diseases

SCIATICA


Introduction
Sciatica refers to pain in the distribution of the sciatic nerve or its component nerve roots Pain begins in the hip and buttocks and continues all the way down the leg. This condition is often accompanied by low back pain, which can be more or less severe than the leg pain.


The sciatic nerve pain can also occur due to pressure on the buttocks or the upper part of the thighs. One of the causes of the sciatic pain can be due to lumbar disc prolapse.

Causes:
1) True sciatic neuritis: Neuritis means inflammation of the nerve which can be caused due to diseases like Leprosy, Polyarthritis nodosa, or due to nerve injury. Nerve injury can be caused due to injections given in a wrong manner or due to trauma. The pain can also be caused after the patient suffers from herpes infection this is also known as post herpetic neuralgia.
2) Mechanical pressure on the nerves or Roots or referred pain
a) In the spinal cord: if there is irritation of the meninges of the brain or pressure caused on the spinal cord due to tumors of cauda equina, archaoiditis.
b) In the cord space: if there is prolapse of the intervertebral disc or an extramedullary tumor, which can cause compression of the nerve roots and cause pain.
c) In the vertebral column: diseases like Arthritis, Tuberculosis, Spondylolisthesis, Ankylosing spondylitis, primary bone tumor, Cancer can cause mechanical pressure on the nerve roots and pain.
d) In the back: due to inflammation of the ligaments (Fibrositis of the sacral ligaments). The pain can be caused by the compression of the nerve in people who lie immobile on a hard surface for a longtime (A form of Saturday night palsy).
e) In the thighs and buttocks: pressure caused on the nerve roots due to Fibrositis, Sacro-sciatic band, diseases of the hip joint or Sacro-iliac joints, Neurofibroma, or due to hemorrhage within or adjacent nerve sheaths. Pain can be caused during the anticoagulant therapy and also due to misplaced therapeutic injection.
f) In the pelvis: due to Sacro-iliac arthritis or Strain, Hip diseases, infection of the prostrate gland or female genital tract, rectal impaction, or due to tumors of the lumbo-sacral plexus

Investigations done in a case of Sciatica:
History: note should be made of any trauma, exposure to cold damp weather or cold weather. Enquiry should also be made if the person has problems with control of bladder and rectum. The patient should be asked if he has suffered from any previous attacks.
The type of pain and radiation is also very important to come to a correct diagnosis or clinical understanding of the disease. If the pain is due to involvement of the nerve roots there will be radiation of pain.

If the sensory pathways of the nerves are involved there will be a loss of sensation in the affected part (Paraesthesiae).

If the pain is aggravated by coughing it indicates involvement of root lesion and also acute extra spinal disease of the spine, Pelvis, Sacro-iliac joints.

Physical examination:
a) Lumbar spine: note should be made of the shape of the spine, the mobility of the spine. Also note should be made if there is any muscle spasm or tilt of the spine to one side, which can be caused to sciatic scoliosis.
b) A physical examination should be made and note should be made of tenderness in the back and trigger point in the back and the limbs. Sciatica can be the first symptoms of Spinal caries.
c) Special signs: a) SLR test [Straight leg raising test] if there is restriction in raising the leg straight while lying down in supine position then it is mostly due to involvement of the nerve roots rather then due to skeletal affections. SLR test gives a very useful indication of the severity sciatica and it can be also useful in assessing the recovery of the patient from sciatica.
d) Tenderness of nerves
e) If there is intensification of pain in the back and leg during rotatory extension of the lumbar spine it suggests a ruptured intervertebral disc.
f) Popliteal compression: the radiating pain can be aggravated by putting pressure over the course of the tibial nerve that passes through the popliteal fossa (Behind the knee). This finding is in the favor of root compression.
g) Testing of the Sacro iliac joints
h) To check the range of painlessness and otherwise by making passive movements of the hip joint.
i) To check the muscle power in the lower limbs against resistance.
j) Checking the reflexes
k) To check the tone and size of the muscles in the gluteal region
l) Sensations: if there is impairment of perception of pinprick commonly found on the dorsum of foot is an implication of 5th lumbar and 1st sacral nerve root involvement.
m) Presence of tender nodules: due to inflammation of muscles and fascial structures there can be presence of tender nodules along the Para spinal muscles and the iliac crest.

Imaging of the spine:
Straight x-rays for detection of disc narrowing in the lumbar spine, or lesions of the Sacro -iliac or hip joint.
Magnetic resonance imaging (M.R.I)

Cerebro-spinal fluid examination may show increase proteins with normal cell count in a large protruded intervertebral disc.

EMG -may be used to confirm presence of denervation in the affected muscles.

Homeopathic treatment:
The first question that comes to the mind is how these Homeopathic medicines are going to help in fighting the disease. As we all know in a diseased state the internal bodily mechanisms do not work in a harmonious way. So to bring back the lost harmony to its original balanced state the correct Homeopathic medicine has to be given.

The homeopathic medicine acts at 3 levels the Psyche, Neuro, Endocrines at the level of the psyche it helps to bring balance which in turn will affect the neurological balance and the correct secretion of the hormones which play an important role in maintaining the harmonious flow. The homeopathic medicines do not treat the disease but it helps in bringing back the lost imbalance back to its normal state.

To find the correct Homeopathic remedy one needs a complete case study so all the aspects of the emotional nature, Fears, Social relations, family relations, ups and downs in life have to be taken into consideration. Also the past history, problems in adjusting, Family history of any major illnesses have to be mentioned.

If we consider a remedy say Calcarea flur in this remedy we find the symptoms of erosion of joints, cracking of the joints, destruction is as if the theme of the remedy.

At the mental level the patient is very aggressive, angry and destructive. So this remedy has the capacity to act in diseases, which have progressed, to the level of destruction and when it is given in the indicated case it will relieve the patient at the physical as well as at the mental level.

So we have to understand that the homeopathic remedies act at a very deep level and if the line of treatment is managed properly we can get amazing results.

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