Sciatica : Pathophysiology, Examination, Treatment

1
Sciatica Pathophysiology, Examination, Treatment
2
Introduction

• Sciatica is a condition in which symptoms of
  radiating pain are present in one leg, with or
  without associated neurological impairments on
  examination.
• Lumbar disk herniations are the frequent or
  persistent cause of sciatica in about 70 to 90
  of people. Symptoms are usually self-limiting and
  generally disappear within three months.

3
Pathophysiology of  Sciatica

• One can feel the symptoms of sciatica along the
  course of the sciatic nerve. Sciatic nerve
  branches from your lower back through your
  buttocks hips and runs down the leg. The
  neurovascular bundles may be subjected to a toxic
  biochemical environment or mechanical irritation
  at many different points.
• Prolonged irritation may result in a decrement
  of intraneural blood flow. This, in turn, causes
  local hypoxia in peripheral nerves leading to a
  decrease in the pH of tissues. This stimulates
  the release of inflammatory mediators, called
  inflammatory soup.
• The toxic substance may contribute to the
  ongoing nociception without causing any visible
  nerve damage.
• The application of neural mobilization and
  specific soft tissue treatment may help decrease
  sciatic nerve stiffness and also help in
  decreasing intraneural pressure and/or edema by
  mobilizing the neural tubes.

4
Examination for Sciatica

• An in-depth health history intake can be
  conducted to collect information regarding the
  patients course of pain, limitations, the
  prognostic factors for delayed recovery (e.g.,
  fear of movement, inadequate coping strategies,
  low self-efficacy, fear-avoidance).
• Perform a physical exam for evaluating muscle
  strength and mobility. Screen patients to pick
  out those who are at greater risk of developing
  the severe condition and/or red flags.

5
Red flags for serious spinal pathology

• Red flags are signs symptoms that gives
  indication of more serious underlying
  pathology.for patients suffering from low back
  pain. There are many serious spinal pathologies
  that one should be aware of.
• These are spinal malignancy, spinal fractures,
  spinal infection cauda-equina syndrome (0.08
  percent of the patients suffering from low back
  pain presenting to primary care are because of
  cauda-equina syndrome).

6
Outcome Measurements

• Include one or more of the following outcome
  results when evaluating and monitoring the
  patient's progress
• Roland-Morris Disability Questionnaire
• LEF - Lower Extremity Functional Scale
• Patients Specific Functional Scale
• Self-Rated Recovery Question
• Oswestry Disability Index
• VAS - Visual Analog Scale
• BPI - The Brief Pain Inventory

7
Physical examination tools used for Sciatica

• You can perform one or more of the following
  physical examinations tests and you can interpret
  results of these physical examinations tests in
  the context of all clinical exam findings.
• McBurneys Point - For Rebound Tenderness
• Piriformis Test
• FAIR Test
• Kemps Test (Lower Quadrant Test)
• Kernig or Brudzinski Test
• Well Leg Raise
• Bowstring Maneuver
• Slump Test
• Prone Knee Bend Test
• Valsalva Maneuver
• Straight Leg Raise Test

8
Treatment for Sciatica

• Education
• Educate the patient offer reassurance
  regarding the condition and the treatment options
  encourage the use of active approaches like
  physical activity to help manage the symptoms.

9
Manual Therapy

• The treatment plan should be developed
  based on patient-evaluation findings patient
  tolerance. The structures to be kept in mind when
  evaluating treating sciatica patients could
  include neurovascular structures the investing
  fascia of the following structures
• Piriformis, gemellus superior, externus and
  internus obturators, gemellus inferior, and
  quadratus femoris - External Rotators of The Hip
• Quadratus Lumborum
• Multifidus Erector Spinae (spinalis,
  iliocostalis, longissimus)
• Latissimus Dorsi and Thoracolumbar fascia
• Biceps femoris, semitendinosus, and
  semimembranosus - Hamstring Muscle Group
• Gluteus maximus, gluteus medius, gluteus minimus,
  and tensor fasciae latae - Gluteal Muscles

10
Self-Management Strategies

• Massage therapists offer hands-on therapy and
  can also create self-management programs that
  assist patients in managing their symptoms.
  Simple home-care suggestions like stretching
  hydrotherapy may be helpful for patients
  suffering from sciatica.

11
Prognosis

• The majority of patients improve over time by
  conservative treatment, including pain
  management, manual therapy, and exercise.