Causes, symptoms and treatment of sciatica
What is lumbar radiculitis?
Lumbosacral sciatica is a disease affecting the peripheral nervous system. With this pathology, compression and inflammation of the roots of the spinal nerves in the lumbosacral spine.
This disease occurs quite often. According to statistical data, about 10% of the adult population is affected to varying degrees. The risk group includes people of working age from 35 to 50 years. The main cause of the disease are degenerative-dystrophic changes in the spine( osteochondrosis).
For lumbosacral radiculitis usually characterized by a chronic course, with periodic exacerbation of varying duration. The development of the disease is provoked by finding and working in bad climatic conditions and considerable physical stress on the spine.
Causes of lumbosacral radiculitis
Lumbosacral sciatica is a complex of symptoms arising from irritation or compression of the roots of the spinal cord. This is not an independent disease, but a pathological process that has a secondary character.
Earlier it was believed that the cause of the development of radiculitis is an infection. Currently, most experts are of the opinion that it is one of the consequences of the development of osteochondrosis( degenerative changes occurring in intervertebral discs).
When the intervertebral discs of the spine receive insufficient nutrition, qualitative and structural changes of non-inflammatory nature begin to occur in their tissues. The fibrous ring surrounding the pulpous nucleus of the disk, dries and compacts, cracks are formed in it. As the degenerative process develops, the nucleus of the disc together with the fibrous ring protrudes into the intervertebral canal( protrusion of the disc), or the fibrous ring breaks and the nucleus exits( hernia of the intervertebral disc).
The height of intervertebral discs is reduced, the ligamentous apparatus is weakened. To compensate for excessive mobility and prevent possible displacement of the vertebrae, bony projections, called osteophytes, grow on the vertebrae edges.
As a result, bulging or dropping disks, coupled with soft tissues that are injured by osteophytes, put pressure on the closely spaced nerve endings of the spinal cord, against which a characteristic pain syndrome arises. Progression of osteochondrosis can lead to such a complication as stenosis( narrowing) of the spinal canal. This process can capture and foraminar channels. Bunches of nerve fibers leave the spinal canal through the foraminous openings between the vertebrae and are sent to the lower extremities and internal organs. Their squeezing causes characteristic symptoms of pinching of the sciatic nerve.
In addition, the development of lumbosacral radiculitis can be triggered:
Injuries of the spine;
Tumors of the peripheral nervous system;
Other diseases, such as arthritis or spondylolisthesis;
Inflammatory process in the near-vertebral soft tissues;
Metabolic disorders( deposits of calcareous salts that cause the formation of osteophytes);
Regular increased strain on the spine;
Another attack of radiculitis can be caused by:
Sharp or awkward movements of the lumbar region of the back.
Thus, the causes of lumbosacral radiculitis are of a polyethological nature.
Symptoms of lumbar sciatica
The general symptoms of lumbosacral radiculitis include:
Pain syndrome of varying intensity and localization, which is aggravated by abrupt movements of the lower part of the trunk, with falls, lifting of weights and other physical exertions on the lower back;
Strengthening pain when coughing, sneezing, tension of abdominal muscles;
Restriction of movements with torso tilting to the sides, forward and back;
Such impellent violations as the inability to stand on your fingers or bend your toes.
Depending on the severity of the lesion, the pain can be localized in different parts of the body: in the lumbar and gluteal regions, the hind and frontal surface of the thigh, the calf muscles and the calves. Also, the pain syndrome can affect both one and both sides of the body. Explain this by the nature of the protrusion of intervertebral discs( median or lateral).
When lesions of nerve endings under I-II lumbar discs, lumbar and buttock lumbago, pain sensations passing along the posterior and lateral surfaces of the thigh are observed. With the defeat of the nerves of IV-V lumbar discs, the pain drops to the anterior part of the shin, the calf muscle, the outer ankle and the heel;there are violations of flexion of the foot and the big toe.
The acute period of sciatica continues for an average of 2-3 weeks. For its diagnosis, the following set of specific symptoms is also used:
Bechterev's symptom - a reflex leg flexion is observed on the side of the lesion when passing from a supine position to a sitting position;
Symptom Lasega - pain in the lumbar, gluteal region and the back surface of the leg is dramatically increased during lifting of the straightened leg in the supine position;
Dejerine symptom - pain increases during coughing and sneezing;
Symptom Bonnet - on the side of the defeat the fold under the buttocks is smoothed;
Symptom Neri - pain in the lower body increases with a sharp tilt of the head forward.
For radiculitis caused by osteochondrosis, external changes in the body are also characteristic: straightening of the lumbar lordosis, an increase in kyphosis, scoliosis with bulging in the direction of the lesion. In the pathology of the disc between the V lumbar and I sacral vertebrae, it is possible to develop a scoliosis with a concavity to the healthy side.
The cause of infectious infection of the nerve roots of the lumbosacral can be acute( influenza, malaria) or chronic( brucellosis) infections. The pain increases with the body tilted forward and does not increase during the load on the spine. Vegetative disorders are possible. In this case, with the extinction of the inflammatory process, the pain stops relatively quickly. There are no deviations on X-rays.
Treatment of lumbosacral radiculitis
Treatment of the disease is carried out depending on the causative factors( infectious-inflammatory or disco-conditioned) and its stages( acute or chronic).
Conservative treatment is complex and includes:
Bed rest( in acute period);
Wearing a corset for immobilizing the spine;
Use of drugs that remove inflammation( in the form of injections, tablets, topical products);
Use of muscle relaxants, eliminating muscle spasm in the lumbar region;
Physiotherapeutic procedures that provide analgesic and preventive action;
Extension of the spinal column;
Exercises exercise therapy, aimed at strengthening the muscles and forming a muscular corset, supporting the spine.
Medication for lumbar sciatica
The most effective drugs to date remain from the group of non-steroidal anti-inflammatory drugs. They stop the inflammation and remove the swelling. However, NSAIDs have a number of contraindications, have a negative effect on the gastrointestinal tract and are not recommended for long-term use.
With a sharp exacerbation, Diclofenac, Ibuprofen, Orthofen tablets are taken, afterwards, after easing the pain, it is better to use ointments and creams that are applied to the sites of pain localization. These include Finalgon, Apizarthron, Diclofenac, Naise, Indomethacin. Well-proven ointment based on snake venom Viprosal. Provoking local irritating effect, it improves blood circulation in the affected area.
Injections and blockades are prescribed for very severe pain. But they do not cure the disease, but only relieve the symptoms. As anesthetics, Novocain, Lidocaine, Trimecaine are used. Depending on the nature of the course of the disease, chondroprotectors or milgamma are put.
Of muscle relaxants are used Midokalm, Baksolan, Sirdalud. However, they also have many side effects and should be applied only once.
Physiotherapy with lumbar radiculitis
In the subacute stage, together with drug therapy, ultraviolet irradiation of the waist and legs along the affected nerve is performed.
It is often used electrophoresis with various medications: novocain solution, a mixture of phenol, dicaine and adrenaline solutions, with virapin ointment. Also electrophoresis with an extract of medical mud is done. With infectious radiculitis - with salicylates, a solution of copper, lithium.
In the acute stage with discogenic radiculitis, ultrasonic therapy in pulsed mode is prescribed, in which a mixture of analgesics can be used as a contact substance. With the weakening of symptoms, ultrasound is used in both pulsed and continuous mode. In the infectious nature of radiculitis, an effective combination of ultrasound with hydrogen sulphide and sodium chloride baths is effective.
Diadynamic currents showed good results in which small electrodes are installed on the nerve root exit zones and along the affected nerve.
In severe infectious lesions, physiotherapy is supplemented by injections of antibiotics or urotropine( intravenous).
