Sciatica is a pain felt when the sciatic nerve is compressed. Indeed, it is a pain in the lower back often unbearable and which radiates in the buttocks, the thigh, the front leg and sometimes until the big toe.

Synonym: Lumbosciatica

Symptoms

  • Lower back pain
  • Pain in the back or leg that is worse when sitting
  • Hip pain
  • Burning or tingling in the leg
  • Weakness, numbness, or difficulty moving the leg or foot
  • Constant pain on one side of the back
  • A throbbing pain that makes it hard to get up

Conditions that predispose

  • Lumbar disc herniation
  • Lumbar stenosis
  • Lumbar degenerative disc disease, general degenerative changes in vertebrae or discs
  • Spondylolisthesis
  • Muscle spasm and / or inflammation of the lumbar and / or pelvic muscles
  • Sacroiliac joint dysfunction

Differential diagnosis

Vertebral causes

  • Proximal to the disc: cone and cauda equina lesions (e.g., neurofibroma, ependymoma)
    • Disc level
    • Nucleus pulposis herniation
    • Stenosis
    • Infection: osteomyelitis or discitis (with pressure on the nerve roots)
    • Inflammation: arachnoiditis
    • Tumor: benign or malignant, with pressure on the nerve roots

Non-vertebral causes

  • Pelvis
    • Cardiovascular conditions (e.g., peripheral vascular disease)
    • Gynaecological conditions
    • Orthopedic conditions (e.g., osteoarthritis of the hip)
    • Sacroiliac joint disease
    • Tumors (invading or compressing the lumbosacral plexus)
  • Peripheral nerve damage
    • Neuropathy (diabetic, tumor, alcohol)
    • Local affections of the sciatic nerve (trauma, tumor)
  • Inflammation (herpes zoster)

Risk factors

  • Age
    • The spine changes with age
      • Herniated discs
      • Osteophytes
  • Obesity
    • By increasing stress on the spine, excess body weight can contribute to changes in the spine that trigger sciatica.
  • Job.
    • A floor with a hard surface
    • Sitting for a long time in an inadequate chair
    • A job requiring to do jumps

The sciatic nerve is the longest nerve in the human body and is approximately the size of the thumb. The most common cause of sciatica is a herniated disc. Sciatica is not a condition; it is a symptom.

Prevention

  • Regular exercise.
    • Good tone of abdominal muscles
    • Stretching the lower back muscles
    • Maintain good posture while seated.
      • Choose a seat with good lower back support
      • With armrests and a swivel base.
      • Keep your knees and hips level.
      • Get up regularly
  • A healthy weight
  • If possible take a nap during the day

Screening tests

Sign of Lasègue

Manoeuver

  • Patient in supine position
  • Thigh bent at 90° and knee bent at 90
  • Progressive extension of the knee while keeping the hip flexed
  • Thigh pain radiating down the leg = +v

Extended leg raise

To perform the test, the patient lies supine on the bench. Standing on the affected side, you will grasp the patient’s leg to ensure full knee extension during the test. Then slowly lift the leg to induce hip flexion while maintaining full knee extension and carefully observe the patient’s response.

Interpretation: If the patient experiences sciatic pain, specifically pain radiating down the leg (radiculopathy), when the outstretched leg is at an angle between 30 and 70 degrees, then the test is positive and a herniated disc is a possible cause of the pain. A negative test suggests a possibly different cause for the back pain.

Rollover test

Flip Test Extending the leg in a sitting position causes the back to extend or roll back because of the strain on the sciatic nerve.

Stretching

Pigeon pose

Start on all fours. Slide the left knee forward and bring the left shin diagonally under the bust, the left foot in front of the right knee, the outside of the left shin resting on the floor.

Hands to toes

Références

  1. Lagerbäck T, Fritzell P, Hägg O, Nordvall D, Lønne G, Solberg TK, Andersen MØ, Eiskjær S, Gehrchen M, Jacobs WC, van Hooff ML, Gerdhem P. Effectiveness of surgery for sciatica with disc herniation is not substantially affected by differences in surgical incidences among three countries: results from the Danish, Swedish and Norwegian spine registries. Eur Spine J. 2019 Nov;28(11):2562-2571. [PubMed]
  2. Alrwaily M, Almutiri M, Schneider M. Assessment of variability in traction interventions for patients with low back pain: a systematic review. Chiropr Man Therap. 2018;26:35. [PMC free article] [PubMed]
  3. Hong X, Shi R, Wang YT, Liu L, Bao JP, Wu XT. Lumbar disc herniation treated by microendoscopic discectomy : Prognostic predictors of long-term postoperative outcome. Orthopade. 2018 Dec;47(12):993-1002. [PubMed]
  4. Flug JA, Burge A, Melisaratos D, Miller TT, Carrino JA. Post-operative extra-spinal etiologies of sciatic nerve impingement. Skeletal Radiol. 2018 Jul;47(7):913-921. [PubMed]
  5. Hicks BL, Lam JC, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2022. Piriformis Syndrome. [PubMed]
  6. Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]. Neurocirugia (Astur). 2017 May – Jun;28(3):124-134. [PubMed]

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