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Home > Products > Article - Excerpts From The Sciatica Relief Handbook
Excerpts From The Sciatica Relief Handbook
by Chet Cunningham
What is Sciatica?
Sciatica is a condition of the spinal column where some object is pressing against the sciatic nerve root, which results in serious pain in the lower back and buttocks often radiating down one or both legs, sometimes all the way into the foot. In Germany it is known as hexenschuss, which means witches brew. This aptly named witches brew pain is one than can immobilize even the toughest individuals.
This pain can be light and periodic, or it can be so tremendously painful that the victim can't move his or her legs or back without the pain surging up. It can be totally debilitating. At the same time there can be a tingling, weakness and numbness in part or all of the affected leg.
Just how far the pain extends down the spinal column and into the legs depends on which disc and sciatic nerve roots are affected. The sciatic nerve is actually a bundle of nerve roots and makes up the largest nerve in the body.
It's Been Around A Long Time
This agonizing pain in the legs has been recorded in history down through the ages. Hippocrates, the Greek physician, in the fifth century B.C. wrote that Scythians had a lot of sciatica pain, which he attributed to their riding so much on horses.
Roman Pliny, the Elder, noted five hundred years later that he had a cure for this sciatica pain. It was called hiberis and was made from earthworm washings.
Shakespeare, in seventeenth century England, used the term in one of his plays when Timon of Athens said: "Thou cold sciatica, cripple our senators."
Doctors laid the cause of sciatica to a great many reasons, all which proved to be wrong until the 1930's when two doctors discovered that sciatica often was caused by the herniation of one or more intervertebral discs.
Why Do Discs Bulge and Rupture?
Those intervertebral discs are the villains. What are they? Between your vertebrae are twenty-three discs that serve, as cushions to let your spine do the work it must do. These discs are made up of a wet, spongy inner core and a stiff, sturdier outer shell that keeps the disc intact. After a person is twenty years old, these discs begin to wear in relation to the amount of pressure and movement the spine is subjected to. Many people have sciatic pain in their late twenties. It becomes more prevalent in people from thirty to fifty years of age. Thirty-eight is the average age for patients having lumbar disc surgery.
While age often is a factor, that isn't the cause of sciatica. There are a complex group of other factors that have a bearing. These include work that requires repetitive lifting, constant exposure to vibrations like long rides on a motorcycle or driving a car or truck for long periods of time. Dr. John Frymoyer, in an article in The New England Journal of Medicine, said that there might also be a correlation between sciatica pain and job dissatisfaction and depression. Another study showed that cigarette smoking could be a risk factor leading to sciatica in some people.
Not all of the discs are prone to herniate. The two areas that are most often affected are the lumbar region, which includes the lower most vertebrae, and those high in the neck region of the spine. The lower ones are those which also bear the most weight. Both regions are subject to the greatest stress because they are mobile areas of the spine that are next to stiffer sections.
If the disc that herniated is in the neck region, it will produce pain in the neck and radiating out into the arms sometimes and all the way into the hands, resulting in numbness and muscle weakness. If the protrusion from a bulging or herniated disc touches nerve roots in the cauda equina, the patient may have trouble urinating or defecating. These are the nerves that control the bowels and bladder. Most sciatica problems deal with pain in the buttocks and down the legs to the feet.
When a disc herniates it is almost always the final phase of a long process of wear and tear on the disc caused by work habits, lifting or straining. The final "blow out" of the disc might come from some innocent movement such as picking up a newspaper or bending over to sit down.
Other Causes of Sciatica
What else might be a cause of sciatica? Muscle spasms resulting from an injury or just a fall can irritate the sciatic nerve. Some experts say that an inflamed piriformis muscle in the buttocks can press against the sciatic nerve and cause the pain. This muscle is the one that lets you lift your leg sideways. The piriformis can become inflamed from an injury or over-exertion.
When the body functions properly, the vertebral discs absorb and lose a certain amount of water and nutrients from the bloodstream. After a person is thirty years old, this balanced operation goes a little out of whack, and the discs begin to lose a little more water than they absorb. So the disc begins to dry out. This causes the width of the disc to shrink. Over the next thirty to forty years, each disc may lose up to one-eighth of an inch in thickness. Multiply this times twenty-three and you see why your grandmother is shorter now than she used to be by three or four inches.
The drying out has other problems as well. If the outer layer dries out quicker that the soft, inner layer, it can often result in a "leak" or rupture in the outer layer. When a leak occurs the soft inner core of the disc drains through the outer layer. When this happens the protrusion often presses against the sciatic nerve root. This pressure produces the pains and discomforts of sciatica.