In lumbar sciatica caused by osteochondrosis, traction on the inclined plane is very important. It can be carried out on a simple bed, the head of which is raised by 10-15 cm. The body of the patient is fixed at the head level. Stretching may be short-term( 2-3 times a day for 10 minutes) and long( up to 2 weeks), depending on individual tolerability.
Indications for surgical intervention are( in complex):
Pain syndrome, not amenable to conservative treatment for 3-4 months;
Severe neurological symptoms;Symptoms of degenerative-dystrophic changes in discs on the roentgenogram;
Changes in the composition of cerebrospinal fluid;
Dysfunction of the pelvic organs.
Exercises for radiculitis
Physiotherapy is an important component of therapy. It must be done under the supervision of a doctor in the chronic stage of the disease and in subacute periods, for the prevention of relapses.
Before you start, you need to assess the condition of the spine, check the gait, reveal the tolerability of stretching and movement, which increase pain. With discogenic radiculitis, stretching the back is an obligatory part of medical gymnastics and is performed at the beginning and at the end of the complex.
Basic exercises of the complex:
Passive and active leg exercises in the supine position.
During the opening period, the focus is on relaxation skills: the muscles of the arms, legs, and trunk relax at rest and during the execution of elementary movements.
In the basic period, stretching exercises are added. Each exercise should end with relaxation of the muscles of the whole body. Useful vises on the hands on the bar or the gym wall for 30-60 seconds.
As the pain is extinguished, it is possible to include in the exercises strength exercises( with objects or, when the role of burden fulfills the weight of your own body).
Corrective exercises for correcting posture can be done only after complete cessation of the pain syndrome.
A small training complex can be viewed on the following video:
Author of the article: Andrei Sokov, neurologist, especially for the site ayzdorov.ru
How to treat lumbosacral sciatica
When talking about radiculitis in the imagination, a figure is immediately drawna bent man holding his lower back. Indeed, this disease most often affects the lumbar region. And this is not surprising: the load on this part of the back exists almost continuously, even if we are not engaged in physically hard work or active activities associated with intense tilts and turns of the trunk, but just stand or sit. Especially subjected to stress transitional segments of the spine, located on the border of two departments. One of them is the vertebral segment l5 - s1. Pathologies in it and lead to lumbosacral radiculitis, the treatment of which we will talk in this article .
The most common lumbosacral radiculitis occurs on the basis of degenerative dystrophic processes in the l5-s1 segment due to age-related changes or sedentary lifestyle
Causes and symptoms of sciatica
When talking about the etiology of the disease, one can not help noticing some patterns. Who most often develop lumbosacral radiculitis? At risk people:
- Those who are barely over forty and elderly
- Those who live and work in severe conditions of the north
- Those who often get wet( for example, fishermen, water tourists, rowers)
- Constantly experiencing heavy loads( athletes, loaders)
- Forced to stand idle for hours or sit in the same posture( machine workers, drivers, mental workers, students)
Reasons for radiculitis
If you have noticed, age is by no means the only factor in such a disease as the lumbosacralsciatica, though for some reason it is considered to be only a disease of older. Today, in this etiological scale, there has been a clear shift to the last of these factors - the factor of sedentary lifestyle .It is the smallest mobility that leads to the early development of degenerative dystrophic processes( DCF), the main cause of lumbosacral radiculitis:
to various forms of arthrosis and arthritis, hernial formations, spondylitis
. Other causes of may be caused by DCF:
- Hereditary diseases
- Failures of intra-metabolic processes, endocrine and immune disorders
- Congenital or acquired vertebral anomalies( sacralization, lumbarization) and bias
- Scoliosis strains and t.
How does sciatica develop in DDD
- Deforming changes in the intervertebral discs result in the breakthrough of the fibrous ring and the release of the pulpous disk nucleus beyond its limits
If the exit of the nucleus( hernia) is directed toward the spinal canal, this formation and the nerve root can come into contact, resulting in irritation -i.e. radiculitis
- There is also a protective reflex pain symptom in the form of a muscle reaction - myofascial syndrome:
muscles come in a state of increased tone,to relieve pressure on the nerve by increasing the spacing between the vertebrae of the lumbosacral section of the
- The longer there is radiculitis, the more it flows into the chronic process
In the later stages of radiculitis, spondylosis develops:
Spondylosis at the edges of the thinned disc and vertebrae begins to appear abnormal compensating bony proliferation- osteophytes
- Osteophytes, irritating muscles, nerves and vessels, lead to even more acute and prolonged attacks of radiculitis and mobility limitations
Symptoms of lumbosacral radiculitis
How does lumbosacral radiculitis manifest?
Symptoms of lumbosacral radiculitis are pain and paresthesia in the lumbar and gluteal regions that extend over the hip, shin, and foot surfaces of the
- . Almost always it starts with the symptoms of sudden and sharp pain in the lumbar region of the
- . The pain may coincide with the rise in severity, activemovements, physical exertion or hypothermia
- Painful symptoms can last up to three weeks and progressively pass from acute manifestations to more moderate
- From the lumbar region painsprostranyaetsya further - into the back of the leg
simultaneous presence of pain symptoms in the lower back and limbs - a rare phenomenon. Even more rarely there is pain only in the leg
- The nature and spread of pain depends on the level of lesions of the nerve roots
- If the lumbar spine l5 is annoyed, the pain zone includes :
- gluteal region
- outer surface lateral thighs
- front - tibia
- inner part of the foot beforeof the thumb
- In the lesion of the sacral spine s1, the following areas of the suffer from pain:
- hamstring and outer thighs and lower leg
- plantar andthe outer part of the foot, including the little finger
- If the lumbar spine l5 is annoyed, the pain zone includes :
With prolonged pinching of the roots to pain symptoms,
- can connect the phenomena of paresthesia with signs of a violation of skin sensitivity and numbness of
- signs of muscle weakness, flaccid paralysis and partial decrease or even complete loss of reflexes of tendons
Clinical signs of radiculitis
Clinically lumbar-sacral sciatica manifests itself in:
- Limitation of mobility:
patient strive to lie mostly and moves with great care
- Education of analgesic scoliosis:
the spine curves to the sore side - this is due to increased muscular tension on the pathological site of
- Adopting the sick person with forced postures in which the pain is less:
- flexion of the aching leg
- choosing a specific position on the side:
With lumbosacralradiculitis in the segment l5 - s1, oddly enough, prefer to sleep on the side of scoliosis, that is, on pain
A doctor's examination allows you to determine the sciaticathe following symptoms:
- Long back muscles are in a stressed state
- Lateral pressure on the spinous processes of the lumbosacral region leads to pain that may spread to the buttock
- Skin can be affected by vegetative-trophic symptoms:
paling, cooling, sweating, impaired pulsation,e.
Classical symptoms of sciatica
In addition, there are classic "reference" symptoms by which an experienced neurologist diagnoses sciatica and sciatica :
- Strengthening pain in the lumbar region, buttock, femoral posterior surface when lifting a straight leg from a sore side - symptom Lasega
- Reflective flexion of a diseased limb at the time of transition lying in a seated position - Bechterew's symptom
- Increased pain in the lumbar region and lower limbwhen the head is tilted forward sharply - Neri symptom
- Strengthening of the pain sign by sneezing, coughing, tension - Dejerine
- symptom Smoothness of the fold of the buttock located on the sore side - Bonnet symptom
Treatment of the lumbosacral
Even if the sciatica is diagnosed during examinationdoctor, this does not mean that he can be quickly cured.
The chance of recovery depends on the cause that caused this pain, and on the stage in which the process itself is located :
- If a person calls for help immediately after the first attack, without driving the disease into chronic form through independent taking pain medications, then the cure for sciaticahe has very large
. But when the patient comes to the doctor, without feeling the legs, with half absent reflexes of the feet, with signs of urinary and intestinal disorders, whatever the treatment, it is unlikely that it is already a creatureNGOs help. Speech in this case will be maintained about the preservation of the remaining motor functions and some palliative measures
Treatment in the acute period
How to treat the lumbosacral radiculitis?
