What to check for sciatica

Written by Na Hong Wei
Orthopedics
Updated on September 06, 2024
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Sciatica is divided into primary sciatica and secondary sciatica. Secondary sciatica is very common and is mainly due to diseases of the spinal canal, including herniated lumbar discs, lumbar spinal stenosis, or spinal tumors compressing the spinal cord and nerve roots. Another condition is piriformis syndrome, where the sciatic nerve exits; if there is narrowing here, it can also cause sciatica. Therefore, clinically, one starts with secondary sciatica, conducting either a lumbar spine CT scan or an MRI, which can basically clarify the location causing the compression. Another type is called primary sciatica, which is caused by inflammation of the sciatic nerve, and is an internal medicine disease, not an orthopedic disease. This requires an electromyography (EMG). After completing the EMG, the diagnosis can generally be made based on the injured muscle or the muscle with abnormal electromotor conduction. Thus, the routine examinations for sciatica are X-rays, CT, MRI, and the non-routine examination is the EMG.

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Can sciatica patients walk?

Sciatica can be managed with activities like walking, brisk walking, or jogging. It is best to walk or even walk backwards. It is important to avoid sitting for long periods, bending over, or carrying heavy objects. When the spine is bent, it can increase the pressure on the intervertebral discs, potentially worsening the nucleus pulposus, rupturing the annulus fibrosus, and causing a series of symptoms related to nerve root compression. This compression can cause local swelling, which can press on the nerves to varying degrees. It is recommended to strictly rest on a hard bed, and generally, with about ten days to two weeks of warming up the lower back, recovery is usually achievable. Gradual relief and disappearance of symptoms can occur, and it is advisable to avoid sitting for long periods, bending, or carrying heavy loads. Moderate walking is suitable.

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Written by Na Hong Wei
Orthopedics
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What Chinese medicine is taken for sciatica?

Sciatica is categorized under "Bi Syndrome" in traditional Chinese medicine. There are several Chinese herbal formulas to consider for treatment. The first is Xuan Bi Tong Bi Tang, which has an overall effectiveness rate of about 96%. The second herbal formula is Wu Tou Xi Xin Tong Bi Tang, which also has good therapeutic effects and is statistically shown to be superior to non-steroidal measures. The third medication is Du Huo Ji Sheng Tang, which also has a high effectiveness rate and significant results, but lacks large-scale clinical data. Additionally, in terms of diet, it is advisable to consume dishes such as Sichuan Duan stewed pig tail and other traditional Chinese medicinal foods that include old mulberry branches like Sang Ji Sheng.

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Written by Xie Yi Song
Orthopedics
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What are the symptoms of sciatica?

Sciatica refers to the pain caused by the sciatic nerve due to various reasons, such as compression from spinal diseases or simply sciatica itself, and it is inherently a symptom. What are the characteristics of this symptom? Sciatica can occur on one side or both sides simultaneously. When it occurs, the pain is usually continuous and can have episodic exacerbations. The pain is often dull, stabbing, burning, or like a knife-cutting sensation. It radiates from the buttocks along the back of the thigh and the outer back of the lower leg toward the foot. Clinically, sciatica is divided into secondary and primary types. Secondary pain is due to compression of the sciatic nerve root, commonly seen in conditions like lumbar disc herniation and other spinal disorders. It often accompanies percussion pain in the lumbar spine, and the pain may worsen with coughing, sneezing, or bending, and severe cases may experience numbness in the skin of the lower limbs. Primary sciatica refers to simple inflammation of the sciatic nerve. This type generally presents pain in the buttocks and back of the thigh and usually does not involve percussion pain in the lumbar spine.

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Written by Na Hong Wei
Orthopedics
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How to treat sciatica?

For sciatica, conservative treatment methods should first be adopted, which include the following five points: The first is general treatment; as soon as sciatica appears, immediately rest in bed, and the bed should be relatively hard. Second, you can apply heat to the lumbar area, use physical therapy, or acupuncture. Third, lumbar traction can be performed, which has a very clear effect in alleviating sciatica. Fourth, consider performing an intradiscal injection or sacral injection therapy, and chemical nucleolysis can also be performed. After the above treatments, if the symptoms and pain are reduced, you can start functional exercises for the lower back muscles. Functional exercises of the lower back muscles play a significant role in enhancing the stability of the lumbar spine. If the effect of the aforementioned treatments is not significant, or if the symptoms worsen, then surgical treatment may be necessary at this time.

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Written by Na Hong Wei
Orthopedics
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Which department should I register for sciatica?

Sciatica is divided into primary and secondary types. Primary sciatica is caused by inflammation of the sciatic nerve itself, thus one should visit the Department of Neurology. Secondary sciatica is more common and usually stems from spinal conditions, so initially one should visit the Department of Spinal Surgery. Alternatively, one can visit the Department of Orthopedics, which deals with broader orthopedic issues. If experiencing severe acute pain, a visit to the Pain Management Department can provide rapid and effective pain relief. For frequent episodes of sciatica and interest in rehabilitation, the Rehabilitation Department can be considered. Additionally, traditional Chinese medicine has unique approaches to treating sciatica, so visiting the Department of Traditional Chinese Medicine to try treatments with Chinese herbs and methods is also an option.