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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Pre-symptoms of sciatica

For the early symptoms of sciatica, it is usually manifested as obvious pain in the area where the sciatic nerve enters and distributes. The main symptom is radiating pain, especially under circumstances such as catching a cold, strenuous exercise, fatigue, or suffering from trauma, where the pain will be more pronounced. There are many causes of sciatica in clinical practice. Common causes include issues with the lumbar spine, such as disc herniation, lumbar spondylolisthesis, and spinal stenosis, which can compress the spinal nerves and result in symptoms of sciatic nerve pain.

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Where to perform moxibustion for sciatica

Typical sciatica, in addition to soreness and numbness in the buttocks, is accompanied by sensory abnormalities in the back of the thigh, the back of the calf, the lateral muscles, and the foot. Thus, the location for moxibustion treatment spans from the buttocks to the thigh and calf, targeting corresponding traditional Chinese medicine acupoints progressively. This can alleviate, to some extent, the sensory abnormalities in the buttocks and lower limbs caused by sciatica. It is recommended to concurrently take oral medications that nourish the nerves to collectively reduce symptoms and shorten the duration of the illness. If there is no significant relief after two to four weeks of treatment, it is advised to revisit the hospital for further examination and treatment. Hospitalization for systematic treatment may be necessary.

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How to treat sciatica

Sciatica typically has two treatment methods. One is non-surgical treatment, which is currently the first and most commonly used approach. The first step is general treatment, meaning that once symptoms of sciatica occur, one should rest on a hard board bed. Second, one can combine this with some heat applications to the lumbar area, physical therapy, and acupuncture; all of these are options. The third is traction therapy, which is very effective for discogenic sciatica, as it can reduce the pressure on the intervertebral disc, thereby increasing the volume of the spinal canal and enlarging the area of the intervertebral foramen, thus reducing stimulation to the nerve. Fourth, one can consider undergoing sacral canal injections, or using papain or collagenase for chemical dissolution of the nucleus pulposus, which usually can also achieve a good effect. The fifth point is that when symptoms are reduced, one should start exercising the lumbar and back muscles to increase their strength and enhance the stability of the lumbar spine, thereby ensuring the stability of the intervertebral disc. It should be mentioned that massage and manipulation are quite effective for herniation of the disc nucleus pulposus, but if there is already obvious osteophyte formation, narrowing of the intervertebral space, or disorder of the facet joints, or even lumbar spinal stenosis, then massage and manipulation are not recommended. If the aforementioned treatments prove ineffective, the condition does not relieve or even worsens, or if there is central herniation of the lumbar disc, or if the patient shows significant cauda equina nerve stimulation symptoms, then surgical treatment is required.

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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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Where to go for sciatica treatment

The sciatic nerve is the largest nerve in the human lower limb. If symptoms of sciatic nerve pain occur, it is first necessary to determine the cause of this pain. Sometimes, the pain is caused by degeneration of the intervertebral disc, leading to a ruptured nucleus pulposus protruding from the annulus fibrosus, which compresses the nerve root canal, causing this nerve pain. In such cases, it is recommended to visit an orthopedic or spinal surgery department. If there is no degeneration of the lumbar intervertebral discs or the condition of spinal stenosis, and only this pain occurs, it is advisable to visit a pain management department.