- For a sick person it is important from the first day of a radiculitis attack to create comfortable conditions of rest and a warm( literally) atmosphere:
- For two to five days it is better to lie wrapped in a waist with a woolen shawl or a warming belt.
- Heat should be dry: no hotcompresses or baths with exacerbation of radiculitis are unacceptable!
- Drug medication is carried out with a wide arsenal of remedies( NSAIDs, Novocain blockades, corticosteroids, etc.)
- The most commonly used drugs are
Diclofenac, ibuprofen, ketoprofen, indomethacin
- These drugs can not be used for a long time,, they attack many organs, especially the digestive tract
- The most commonly used drugs are
- is often used for analgesia in the lumbosacral radiculitis. People suffering from peptic ulcers should better take more modernAdmixtures :
- Complex products containing both NSAIDs and vitamins B, such as Neurodiclovitis, increase the effect of analgesia and smooth out side effects from NSAIDs.
- Treatment of muscle spasms is also anesthesia, but by eliminating myofascial syndrome. For this purpose, muscle spasmolytics( midolkalm, sirdalud, etc.) are used.
- Often in parallel with the main pain treatment, sedative sedatives are prescribed, especially if radiculitis was caused by stress.
Anesthetic effect in this case is achieved through inhibition of consciousness with the help of brain receptors
Treatment with ointments and plaster
Very many people try to treat the radiculitis with ointments of irritating action:
- viprosal by finaldon
- natyatx, etc.
Some primary analgesic effect is observed in this case, however in the future such treatment brings few results, as external agents are able to penetrate to the surface layers of the skin,but to the vertebral joints - hardly
The same applies to the recently advertised patches of radiculitis, for example, Nanoplast. No matter how good it may be by descriptions, we must not forget that this is just an external remedy that is basically a warming and irritating action, like ointments.
Methods of non-drug treatment of radiculitis
Treatment of lumbosacral radiculitis can not only be medications. In addition, the following methods are applicable:
One of the methods of non-drug treatment of sciatica is physiotherapy
- Spinal traction( spinal traction) in order to increase the spacing between the vertebrae and eliminate contact of the deforming formations with the nerve.
- Manual therapy
Non-pharmacological treatment of lumbar spine, Sacral radiculitis is carried out already when the period of exacerbation has passed to prevent the deepening of muscle spasm and worseningeniya situation.
Video: Lumbar sciatica
Lumbar sciatica and its treatment
Almost the entire adult population is familiar with the pains in the back, and usually connect them with sciatica. In fact, the causes of their occurrence are different, and only 35% fall on true radiculitis. It usually arises against the backdrop of another disease of the spine and is its symptom.
The most common cause of lumbosacral radiculitis is the osteochondrosis of this part of the spine. The protrusions of the intervertebral disc, enlarged osteophytes and spasmodic muscles characterizing osteochondrosis, squeeze and irritate the bundles of nerve fibers emerging from the spinal cord. With an awkward movement, incorrect lifting of the weight, there is an acute attack of radiculitis. He can pass even independently, but the reason remains, and necessarily after some time the repetition will follow.
Acute lumbosacral sciatica( lumbalgia) is manifested by sharp pain, "piercing" at the site of infringement of the rootlet. Any movement aggravates the condition, the person freezes in a certain position, becomes helpless, the muscles of the lumbar region spasmodic. Movement in this department of the spine is sharply limited. Pain can also stop suddenly, as it has appeared, or persist for several days. The condition improves when lying on a hard surface.
How to recognize sciatica?
Chronic lumbosacral sciatica, characterized by periods of remission and exacerbation, and in any case there are 3 main symptoms expressed in different degrees:
- impaired sensitivity;
- movement disorders.
Pain with radiculitis unusual
Intense, sweeping pain in the back, giving up the affected root in the course of innervation - this is typical of radiculitis. A certain posture or movements in the back strengthen it. The intensity of pain depends on the degree of infringement of the rootlet. When the lumbar spine irritates, it senses pain in the anterior abdominal wall, in the buttock and leg.
Osteoporosis progresses and the character of pain with radiculitis changes. Sciatica is associated with irritation of the sciatic nerve, consisting of the roots of the lumbar and sacral spine. Severe pain occurs along the sciatic nerve - from the waist along the back surface of the foot to the heel and foot. They increase in sitting position, with movements of the trunk and strong coughing.
More often sciatica is one-sided, but there are "lucky ones" with a two-sided process. The pain forces to tilt the body in the opposite direction from the infringement, so there is a deformation of the spine, which contributes to the rapid progression of osteochondrosis.
Massage with radiculitis can be performed with ointments
Radiculitis, it's not just pain
In addition to pain, there are other manifestations of radiculitis - a violation of sensitivity in the innervated zone. Feels chill in the thigh, tingling in the shin and foot, feeling hot or burning. The sciatic nerve has sensory and motor fibers. And the symptoms of radiculitis acquire the character of motor disorders. It is difficult to raise the foot, flexion of the lower leg and extension of the thigh. A person can not walk on heels and on toes. Gradually, the muscles of the thigh, lower leg and buttocks atrophy, legs weaken. Impaired stability of movements, gait becomes uncertain.
How to treat sciatica
Since vertebrogenic lumbosacral radiculitis occurs against the background of osteochondrosis, the treatment should be directed, first of all, to the preservation of intervertebral discs.
Neurologists believe that radiculitis can be cured if the processes in the spine have not become irreversible.Read more:
Symptoms of lumbar sciatica
In the period of severe pain, additional treatment is required:
- In case of exacerbation, the patient needs to create peace. A few days of bed rest on a hard bed will reduce the burden on the spine.
- Taking anti-inflammatory analgesics( Xefokam Rapid, Nimesulide, Voltaren) in tablets and injections quickly improves the condition.
- Muscle relaxants( Midokalm) will eliminate muscle spasm, which is also the cause of pain.
- In case of ineffectiveness of pain medications, blockades with novocaine or steroids are prescribed.
- Warming and anti-inflammatory ointments( Viprosal, Gevkamen, Dolgit, Fastum gel) expand the vessels, relieve muscle spasm.
- Group B vitamins, increase the analgesic effect.
- Massage and exercise prevent the development of atrophy and muscle weakness.
- Physiotherapeutic procedures can be prescribed from the first day of exacerbation of lumbosacral radiculitis. Electro- and phonophoresis with anesthetics, laser and magnetotherapy, diadynamic currents act multilaterally.
- Fixation of the lumbar region with the help of orthoses with vertical ribs of stiffness relieves the load from the spine and is applied until the sting of acute pain.
Physiotherapy is indispensable in the treatment of radiculitis
What massage will help with radiculitis
At all stages of treatment of chronic radiculitis massage is performed. With acute pain, only mild strokes are used. In the future, according to the indications, all methods of manual, segmental, point and hardware massage are used. More efficiently the procedure with aromatic oils and ointments. During the period of remission, one should not neglect self-massage.
Do gymnastics need
Even in the acute period of chronic radiculitis a person should not be in bed for more than 2 - 3 days. You need to move around the apartment or ward. In the first days after the easing of pain, exercises are performed only in a lying position, at a slow pace, without jerks. When the pain subsides, gradually increase the motor activity, to create a muscle corset.
During the period of remission, muscle stretching exercises are recommended. Rotations, bends of the trunk and elements of weightlifting are prohibited. Complex LFK should be compiled by an experienced instructor specifically for you and gradually expand.
How to prevent exacerbations of
Prevention of exacerbations of chronic sciatica is the preservation of a healthy spine. Therefore, the following recommendations are advisable:
- Treatment of osteochondrosis. Periodic courses of drug therapy.
- Mandatory appointment of gymnastic exercises, sparing the spine and training muscles;
- Training in rational behavior. Every patient should know what causes an exacerbation and what movements are safe.
- Use of fixing corsets for prolonged and intensive loads on the spine( driving, sitting at the table).
Please note! The load on the fifth lumbar vertebra in the lying position is 20 kg. When walking 85. In sitting position 150. If you hold a weight of 40 kg on elongated hands, then the load increases to 500 kg.
Radiculitis, it's not only pain, but also muscular atrophy, impaired sensitivity, posture and gait. Treatment should be carried out during the period of exacerbation, and in the absence of acute pain. To prevent complications of radiculitis every 4 to 6 months, it is necessary to conduct courses of massage, vitamin, reflex and physiotherapy.
Radiculitis of lumbar: symptoms and treatment
If the sciatica affects the lumbosacral spine, then it is considered a polyethological disease. Any sudden movements, physical overstrain in the lumbar region, hypothermia, intoxication or colds can trigger an aggravation of radiculitis.
The main symptom that indicates that the lumbosacral region is affected by sciatica is severe back pain, which radiates to the thigh, or rather to its posterior part. In 80% of the pain occurs initially in the back of the , only then it gives back to the foot.
Simultaneous pain in the leg and lower back occurs at an early stage quite rarely, as well as only pain in the leg. Depending on the degree of damage depends on the nature of pain.
In case of inflammation or infringement of the fifth root of the lumbar region, the patient may complain of acute shooting pain in the buttock area, the front surface of the shin, the outer-lateral surface of the thigh, the inner side of the foot sometimes up to the thumb. The manifestation of paresthesia is often a violation of skin sensitivity.
If the first sacral spine is affected, then the pain sensations go along the buttock, the outer and the back of the thigh, then along the shin and to the foot from the external and plantar side to the little finger. It is possible to observe the disappearance or simply lowering of the Achilles tendon reflex.When diagnosing the disease, it can be seen that the muscles are tense - this is their protective state. Also, when examined, it is possible to identify a number of other symptoms - vegetative-trophic disorders: increased sweating, pallor and coldness of the skin, weakening of pulsation in the arterial foot and others.
When examining a patient with suspected lumbosacral scars, the symptoms have the following expression:
- Bechterew's symptom: the patient should sit down from a reclining position on the back, with the patient's leg bending at the reflex level;
- symptom Lasega: the patient lies on his back, and his leg on the side of the lesion is raised in a straightened position.with the pain syndrome sharply increased in the lumbar region, back of the thigh and gluteal region;
- Dejerine symptom: when sneezing, coughing, or straining, the patient feels an increase in the pain syndrome in the lower back;
- Neri symptom: if the patient sharply tilts his head forward, then it occurs in the lower back, and also in the leg pain intensification;
- Bonnet symptom: the gluteal fold on the side of the disease is flattened.
Diagnosis of the disease
To ensure that the diagnosis and, as a result, the treatment of sciatica are successful, you should consult a qualified, competent doctor who will perform a differential analysis of with similar diseases in its symptoms.
In addition, an experienced specialist will take into account all diseases that a patient may have. Anamnesis is the first stage in the diagnosis of lumbosacral radiculitis. Even at the very beginning of the survey, one can already assume that it led to the development of sciatica in the lumbosacral spine. Only after a thorough examination, the doctor prescribes additional methods of diagnosing the disease. Among them may be:
- laboratory( urinalysis and general blood test);
- methods with which you can visualize the disease( X-ray pictures, CT, MRI);
Treatment should take place in such conditions that the patient has been maximally protected. First of all, the patient should be given rest.
It is also necessary to pay attention to the bed of the patient with radiculitis - it should be rigid, it is best to sleep on a special orthopedic mattress. It is advisable not only to limit the load on the lumbar spine, but also to minimize the movement of the damaged part of the .
It is possible to wear corsets, but not more than 3 hours a day. In addition, the treatment of radiculitis is almost always medically necessary.
The amount and timing of drug use is determined by the stage of the disease. Medication is used for local and systemic therapy.
The local treatment of is the use of ointments on the affected area, and systemic therapy means taking medications inside or injections. The primary goal of taking medicines is to remove the pain syndrome.
Systemic treatment of includes the following remedies for radiculitis:
Manifestation and treatment of lumbosacral radiculitis
A frequent reason for going to the doctor is back pain( dorsalgia), especially in the lumbosacral region. The mechanism of its development can be different. If the pain syndrome occurs due to infringement or inflammation of the roots of the spinal cord nerves, this condition is called radiculitis or radiculopathy.
In the lumbosacral spine, massive, intervertebral discs between them have a lower height than in the overlying areas. It is on this area that the maximum load is borne by bends, corners of the trunk, improper lifting of the load. All this causes a frequent lesion of the lumbar vertebrae, discs and nerve roots that exit between adjacent vertebrae.
- congenital anomalies of the spine with irregular structure and position of bones;
- acquired disorders of posture( scoliosis);
- inflammation near the vertebra, leading to swelling and squeezing of the roots;
- infectious-inflammatory or autoimmune lesions of roots;
- primary tumors of different tissues and metastases.
The most frequent cause of infringement of rootlets in the lumbar region is degenerative changes in the vertebrae and intervertebral discs( osteochondrosis).
The disc thus becomes less elastic, low and no longer holds between adjacent vertebrae due to the destruction of the outer shell. There are protrusions( protrusions) or prolapsed structures of the disc( hernia).They squeeze and push back the nerve root, leading to tension, inflammation, ischemia of this formation. There is discogenic radiculitis.
On the vertebrae, bone spines, antennae, outgrowths of marginal areas are formed. All this narrows and deforms the holes to exit the rootlets, and when the outgrowths traumatize the roots. Such a radiculitis is compression.
Infringement of the spine is acute after an unsuccessful turn, jump, sharp extension in the loin, lifting of the weight, with spasm of the lumbar psoin invertebral muscles against the background of a long uncomfortable position of the body, sometimes against a background of stress.
Inflammations and tumors give a picture of subacute development of radiculitis, usually the same provoking moments are present.
Manifestations of radiculitis
Radiculitis is primarily a pain syndrome. The pain is one-sided, strong. Because of it, the body tilts in the opposite direction( to widen the distance between the vertebrae), the movements in the lumbar region are severely restricted. Pain can be given to the buttock, thigh, down to the popliteal fossa.
The muscles in the lower back are tense, the walk is limp, sparing the affected side. Acute pain only in the lumbar region( like a lumbago) is called lumbago. If it appeared at the torso, the person sometimes can not straighten.
There are neurological manifestations - symptoms of Lasega, Neri tension, etc., changes in tendon reflexes, skin sensitivity and muscle strength. Sometimes there are moderate signs of inflammation - fever, malaise.
The acute form of infringement of a root can pass in a chronic current, in this case neurologic signs with decrease in force in legs or foots will begin to grow and the atrophy of muscles will begin.
Radiculitis leads to temporary disability and requires comprehensive treatment.
Principles of Treatment of
Directions of exposure in the treatment of acute stage radiculitis:
- elimination of the etiologic factor( if possible);
- pain relief;
- reduction in muscle tension;
- improved the functioning of nerve fibers, increased nerve conduction.
In the first days of the disease, the physical load of should not be given to the affected area. Therefore, exercise therapy is only permissible after a reduction in the severity of the process, in the period of recovery and rehabilitation. In this case, it is necessary primarily to correct pathological settings and complexes of movements, strengthen the muscular paravertebral corset, that is, to prevent repetition of infringement of rootlets.
In chronic radiculitis therapy during an exacerbation of is performed as well as treatment of lumbago. But later, measures will be included to reduce the constant compression of the spine.
Treatment may include:
- intramuscular and intravenous injection,
- and also administered as part of different blockades.
Preference is given to conservative methods of treatment, while simultaneously using drugs from different pharmacological groups and various non-pharmacological techniques.
The operation is indicated in the absence of the effect of complex conservative treatment for 1.5 months, with a rapid increase in weakness in the leg and with the attachment of disruption of the bladder and sphincter of the rectum. This can be endoscopic discectomy( removal of the disc), laminectomy( removal of a part of the vertebrae that infringes the spine).
Drugs for radiculitis
In acute radiculitis and with exacerbation of the chronic process, different drugs are used. These include:
- non-steroidal anti-inflammatory drugs( NSAIDs);
- antibiotics and therapeutic sera for infectious etiology;
- vascular and neurotrophic agents;
- burning ointments with a distraction effect;
- means with cooling effect for skin application;
- psychotropic drugs( tranquilizers, tricyclic antidepressants).
A combination of different means is used. This has a multifaceted impact and can reduce the period of acute pain. In infectious nature, it is necessary to influence the causative agent, for which, taking into account the etiology, antibiotics, vaccines or serums are prescribed.
Reduction of pain intensity is necessary not only for subjective improvement of well-being, but also for medical purpose. Pain causes a protective muscle tension. Prolonged tonic tension leads to swelling of the tissues and compression of nearby structures, including nerve roots.
Pain can be reduced by blockade of pain receptors, limiting the number of nerve impulses going to the central nervous system, reducing the severity of inflammatory reactions and edema. Preference is given to means with several mechanisms of action.
NSAIDs are a first-line drug in the treatment of radiculitis, reducing the production of inflammatory mediators and reducing edema of tissues. Thus, they have both an analgesic and a curative effect. These include Diclofenac, Ibuprofen, Naproxen, Ketoprofen, Arkoksia, Movalis, Voltaren and many others. Some of them are produced not only in tablet form, but also in the form of solutions for injections, ointments and gels for external application over the focus of inflammation and damage.
In the treatment of NSAIDs, daily and age-related dosages should be observed, the picture of the OAB and the state of the gastrointestinal tract should be monitored. Preparations of this group can cause damage to the stomach and duodenal mucosa( up to ulcers), immunoallergic damage to the liver, tendency to bleeding. Presence in the anamnesis of aspirin-dependent bronchial asthma, stomach ulcers limit the use of these funds.
Ketonal, Ketanov are used for painkillers. They have a fairly fast and powerful effect. With severe pain, narcotic analgesics are prescribed for a short time.
Given the severity of pain with radiculitis, is widely used as a therapeutic blockade of with the use of analgesics, steroids with the addition of vitamins. Enter a strictly dosed mixture of Novocain( Lidocaine), corticosteroid and one of the vitamins of group B( Thiamine B1 or Cyanobalamin B12).
The use of blockades can reduce or stop pain very quickly, often even during the procedure. Drugs in this case enter the area of the lesion, acting directly on the spine. Nerve impulses are blocked, edema is removed, blood supply is improved due to vasodilation.
Blockade medications can be administered:
- subcutaneously( with novocaine blockade),
- is paravertebral in the area of the restrained root;
- epidurally - into the space inside the spinal canal at the level of the sacrum, between the periosteum and the dura mater, that is, before the roots are out of the spine;
- is epidural - in a similar to epidural space, but located from the lumbar level and above.
In the radiculitis it is recommended to use also muscle relaxants ( Midokalm, Methocaramyl, combined drug Scutamyl).They can reduce reflex muscle spasm, relaxing the skeletal muscles and not affecting the internal organs. They are contraindicated in case of myasthenia gravis, expressed slowing of heart rhythm.
To improve the blood supply of and the supply of tissues, may be prescribed vascular medications - Eufillin, Pentoxifylline( Trental).In an acute condition, they are usually administered intravenously. Contraindications are cardiac arrhythmias and severe liver disorders.
In the development of peripheral paresis, use of Proserin, Dibasol, helping to restore motor function.
Widely used products for applying to the skin .They are of 3 kinds:
- containing NVS, based on poisons( bee, snake) and locally irritating. These are various gels and ointments, which are rubbed and massaged onto the undamaged skin of the loin over the site of infringement.
- Optimum use of pharmaceutical products, although there are traditional medicine products based on turpentine, body-water, red pepper, camphor and other substances.
The use of non-steroidal agents in ointments gives less effect, but reduces the risk of side effects compared to tablets and injections.
- Ointments with poisons( Apizartron, Mellivenone and Viprosal) increase blood flow, improve metabolism under the application site, remove edema of roots.
- Local irritants have a rapid warming and distraction action, leading to local vasodilation and improved tissue nutrition. These include Finalgon, Kapsikam, Gymnastal.
- There are also special plasters.
Treatment of radiculitis is the use of various drugs, supplemented by a wide range of non-medicament measures.
Non-pharmacological treatment of
Resting the affected area is the most important condition for .This reduces the risk of infringement of neighboring roots, helps to cope with muscle spasm and reduce pain. Inadmissible attempts to "develop" the lower back, in an acute period, various exercises are contraindicated. In the first day, the half-bed regime is optimal, sleep on an even semi-rigid base with a mattress shield, restriction of movements and back support with a removable corset. Rise from the bed should be carried out without twisting movements of the torso, only by turning the whole body.
In the first day, the pain is often alleviated by local cooling with tissue wrapped with ice packs or camphor skin lubrication. In the subsequent recommend warming up and wearing special belts from wool( sheep, dog, camel).
A physician can be assigned stretching by its own weight. To do this, the bed shield is lifted so that the head end is 30-40 degrees higher. Armpins placed through the armpits fix the upper part of the body, and the weight of the trunk stretches the intervertebral spaces, reducing pressure on the roots.
Manual therapy is acceptable with compression radiculitis. If the infringement is of a discogenic nature, then only separate methods are used. And in the case of a disc herniation, it is generally not advisable to use this method of treatment in an acute condition.
Physiotherapy is allowed in the first day of .These can be:
- microcurrents and galvanic currents,
With the help of electrophoresis, it is possible to inject anti-inflammatory, anesthetic substances and microelements( lithium, copper).And in the subacute stage, electrophoresis of therapeutic mud, mud applications, therapeutic baths is additionally used.
The massage is carried out after the acuity of pain is reduced, soon the physician is attached to it under the supervision of a doctor and an instructor. The initial exercises are carried out in the bed, in the future the volume of the load increases.
Treatment of radiculitis should be intensive and complex, using various drugs, ointments, non-medicamentous methods. In the rehabilitation period, it is necessary to continue therapy to restore the nerve conduction along the spine, increase the volume of movements, strengthen the muscles and prevent repeated infringement.
For prevention of lumbosacral radiculitis, the work load should be optimized, avoiding twists, abrupt extension of the trunk, prolonged stay in an uncomfortable position. If it is necessary to lift weights, the main load should lie on the muscles of the thigh, and not on the lower back, that is, it is necessary to lift the load from the half-squat with the vertical position of the body. You also need a comfortable ambient temperature without dampness and drafts. The term sciatica describes the symptoms of leg pain and, possibly, tingling, numbness or weakness that occur in the lower back and pass through the buttock andDown the large sciatic nerve on the back of the foot.
Radiculitis is one of the symptoms of the underlying disease - this is not a medical diagnosis in itself.
Treatment of radiculitis
In severe or recurrent radiculitis, treatment of this condition should be carried out, possibly in such a way that it does not deteriorate over time.
- For the most part, easily accessible non-surgical products and regular exercise for a long time can relieve pain.
- For others, when pain is severe or not, a more structured approach to treatment and possibly surgical treatment can offer a better approach to the search for pain relief and prevention or minimization of future recurrence of lumbosacral radiculitis.
Non-surgical treatment of radiculitis
The types of non-surgical treatment of lumbosacral radiculitis cover a wide range of possible options, with the aim of alleviating the pain caused by jamming the nerve roots. One or some combination of the treatments listed below is generally recommended in conjunction with a special exercise program.
Heat / ice
With acute radiculitis, ice packs or warmers are readily available and can help alleviate leg pain, especially in the initial phase. Usually, ice or heat is held for about 20 minutes, and repeated every two hours. Most people use ice at first, but some people get more relief from the warmer. They can be alternated.
Drugs for radiculitis
Drugs prescribed without a prescription or prescription can also be helpful in relieving pain with radiculitis. Non-steroidal anti-inflammatory drugs( eg, ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids may be helpful in reducing inflammation, which is usually a factor that causes radiculitis.
What is important to know in the treatment of radiculitis
For the treatment of joint pain, many self-prescribe themselves similar remedies and ointments based on diclofenac, without first consulting a doctor. These drugs are really powerful and effective, but cause a large number of side effects up to the stomach ulcer. It is because of side effects that NSAIDs can not be used for a long time, and ideally they should be alternated with warming ointments-harmless, but not less effective. For example, it perfectly warms and relieves pain Capsicum ointment, which is suitable for long-term use, and as a means of alternating with NSAID preparations.
Healing plasters for radiculitis
It is important to remember that tingling, itching, burning, numbness, slight or severe pain are signs that may indicate localized neuropathic pain with radiculitis. In certain cases, it is characterized by persistent and persistent painful sensations, which are not removed by usual analgesics. In the treatment of localized neuropathic pain, local action is considered preferable for pain relief, for which drugs are developed that can cope with it by direct contact with the skin. Doctors often prescribe a modern drug Versasitis - an anesthetic plaster with lidocaine, which when applied to the painful area of the skin, protects and nicely cools it, relieving painful sensations of any intensity.
Epidural injections of steroids
If pains in the lumbosacral radiculitis are intense, an epidural injection can be made to reduce inflammation. Epidural injection is different from oral medications, since steroids are injected directly into the painful area around the sciatic nerve to help reduce inflammation, which can be the cause of the pain. While the effect is usually temporary( pain relief can persist for from one week to one year), and it does not work for everyone, epidural steroids injection can be effective in assisting against an acute attack of radiculitis. It is important that it can provide sufficient relief to allow the patient to improve their health through a special exercise program and physical exertion.
Alternative treatment for radiculitis
In addition to standard treatment, several alternative treatment procedures have also been shown to provide effective pain relief in radiculitis for many patients. Three of the most common forms of alternative treatment for lumbosacral radiculitis include manipulative chiropractic, acupuncture and massage therapy.
Chiropractic / manual therapy
Spine correction and manual therapy performed by specially trained medical personnel( for example, chiropractors, osteopathic doctors, physiotherapists) are aimed at providing a better alignment of the spinal column, which in turn should help resolve a number of underlying conditions, which can cause sciatica. Manual manipulations performed in order to address the correct indications of health care workers who have received appropriate training can create an environment for better healing and should not be painful.
Practice focuses on the philosophy of achieving or maintaining well-being through an open flow of energy through specific ways in the body. Needles, thin as hair( which, as a rule, is not felt) are introduced into the skin, near the area of pain. Acupuncture was approved in the US by the FDA for the treatment of back pain, and the National Institute of Health recognized acupuncture effective in alleviating back pain, including lumbosacral radiculitis.
Treatment of radiculitis with massage
Certain forms of massage have been shown to have a number of advantages in back pain, including improved circulation, muscle relaxation and release of endorphins( natural painkillers in the body).
For most people, the good news is that lumbosacral sciatica usually heals itself, and the recovery process for most will only take a few days or weeks. In general, the vast majority of seizures of lumbosacral radiculitis occur for a period of six to twelve weeks. After the primary relief of pain, you should start a program of physiotherapy and exercises, shown with radiculitis, in order to alleviate the pain and prevent or minimize any current radiculitis.
There are several types of non-surgical professionals who specialize in treating symptoms of lumbosacral sciatica, including chiropractors, physiotherapy and rehabilitation specialists, pain specialists, physiotherapists, all of whom have been trained to provide relief of pain and help preventfuture relapses of radiculitis. It is always advisable to be under the supervision of a qualified medical professional when passing any method of treating lumbosacral radiculitis.
Physiotherapy and Exercise
Exercises of physiotherapy, including strengthening, stretching and the program of aerobic physical activities - are the main component of almost any plan for the treatment of lumbosacral radiculitis.
When patients are involved in a regular program of gentle strengthening, stretching and aerobic exercise, they can recover faster from sciatica and are less likely to have recurrence of lumbosacral radiculitis in the future.
Exercises for radiculitis usually focus on three key areas:
Strengthening exercises from radiculitis
Many exercises can help strengthen the spine and supporting muscles, ligaments and tendons. Most of these exercises for the back are oriented not only on the lower back, but also the ventral, buttock( buttocks) and thigh muscles. Together, these strong "basic" muscles can provide relief of pain, since they support the spine, keeping it in a natural physiological position, and promote movements that expand or twist the spine with less likelihood of injury or damage.
Stretching is usually recommended to relieve sciatic pain. Stretching for the sciatic nerve with radiculitis, is designed for muscles that cause pain when they are stiff and inflexible. Stretching the muscles of the back of the thigh is almost always an important part of the exercise program for radiculitis.
A small influence of aerobic exercise
Some forms of small cardiovascular exercises, such as walking, swimming or pool therapy, are usually components of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help in creating an environment of better healing. Aerobic exercise has the unique advantage of releasing endorphins, natural body analgesics, which help reduce pain with radiculitis.
The special exercises shown in lumbosacral radiculitis will depend on the underlying medical condition that causes radiculitis, as well as a number of other factors such as the patient's pain threshold and the ability to generally carry physical activity.
In severe radiculitis, patients may find the pain unbearable, and they may need rest for a day or two. However, rest more than one or two days is usually not recommended, as long rest or inaction can aggravate the pain and lead to a deterioration in physical condition. Regular movements are also important for delivering healing nutrients to affected structures that cause pain.
There are several types of health professionals who specialize in providing appropriate physical therapy services, exercise programs and instructions, including physical therapists, chiropractors, physiotherapy and rehabilitation specialists, and qualified certified sports trainers.
Surgical treatment of radiculitis
If pain in lumbosacral radiculitis is severe and there is no improvement within six to twelve weeks, it is usually advisable to consider a lower back operation. Depending on the cause and duration of pain of radiculitis, one of two surgical procedures is usually considered:
- Microdiscectomy( open small operation);
- Open decompression( lumbar laminectomy).
In cases where pain associated with radiculitis is associated with disc herniation, one can consider a microdiscectomy option or an open small operation with an increase. This operation removes part of the protruding intervertebral disc, which pinches the nerve.
This operation is usually considered in a period of 4 to 6 weeks, if there is no relief of severe pain from conservative agents. If the patient's pain and disability are severe, the operation can be considered even earlier than 4 to 6 weeks.
As a rule, about 90% to 95% of patients experience relief from radiculitis after this type of surgery.
Lumbar laminectomy with radiculitis
In cases where pain in lumbosacral radiculitis is associated with lumbar spinal stenosis, lumbar laminectomy may be recommended. In this operation, a small part of the bone and / or disc material is removed, which infringes the nerve root.
Laminectomy may be suggested as an option if spinal stenosis reduces a patient's ability to transfer physical activity to an unacceptable level. The general health condition of the patient can also be the cause of doubt, whether to perform surgery or continue to conduct conservative treatment.
After lumbar laminectomy( also called open decompression), approximately 70% to 80% of patients usually experience relief from sciatica.
This is the decision of the patient
In most cases, the operation for the treatment of lumbosacral radiculitis is elective, which means that it is the patient's decision to do or not to perform the operation. This applies to both operations of microdiscectomy and laminectomy.
The patient's decision to perform an operation is based primarily on the severity of the pain and dysfunction that he is experiencing, and the length of time during which the pain persists. The general health of the patient is also taken into account.
Typically, operations for lumbosacral radiculitis can be treated in the following situations:
- Severe leg pain that lasts 4 to 6 weeks or more.
- Relief of pain that is not achieved after concerted attempts to treat with conservative methods, such as one or a combination of oral steroids, non-steroidal anti-inflammatory drugs, manual therapy, injections, and / or physiotherapy.
- The condition limits the patient's ability to participate in daily activities.
An urgent surgery is usually necessary only if the patient experiences progressive weakness in the legs, or a sudden loss of control of the intestine or bladder.
Additional considerations for operation with radiculitis
There are many personal considerations for the patient to consider when deciding whether to perform an operation.
- Some patients may prefer to try as many different non-surgical treatments as possible and remain without surgery for as long as possible, and often they will figure out how to successfully manage their condition and control the painful symptoms. For example, a patient who periodically experiences relapses of acute pain of sciatica can find that a combination of initial rest and epidural steroids, followed by a program of sparing stretches and exercises, is effective in relieving pain as needed.
- Some patients may have personal preferences or life situations that benefit more from immediate pain relief, which is usually achieved surgically. For example, a parent with young children may not have time to undergo conservative treatment, and he may need immediate relief of pain in order to be able to take care of children and perform household duties.
An important point is that it is almost always the patient's decision to do or not do the operation, and the role of the surgeon is to help inform the patient about options that will help the patient make better choices.
For some people, lumbosacral radiculitis can be severe and disabling. For others, the symptoms of lumbosacral radiculitis may be rare and irritating, but there is a potential for deterioration.
As a rule, lumbosacral radiculitis affects only one side of the lower body, and pain often radiates from the waist along the back of the thigh and down the leg.
Back pain may be present along with pain in the leg, but usually pain in the leg is more pronounced than back pain.
- Lower back pain, if any, does not appear as pronounced as leg pain;
- Persistent pain only on one side of the buttocks or legs, but rarely on the right and left sides;
- Pain that occurs in the lower back or buttock and continues along the path of the sciatic nerve - along the posterior surface of the thigh in the shin and foot;
- Pain that is eased when patients go to bed or walk, but are aggravated in a standing or sitting position;
- Neuralgia of the sciatic nerve, which is usually described as acute or stinging, but not blunt;
- Some experience pain in the form of a sensation of "pricking with pins and needles," numbness or weakness or tingling down the leg;
- Weakness or numbness when moving a leg or foot;
- Strong or shooting pain in the leg, which can make it difficult to stand or walk;
- Depending on where the sciatic nerve is affected, pain and other symptoms of lumbosacral radiculitis may also include pain in the foot or pain in the toes.
Symptoms of sciatica for a separate sciatic nerve root
There are two roots of the sciatic nerve that come out of the lumbar spine( L4 and L5) and three that come out of the sacrum( S1, S2 and S3).All five nerves join together and form a sciatic nerve, and then branch out again in the leg to deliver motor and sensory functions to specific places in the leg and foot.
Symptoms of radiculitis vary depending on where the pinch of the nerve is located. For example:
- Symptoms of radiculitis of the nerve root L4 usually affect the thigh. Patients may feel weakness in straightening their legs, and they may experience a weakened knee reflex.
- Symptoms of radiculitis of the nerve root L5 can spread to the big toe and ankle( so-called sagging of the foot).Patients may feel pain or numbness in the upper part of the foot, especially on the skin between the thumb and the second toe.
- Symptoms of radiculitis of the nerve root S1 affect the outer part of the foot, can irradiate into the little finger or toes of the foot. Patients may experience weakness when trying to tear the heel off the ground or stand on tiptoe. The reflex "ankle-knee" can also be weakened.
Since more nerve roots can be jammed than one, patients may experience combinations of the above symptoms.
Symptoms requiring immediate attention
Rarely, the symptoms of lumbosacral radiculitis, which are rapidly aggravated, may require immediate surgical treatment. The following symptoms indicate the need for immediate medical attention:
- Symptoms of radiculitis that continue to deteriorate rather than improve, which may indicate a possible nerve damage, especially if the neurologic symptoms progress( for example, weakness).
- Symptoms that occur in both legs( the so-called bilateral lumbosacral radiculitis) causes either incontinence of the bladder and intestines or dysfunction, which may indicate a pony tail syndrome."Ponytail" syndrome is an acute compression of one or more nerve roots, which occurs relatively rarely, for example, in 2% of cases of a herniated intervertebral disc of the lumbar spine.
Patients should consult a doctor immediately if they experience any of the above symptoms.
The 6 most common causes of radiculitis
When discussing lumbosacral radiculitis, it is important to understand the underlying medical causes of radiculitis symptoms. There are 6 lower back problems that are the most common causes of sciatica:
Herniated disc herniation
A herniated disc occurs when the soft inner core of the disc( pulpous nucleus) flows out, or protrudes through the fibers of the outer core( fibrous ring) of the disc andirritates the adjacent nerve roots when exiting from the spine. In general, it is believed that sudden twisting motion or trauma can lead to bulging of the disc and radiculitis. However, most drives become weak over time due to repeated loads, eventually leading to a hernia. Herniated discs are sometimes called a slipped disc, ruptured disc, bulging disc, protruding disc, or pinching of the nerve;and lumbosacral radiculitis is the most common symptom of lumbar herniation of the intervertebral disc.
Lumbar spinal stenosis of the spinal canal
This condition usually causes sciatica inflammation due to narrowing of the spinal canal. Lumbar spinal stenosis is associated with natural aging in the spine and is relatively common in adults over 60 years of age. The condition usually occurs as a result of a combination of one or more of the following: enlargement of the joint surfaces, proliferation of soft tissues, and protrusion of the disc that presses the nerve roots in the place where they exit from the spine, causing radiculitis.
Degenerative disc disease
While degeneration of the disc is a natural process that occurs with aging, for some people, one or more degenerated discs in the lower back can also cause irritation of the nerve roots and sciatic nerve neuralgia. Degenerative disc diseases are diagnosed when a weakened disc leads to excessive micro-movement at this level of the spine, and inflammatory proteins from within the disc become prominent and irritate the area( including nerve roots).It's really not a disease, despite its name, it's part of the natural aging process.
This condition occurs when a small stress fracture allows the vertebral body to slip forward into another vertebral body( for example, the vertebra of L5 jumps out onto the vertebra of S1).Due to the combination of the collapse of the disk space, a fracture, the vertebra that slipped forward, the nerve can be jammed in the place where it leaves the spine and cause sciatica.
Pear-shaped muscle syndrome
The sciatic nerve can also be irritated, as it passes under the pear-shaped muscle behind. If the pear-shaped muscle irritates or presses on the nerve root that constitutes the sciatic nerve, it can cause pain such as radiculitis. This is not a true radiculopathy ( clinical definition of lumbosacral radiculitis), but pain in the leg can be felt in the same way as radiculitis caused by nerve irritation.
Dysfunction of the sacroiliac joint
Irritation of the sacroiliac joint located at the bottom of the spine can also irritate the L5 nerve that lies on the top of the sacroiliac joint, causing pain such as sciatica. Pain in the leg can be felt in the same way as radiculitis caused by irritation of the nerve.
Other causes of sciatica
- Pregnancy. Changes through which the body passes during pregnancy, including weight gain, a shift in the center of gravity, hormonal changes, can cause sciatica inflammation during pregnancy.
- Scar tissue. If scar tissue compresses the nerve roots, it can also cause radiculitis.
- Muscle tension. In some cases, inflammation associated with muscle tension can put pressure on the nerve roots and cause radiculitis.
- Tumor of the spine. In rare cases, a tumor of the spinal cord can press on the back of the nerve and cause symptoms of sciatica.
- Infections. Although infrequent, the infection that occurs in the lower back can affect the nerve roots and cause radiculitis.
It is important to know the underlying clinical diagnoses of the cause of lumbosacral radiculitis, as treatment methods will often differ depending on the cause. For example, special exercises for lumbosacral radiculitis, which are almost always part of the radiculitis treatment program, will be different depending on the underlying cause of symptoms of sciatica.
Disease Radiculitis is often characterized by one or more of the following symptoms:
- Constant pains on only one side of the buttock or leg( rarely occur in both legs);
- Pain is aggravated in sitting position;
- Burning or tingling down the leg( as opposed to blunt pain);
- Weakness, numbness, or difficulty in moving the leg or foot;
- Constant pain on one side of the buttock;
- Acute pain, which can make it difficult to get up or walk.
Radiculitis can vary from rare and irritating to permanent and disabling. Specific symptoms of sciatica also differ in type, location and severity, depending on the condition causing sciatica inflammation. Although the symptoms can be very painful, it is rare that permanent damage to the sciatic nerve( tissue damage) occurs.
Symptoms of radiculitis occur when a large sciatic nerve is irritated. The sciatic nerve is the largest nerve in the body, and consists of separate nerve roots that begin by branching from the spine in the lower back and collectively form the "sciatic nerve".
- The sciatic nerve begins in the lower back with the lumbar segment 3( L3).
- At each level of the lower part of the spine, the nerve root emerges from the inside of the spine, and then connects to another rootlet, forming a large sciatic nerve.
- The sciatic nerve passes from the lower back, along the back of each leg.
- Parts of the sciatic nerve branch into each leg to innervate certain parts of the leg - for example, buttocks, hips, calves, feet, toes.
Symptoms of radiculitis( eg, pain in the foot, numbness, tingling, weakness, perhaps pain in the feet) vary depending on where the nerve is trapped. For example, pinching the nerve of the lumbar segment 5( L5) can cause weakness in the extension of the big toe and, possibly, in the ankle( "sagging foot").
Course of ischial pain
The incidence of lumbosacral radiculitis increases in middle age. Rarely occurring at the age of up to 20 years, the likelihood of the occurrence of pain reaches a peak in the 50's, and then decreases.
Often, a particular incident or injury does not cause sciatica, but the pain tends to increase with time.
The vast majority of people who experience radiculitis get better within a few weeks or months, they relieve pain without surgical treatment. For others, however, pain from pinching the sciatic nerve can be severe and disabling.
There are several symptoms that may require immediate medical, and possibly surgical, interventions, such as progressive neurological symptoms( eg, leg weakness) and / or bowel or bladder dysfunction.
Since pain with radiculitis is caused by a major disease, the treatment is aimed at alleviating the underlying causes of the symptoms. Treatment, usually - is self-medication, and / or non-surgical treatment, but also for severe or insoluble cases, surgical treatment can be a choice.
Radiculitis refers to a set of symptoms caused by a problem in the lower back called by radiculopathy - a condition in which the nerve roots that approach the sciatic nerve are clamped, pinched or irritated.© Authors and Reviewers: Editorial Team of the Health Portal "On Health!".All rights reserved.
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Radiculitis: medicamentous treatment of lumbar sciatica, physiotherapy, massage
Radiculitis is a combination of symptoms characterizing the damage of vertebral discs of the lumbosacral spine. It is this zone of the spinal column that experiences the most severe loads. Radiculitis manifests itself in the form of severe pain and almost immobilizes a person.
Medication for lumbar sciatica
Before beginning treatment, the doctor appoints the patient to bed rest. Observe it is very important not to aggravate the course of radiculitis. The thing is that with radiculitis, the vertebrae are pinched by bundles of nerve endings that are displaced as a result of herniated discs. In order not to damage the nerve endings and in the future to return to the normal way of life, one should observe complete physical rest.
Since there are severe pains with radiculitis, the first stage of treatment consists of the use of pain medications. Drugs can be used orally, for example, in the form of Nisez tablets, but this method relieves pain after a while, so when taking an acute attack of radiculitis, taking tablets is ineffective. Painkillers are best injected with intravenous injections, Ketonal, Ketorol, Voltaren, Milgamma and others are highly effective.
In rare cases, sciatica requires immediate anesthesia. For this purpose, the patient is given a novocaine blockade, and the pain disappears for several hours. However, the Novocain blockade is an emergency measure, after the pain symptom is removed, it is necessary to continue treatment with nonsteroidal agents. Also in the case of a severe attack of radiculitis, the doctor prescribes muscle relaxants - these drugs relieve spasm of skeletal muscles that provoke the jamming of nerve endings. Miorelaxants are used once, since they have a large spectrum of contraindications, although these drugs are very effective in radiculitis.
Anesthetics can be used as ointments or gels. Modern pharmacology offers a large selection of medications. A good therapeutic effect is provided by Voltaren-gel, Naise-gel and other means for external use. To facilitate the patient's condition, it is better to combine drugs for external use and taking medications inside.
After pain relief, go directly to the treatment of the cause of sciatica. The patient is prescribed non-steroidal anti-inflammatory drugs, such as Diclofenac, Panoxen and others. The drug is also better to use in the form of injections to speed up the healing process. When administered orally, the effect may be slowed, but this is the only drawback. Virtually all non-steroidal anti-inflammatory drugs are well tolerated and do not cause allergic reactions.
In rare cases, sedative or sedatives are used with radiculitis. The saying "all diseases from nerves" in this case is not meaningless, since mental overstrain with radiculitis can provoke pinching of nerve endings and another painful attack.
Physiotherapy treatment is also indicated in lumbosacral radiculitis. External influence on the affected areas of intervertebral discs accelerates the healing process and enhances the effect of drugs.
Patients with radiculitis usually receive electrophoresis sessions. Physiotherapy with electrophoresis is usually combined with drug therapy. Under the influence of current, drugs penetrate the skin better, and are "delivered" directly to the diseased area. The electrophoresis session lasts only 15 minutes, but the effect is very significant. On the waist, an application of gauze is applied, which is impregnated with a solution of Diclofenac and dimexide. Diclofenac is an anti-inflammatory agent, and the dimecid solution is the conductor of the active substance in the tissue.
Massage with radiculitis
How useful is massage with radiculitis? Correct exposure to the affected area increases blood circulation, which provides a better impact of medicines. In addition, massage improves nutrition of affected intervertebral discs, which allows to stop their destruction and further development of sciatica. Also, massage increases the tone of the muscles, and, therefore, reduces the burden on the spine.
Anti-radiculitis massage is always combined with medical treatment. During the session special antiradical balsams are rubbed into the affected area, which have analgesic and warming properties.
It should be noted that at home, massage with radiculitis can not be done, it can complicate the course of the disease. The patient himself can only apply the drug with smooth, stroking movements.
Manual therapy for lumbosacral radiculitis
Manual therapy by the method of influence on the human body is similar to massage, but it can be used only at the stage of final recovery. Manual therapy is necessary, first of all, for mobilization of the patient, that is, its return to motor activity, which is exacerbated by radiculitis.
Treatment of radiculitis with folk remedies
Traditional medicine can become a good tool in the treatment of radiculitis. As a rule, most recipes are used to warm up the skin on the lumbosacral spine. Applying horseradish, mustard bandages, alcohol compresses strengthens the local blood circulation, which improves the access of drugs to the affected organ.
Traditional medicine also recommends that with radiculitis wear a belt of canine or camel wool. The principle of action is the same - in the warmed up area of the skin, blood circulation intensifies, and the medicines act better.