If the outer shell isn't broken but is bulged out by the pressure of the inner layer, the same thing can happen. The bulge of the harder layer presses against the sciatic nerve and triggers the pain.
This condition almost always happens in one of the lower lumbar discs. This rupture of the disc can take place and not cause any pain, as long as the material does not press against or interfere with the work of the sciatic nerve roots. Such sciatic pain happens to about ten percent of the population.
Richard W. Porter, MD, says that only about ten percent of patients with a disc protrusion actually develop any pain from them. He says that in the other ninety percent the spinal canal is usually wide enough for the nerve to escape any damage from the bulging disc. Dr. Porter is a professor of Orthopedics at the University of Aberdeen in Scotland.
Dr. Porter says that inflammatory mediators from the nucleus of the disc that may be touching the nerves may also be responsible for some of the sciatica pain.
No Such Thing As A Slipped Disc
This herniated disc condition is often referred to, by the public, as a "slipped disc," which is incorrect. There is no slippage of the affected disc. Old labels die hard, and this condition probably will be called by this name for many years.
In some cases this bit of material that oozes out of the disc can become disconnected from the rest of the core material. Doctors then say that it is "sequestered" since it is alone. It may remain in the spinal canal and cause further problems or it may remain in place and not cause any trouble.
Usually the material from the disc core remains attached and the body starts the healing process of repairing the "leak" or bulge in the outer shell.
With the bulging disc the protrusion may not press on the nerve so much that it "pinches" it and causes it to malfunction. Many times the bulging is minor and simply irritates the nerve roots, but still causes severe pain.
Most sciatica pain is in the buttocks and legs because of the way the nerve bundles are located. Sometimes nerves are affected which extend into the back and this will produce sciatic pain in the back as well as the lower extremities.
More Causes of Sciatica Pain
The disc is the major cause of sciatica pain, but it can also be triggered by infections, injuries, tumors, arthritis ankylosing spondyltis, a condition known as spondylolisthesis and spinal stenosis.
Arthritis
There are three types of arthritis that affect the spine: degenerative arthritis, osteoarthritis and rheumatoid arthritis.
Degenerative arthritis is by far the most common form of arthritis and at the same time usually the least serious. This is a normal part of the aging process. This simply means that as we get older, the more our joints wear and some of them wear out. The problem is that the cartilage that cushions and protects the joints wears away. The joints most affected include the hands, feet and the spine.
When cartilage wears thin and the discs shrink down because of age and wear & tear, there is more chance of the sciatic nerve roots in the spinal canal being affected.
Osteoarthritis is the growing of rims or bone spurs either on or near the facet joints. They actually help stabilize the discs or joints of the spine and may help avoid back pain, not cause it. In people over sixty-five this condition may limit mobility and cause some stiffness of the back. However, Osteoarthritis is not a big factor in back pain and rarely is there any serious problem involved.
Rheumatoid arthritis can attack the spinal column, but it also is a body wide disease affecting the joints in the hands, elbows, fingers, toes and shoulders as well. If it affects the facet joints of the spine, it results in severe inflammation, swelling and painful stiffness. Rheumatoid arthritis can destroy the joint as it progresses as well as the tissue surrounding it.
Ankylosing Spondylitis
This is a severe inflammation of the spinal joints that then stiffen and causes severe pain. It usually starts at the base of the spine and works its way upward. Twice as many men are affected as women and it usually starts in the late twenties. As it progresses, the vertebrae fuse and the victim hunches over until he can hardly see ahead. This is another of the diseases of the spine we're not concerned with here.
Spondylolisthesis
Spondylolisthesis is the real slipped disc. For this to happen, first there must be a crack in the back of the vertebra. When this crack widens sufficiently, the front section of the vertebra can then slip forward in relation to the vertebra below it. In a mild form this problem can go unnoticed since there is little or no pain involved. A flare up of pain may come from sudden exertion. The best treatment is exercise to strengthen the area after the pain subsides.
Spinal Stenosis
Another way that sciatica pain can develop is from spinal stenosis. This means narrowing, and here it applies to the narrowing of the spinal canal through which the sciatic nerve passes.
This problem comes with the advent of degenerative arthritis when the formation of bone spurs on the spine can change the contours of the vertebrae.
There are a wide variety of ways that this narrowing affects the sciatic nerve, depending on where the narrowing takes place. It can mean the tingling, numbness and the shooting pain and weakness usually associated with sciatica.
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