.

The best way to prevent entrapment of the sciatic nerve is through a straight posture while sitting and through targeted back training. In addition, certain movement exercises can be done that, if repeated regularly, prevent pain in the sciatic nerve.

The first exercise is to lie on your back and pull your knee towards your shoulder. This movement should be performed equally often with both sides. Then both knees should be pulled towards the shoulders at the same time. This movement should also be repeated as often as the previous exercise.
The next exercise is to stretch one leg straight forward while standing and bring it back up to the body. This exercise should be repeated about 10 times per side. Each of the exercises should be repeated daily in three to four sets without overexerting yourself. Symptoms can only be improved through continuous training.
Some specific exercises can relieve the sciatic nerve and relax the muscular region around it.
A good exercise is to lie on your back on the floor. Then one leg is bent and the knee is drawn towards the chest; Next, with the arms around the knee, a slight rotation of the upper body is performed to the side of the extended leg.
For another exercise, stand in front of a shelf a little lower than hip-high and place the foot of your right outstretched leg on it.
Then the lower back and hip flexors are stretched by grasping the lower leg or right foot with both hands and trying to bring the nose to the knee.
A fifth exercise requires sitting on the floor with your legs straight out. Bend your right knee and place your right foot on the floor to the left of your left knee. Then turn your upper body 90 ° to the right and pull your left elbow sideways from your right knee. This should be held for 30 seconds and then practiced with the other side in the same way.

However, if the pain worsens while performing the exercises, it is advisable to stop exercising immediately and to see a doctor. It is also important to ensure that you always do the exercises correctly, preferably after you have done them for the first time under professional guidance. This is the only way to guarantee that the exercises will also help you recover and that the symptoms will not worsen.

Kinesio tapes

The basis of Kinesio-Tape therapy is based on the understanding that muscle healing is accelerated by increasing blood flow and increased movement.

In concrete terms, this is done by slightly lifting the skin and connective tissue with the kinesio tape over the muscle.
This then creates a greater spatial opportunity for blood and other body fluids to flow in and around the muscle. This can also help reduce pain and relax muscles.
Thus, further steps on the way to healing can be achieved without great effort.

Duration of a pinched sciatic nerve

The duration of the entrapment can be very variable. It can range from a brief shooting pain to a chronic pain event that can last longer than three months. Painkillers can be taken for chronic pain. However, due to their side effects, these should be taken in consultation with a doctor.

It can also lead to sensory disorders and paralysis in the leg and foot. In the case of acute entrapment, the symptoms of paralysis should be eliminated as soon as possible.

How long the symptoms of the pinched sciatic nerve will last cannot be precisely predicted, as this also depends on the cooperation of the patient and the severity of the symptoms. Mild symptoms can subside within a few days, while severe symptoms can last a week.

Please also read: Duration of a pinched nerve

Length of time on sick leave for a pinched sciatic nerve

The length of the sick leave varies from person to person and depends on the individual's condition.

The severe pain with restricted mobility should not last longer than two days and even if pain can continue to occur, it should subside and not increase.
Roughly, it can be said that 3-5 days off work are usually appropriate, but this can be extended in the case of complicated processes.

Supportive behavior and a healthy posture must also be observed in the workplace so as not to worsen or re-create problems.

Sick leave

If there is clinically symptomatic sciatic nerve entrapment, the patient may too on sick leave become. The Duration the sick leave depends on the Severity of symptoms from. The patient should be careful not to give the doctor information about the symptoms with regard to a possible sick leave, but rather to make the symptoms as accurate and truthful as possible so that the doctor can suggest the best therapy for an early recovery.

Of course, nobody should have to work in pain, so if the pain limits the ability to work, you should also ask for a sick leave. How long the affected persons are then on sick leave will be determined in each individual case individually decided.

Sciatica in pregnancy

During pregnancy there is increased stress on the spine, gluteal muscles and core muscles. This can more likely cause an entrapment of the sciatic nerve.

During pregnancy, the entire musculature is increasingly stressed. This puts a lot of strain on the spine and gluteal muscles, especially in the last third of pregnancy. When the gluteal and core muscles are exhausted, the sciatic nerve can become trapped. This particularly affects pregnant women who already had weak muscles before pregnancy.

Of course, it is not just the muscles that are decisive for an entrapment of the sciatic nerve during pregnancy, but also the posture. During pregnancy you should try to stay straight, especially in the pelvis. If, in spite of all caution, the nerve is pinched or irritated, it is advisable to look for classic relaxation methods first. Hot water bottles can be used or a warm bath can be taken.

If the sciatic nerve becomes inflamed, you can also use anti-inflammatory drugs (anti-inflammatory drugs). However, taking them during pregnancy is not completely harmless and should be discussed with the gynecologist in charge. The duration of taking the medication should also be kept as short as possible. Pregnant women should speak to their gynecologist as soon as they have back pain or pain in the area of the sciatic nerve, as persistent pain, especially during pregnancy, can lead to additional stress.

More about this topic can be found: Lumboischialgia in pregnancy

Anatomical background

The sciatic nerve known colloquially as the "sciatic nerve" (Ischial nerve; Sciatic nerve) is a so-called peripheral nerve. This means that it belongs to those nerves that are outside the brain.

It is attached to a plexus of nerves located at the level of the lumbar spine (Lumbosacral plexus) and is the thickest nerve in the entire body.

The sciatic nerve emerges from the spinal canal between the 4th lumbar and 3rd sacral vertebrae and extends from there towards the legs.

In the area of the hip it runs through a perforated structure and from there it reaches the extensor side of the hip joint. The sciatic nerve (Sciatic nerve) on the back of the thigh until it extends into the main nerves of the lower leg at the hollow of the knee ( Common fibular nerve and Tibial nerve) splits.

In addition to a few sensitive nerve fibers, it also sends parts to the motor innervation of many thigh muscles.

These muscles include: