Nghe An Rehabilitation Hospital: Sciatica rehabilitation

(Baonghean) - It is known that the leading causes of sciatic nerve root compression are herniated disc, spondylolisthesis, lumbar spine degeneration (CSTL), lumbar spinal stenosis. These groups of degenerative causes can be combined. Less common causes: Inflammation in the CSTL area, tuberculosis lesions, spinal trauma, tumors, simple viral neuritis... Defining sciatica is not difficult, the important thing is to diagnose the cause.

Doctor Thai Thi Xuan - Director of Nghe An Rehabilitation Hospital said: To accurately diagnose the disease, the treating doctor needs to ask the patient specifically, such as if the patient has a history of trauma or other internal diseases in the past or present; or based on the characteristics of the pain such as the circumstances of the appearance and progression of the pain (slow or sudden pain), pain location, direction of spread, nature of pain (severe pain, electric shock-like pain or sharp pain, dull pain...), factors affecting the level of pain (bending, leaning, coughing, sneezing or pain relief when resting, postures that reduce pain symptoms), other associated symptoms (systemic symptoms, fatigue, weight loss, numbness, or loss of sensation, sphincter disorders, motor paralysis...).

What were the results of previous treatment; the impact of pain on the patient's emotional and psychological state and daily activities? The doctor will then conduct a clinical examination and paraclinical tests such as normal hematological and biochemical tests that only change in systemic diseases or inflammation and malignancy. There are no changes in diseases such as disc herniation, spondylolisthesis, spinal degeneration, lumbar spinal stenosis, etc., mainly excluding bone causes.

Disc pathology suggests disc stenosis, in the straight film the disc is narrowed towards the healthy side and in the oblique film the disc is open towards the back. MRI of the lumbar spine is most valuable in diagnosing the exact cause of the disease, the type of lesion, the location and size of the herniated mass... especially detecting other rare causes such as tumors, inflammation... Electromyography: detects and evaluates damage to nerve roots.

Check patient's reflexes in sciatica treatment.

Based on clinical and paraclinical tests, doctors can differentiate between cases of nerve pain in the lower limbs:

Femoral nerve:Pain in the anterior thigh and decreased or absent knee tendon reflex. Cutaneous femoral nerve: Pain in the upper third of the outer thigh.

Obturator nerve:Pain in the inner thigh. Tests causing tension of the sciatic nerve roots or nerves are negative. Can be differentiated more accurately by electromyography to measure nerve conduction velocity. Sacroiliitis. Pelvic floor myositis with infectious syndrome, pain down the back of the inner thigh, the affected leg is always flexed and tends to rotate inward, pain is caused by extending the leg. Abdominal X-ray without preparation shows a blurred image of the pelvic floor muscle on the painful side, pelvic floor muscle ultrasound clearly identifies the injury.

Diagnosis of the cause:Divided into 3 groups: Sciatica due to spinal diseases affecting the nerve roots (Radiculopathy). Degenerative disc disease. Herniated disc: is the most common cause of sciatica due to root damage. Spondylolisthesis, the cause can be a congenital disease causing bone defects, open waist of the lumbar vertebrae, or trauma (acute and chronic) causing spondylolisthesis deformity. Often L4 or L5 spondylolisthesis, clinical manifestations of spinal instability or compression of the L5 nerve root. Patients have dull sciatica pain, pain increases when bearing weight, changes in posture and gait, and the spine is deformed too much (concave). Diagnosis is confirmed by X-rays in 3/4 oblique and tilted positions, CT scan or MRI.

Injury:Direct trauma to the sciatic nerve, lumbar spine fracture, pelvic fracture. Or due to direct injection into the sciatic nerve, due to injection of oil-based drugs in the buttocks spreading to the sciatic nerve, after buttock abscess surgery... These cases require detailed medical history information combined with on-site examination for definitive diagnosis.

There is a common cause that is often overlooked when diagnosing: Piriformis syndrome: compression (irritation) of the sciatic nerve due to spasm of the piriformis muscle. This is a muscle located deep inside close to the pelvis, which supports the flexion and external rotation of the hip joint. The nerve runs close to the bottom of this muscle group, so when this muscle contracts, it will cause nerve irritation. This syndrome is common in athletes or people who run and jump a lot.

Causes of primary tumors:Meningiomas, vertebral tumors, nerve tumors. Metastatic tumors: Metastases from epithelial cancers (prostate, breast, lung, kidney, gastrointestinal tract), multiple myeloma, lymphoma (Hodgkin and non-Hodgkin). Patients with other systemic symptoms, combined with other imaging and functional tests.

Causes of infection:

Inflammation of the disc and vertebrae caused by bacteria: often occurs after skin, urinary, lung infections and after intravenous injections without good sterilization. Tuberculosis of the spine: Usually secondary to pulmonary tuberculosis. Epidural abscess, meningitis... In this group of causes, patients will have other systemic symptoms, infection syndromes... Detected by specialized tests and imaging.

Rehabilitation and treatment:

Principles of rehabilitation and treatment:The most important thing is to accurately diagnose the cause of sciatica. Treatment according to the cause of the disease combines physical therapy and rehabilitation to reduce pain and restore motor function. Prevention of secondary injuries and complications. Surgical interventions: only when really necessary and conservative methods are ineffective.

Physical therapy and rehabilitation methods:Absolute rest in severe cases, should lie on a hard bed, avoid lying on a hammock or sitting on a swing chair. Avoid vigorous movements such as sudden turns, running, jumping, bending over... Thermotherapy has the effect of reducing pain, preventing muscle spasms, dilating blood vessels, and enhancing nutritional metabolism such as: Infrared, shortwave, ultrasound treatment; Farafine bundle, microcurrent pain relief, drug bundle, Electromagnetic field; Electrolysis of drugs... Note: Do not use in cases of acute infection.

Electrotherapy methods:Pulsed electricity, electrolysis, TENS current, and interference current have the effect of stimulating the nerve and muscle, reducing pain, and enhancing metabolism. Massage techniques, moving soft tissue in the lumbar region and affected legs. Through reflex and mechanical mechanisms, have the effect of increasing circulation, nutrient metabolism and excretion, regulating the pathological process, relaxing deep muscles and joints, and reducing pain.

Spinal traction:Can be performed manually in the acute phase or by traction machine in the subacute and chronic phase, applied 1-2 times/day, 15-20 minutes each time. Indicated in cases of spinal degeneration, disc herniation, has the effect of reducing intra-articular pressure while stretching the ligament system around the joint, especially the posterior longitudinal ligament, reducing pressure on nerve roots or discs.

Medication:Depending on the cause, it is necessary to combine antibiotics, immunosuppressants, etc. Treatment of sciatica often combines three groups of non-steroidal anti-inflammatory drugs, pain relievers, and muscle relaxants.

Nonsteroidal anti-inflammatory drugs:Use by injection for acute and severe pain, orally for mild pain or subacute stage. Diclofenac (Voltarene) 50 mg; 2 tablets per day, divided into 2 times (with food). Piroxycam (Feldene), Ticotil 20 mg: 1 tablet per day. Meloxicam (Mobic) 7.5 mg: 1 - 2 tablets per day. Celecoxib (celebrex) 200 mg: 1 tablet per day. First-line pain reliever: Paracetamol 500 mg: 4 - 6 tablets per day, divided into 2 - 3 times.

If the pain is severe, second-line pain relievers can be used:Efferalgan Codein, Ultracet: 2 - 4 tablets/day, divided into 2 - 4 times.

Muscle relaxants:Tolperisone (Mydocalm) 150mg or Eperisone (Myonal) 50mg: 2 - 3 tablets/day, divided into 2 - 3 times. In some cases of chronic sciatica, in addition to the nociceptive pain mechanism, there is also a neuropathic pain mechanism. It is possible to combine the use of neuropathic pain relievers Gabapenthin (Neurontin) 300 - 2700mg/day or Pregabalin (Lyrica) 75 - 600mg/day. Vitamin B group: Neurobion: 2 tablets/day, Methylcobal 0.5mg: 3 tablets/day.

Other treatments:Cognitive-behavioral intervention: helps patients cope with and better control their chronic pain. Psychotherapy: when patients have anxiety disorders, stress, depression caused by chronic pain. Local procedural intervention: lumbar paraspinal block, nerve root block in the graft area, epidural injection, sacral cavity block. Surgical intervention: indicated when conservative treatment is ineffective or to treat the cause of the disease such as trauma, spinal orthopedics, spinal tumors, severe disc herniation, etc.

Acupuncture:(Electroacupuncture combined with Laser acupuncture and warm acupuncture) acupoints: Jiaji L3 - L5 - S1; Baliao; Shendu; Large intestine; Avulsion; Huanqiu; Chengfu; Enmen; Liangqiu; Yanglingquan; Xuanzhong; Zusanli; Fenglong; Chengshan; Taixi; Weizhong.

Sciatica can become chronic, requiring a monthly or 3-monthly follow-up and re-examination plan to promptly detect deformities or worsening symptoms as well as change appropriate treatment methods.

PV