Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.

1. By
Farshid Mokhberi
Shahid Beheshti University of Medical Sciences

3. What is Sciatica?
Injury to or
compression of the
sciatic nerve.
Low back pain that
travels down
through the buttock
and possibly into
the leg.

4. This pain is started slowly & increases with passes time.
It will be worse in sitting , standing , sneezing , coughing .
The feature of this pain is involving only one of the lower
limb.
In lots of intensive cases of pain , probably loosing the
control of bladder or intestine. In this situation surgery
is necessary.

5. Sciatic Nerve Background
Largest nerve of the body.
Usually a combination of
nerves roots that include:
L4, L5, S1, S2, S3.
Leaves pelvis through the
greater sciatic foramen
and passes through gluteal
region, which then enters
into the posterior
compartment of thigh.
Sciatic Nerve then divides
into common fibular and
the tibial nerve.

7. Physiology of sciatic pain
This type of pain is caused by a problem with one or more
nerves themselves. The function of the nerve is affected in
a way that it sends pain messages to the brain.
Neuropathic pain is often described as burning, stabbing,
shooting, aching, or like an electric shock.
Neuropathic pain is less likely than nociceptive pain to be
helped by traditional painkillers. However, other types of
medicines often work well to ease the pain.

8. Causes neuropathic pain
Trigeminal neuralgia.
Postherpetic neuralgia (pain following shingles).
Diabetic neuropathy - a nerve disorder that develops in some
people with diabetes.
Phantom limb pain following an amputation.
Multiple sclerosis.
Pain following chemotherapy.
HIV infection.
Alcoholism.
Cancer.
Atypical facial pain.
Various other uncommon nerve disorders.

10. Mechanism of Injury
Herniated or slipped disc.
Posterior dislocations or fractures
to the hip joint
Piriformis syndrome.
 Inflammation of the piriformis
muscle.
Pinching of the sciatic nerve.
Injections to buttock.
Trauma to the buttock.

11. Herniated Disc
With extreme forces these disc
bulges may tear the annulus
fibrosus & allow leakage of
nucleus pulposus
The chemicals of nucleus
pulposus can cause swelling of
nerves resulting in constant
burning pain termed lumbar
radiculopathy or sciatica, pain
radiating down the leg & feet

12. Risk Factors
Age. Age-related changes in the spine, such as herniated disks and
bone spurs, are the most common causes of sciatica.
Obesity. By increasing the stress on your spine, excess body weight
may contribute to the spinal changes that trigger sciatica.
Occupation. A job that requires you to twist your back, carry
heavy loads or drive a motor vehicle for long periods may play a role
in sciatica, but there's no conclusive evidence of this link.
Prolonged sitting. People who sit for prolonged periods or have
a sedentary lifestyle are more likely to develop sciatica than active
people are.
Diabetes. This condition, which affects the way your body uses
blood sugar, increases your risk of nerve damage.
Genetics. There is two gene that maybe is cuases sciatica.

14. Signs and Symptoms
Described as shooting or
tingling pain and sometimes
numbness.
Prolonged sitting or standing
can worsen pain.
Usually only occurs on 1 side
of the leg.
Weakness of muscles in the
posterior thigh could be due
to spasm, trauma, and
inflammation.
Weakness of the muscles can
also show an abnormality in
the patient’s gait.

15. Palpation of Sciatic nerve
Patient flexes hip,
press firmly between
the ischial tuberosity
and the great
trochanter
The nerve is barely
palpable but if injured
it will become point
tender.

16. Special Test

17. Special Tests
Straight leg raising test should be performed to detect nerve
root irritation
Even with a soft tissue pain source, SLR can be used as an
index of finding the place of pain
 Well Leg Straight Leg Raising Test
Lifting uninjured leg produces pain.
Sitting Root Test
Patient sits with neck flexed and their knees extended, while hips are
flexed at 90o
. (pain is the positive sign)
Further Testing to confirm sciatica would be:
Spinal X-ray
MRI
CT Scan

18. Imaging Test

19. Imaging tests
X-ray. overgrowth of bone (bone spur) that may be pressing on a
nerve.
Magnetic resonance imaging (MRI). Cross-sectional images of
your back. MRI produces detailed images of bone and soft tissues such
as herniated disks.
Computerized tomography (CT) scan. When CT is used to image
the spine, you may have a contrast dye injected into your spinal canal
before the X-rays are taken — a procedure called a CT myelogram.
The dye then circulates around your spinal cord and spinal nerves,
which appear white on the scan.

21. Management Options
Rest
Ice
NSAIDs
Moist Heat
Stretching and strengthening
Massage
Long term nerve damage can occur if not treated
promptly.

22. Therapy
Pharmacologic agents
 Opioid analgesics
 Anti-inflammatories
 Adjuvants and nonopioid analgesics
 Anti Spasm ( Baclophen)
Nonpharmacologic therapies
 Rehabilitative
 Physical Therapy
 Psychological counseling

23. Epidural steroid injection
•60-80 mg of triamcilone
with 0.25% bupivacaine
injected.
•Cortisone injection for
suppress inflammation.

24. Surgical Treatment
Diskectomy- removal of a
portion of the herniated disc
that is irritating the nerve
root.
This surgery helps alleviate
pressure and inflammation, if
conservative management
options such as the ones we
just discussed do not relieve
pain.

25. Sciatica Rehab
After back surgery, you will generally need Avoid:
1- Driving
2-lifting
3-bending forward for about a month
There's an excellent chance you'll be able to get
back to all your usual activities.

26. Exercises
Focus on exercises that
strengthen and stretch
the abdominal and back
muscles for core
stabilization.
Decreases muscle
imbalance, which can
result in decreasing
spasm and pain.

28. Prevention
Maintain a healthy diet and weight
Do not using pocket bag
Exercise regularly
Maintain proper posture
Avoid prolonged inactivity or bed rest
Do not smoke
Use good body mechanics when lifting
Not sleeping on your stomach

29. The time to visit a doctor
The pain is usually becomes better after 2 weeks, but
if it lasts more that 6 months you should visit a Dr.
If the pain is becoming more severe every day in this
case you should also visit a Dr.
Other conditions that necessary to visit a Dr.
• Having an accident
• Having the most severe pain at the first time with lack
of sensation
• Having problem on defecation

30. Thanks for your attention

31. Sources
www.rullichiropractic.com
www.mayoclinic.com
www.nlm.nih.gov/medlineplus
www.emedicinehealth.com
www.spine-health.com