CULSIS - or nerve root attack, lumbago

All it takes is a sudden inclination or a sudden movement when bending over to no longer be able to straighten up. Most often it happens when you least expect it and you can't prepare for it. The worst thing is when the "radiculitis" rushes us to bed and does not want to let go, and the pain in the spine even paralyzes us from the lumbar region, sometimes all the way to the foot.

What we can then do to help ourselves and what sciatica actually is, explains our specialist Fabian Burakowski, M.D.

- Sciatica is a very troublesome set of pain symptoms, which includes acute pain in the lumbar spine with radiation to the buttock, running through the thigh and calf up to the foot, decreased muscle strength and superficial sensation on the thigh or foot. Symptoms can last from a few days to several weeks. The pain makes daily functioning very difficult especially in the acute phase.

The sciatic nerve is the largest nerve in our body. It has its origin in the nerve roots located in the lumbar spine. This is one of the most common places where compression/remodeling by other structures, such as a damaged intervertebral disc or degenerative changes, can occur. It continues to run between the muscles of the gluteal group and the ischiofemoral group (back of the thigh) and at the level of the popliteal fossa divides into 2 smaller nerves: the tibial and fibular. Throughout its length there are characteristic places where there is a risk of its compression, such as the area of the piriformis muscle. In this nerve, we can classify individual fibers: sensory, motor, autonomic.

Sciatica - symptoms

Paralyzing pain with radiculitis, radiating from the buttock to the lower limb with every movement. This is the hallmark of this affliction, but not the only one. The patient may also feel:

• Difficulties with movement, with changing positions,
• Difficult to maintain an upright position,
• Numbness and a burning sensation along the course of the nerve,
• Tingling, numbness in the fingers and toes,
• Weakening of superficial sensation in the lower limb,
• Decreased muscle strength in the affected leg.

The initial acute phase begins with severe, wrenching and stabbing pain in the back, radiating from the lumbar region to the buttock. Most often it runs, through the thigh and calf, to the foot.

Acute phase, or initial phase? How many phases can we expect?

- The affliction is divided into two phases:

• acute - rest and pharmacotherapy are recommended,
• Chronic, in which physiotherapy will be helpful.

Acute phase - usually lasts several days, is characterized by severe pain. It becomes a problem to change position in bed, it is often impossible to adopt a verticalized posture (patients then say that they go to the toilet on all fours). This is a phase in which one is generally not without pharmacotherapy (painkillers, anti-inflammatory drugs) to relieve pain. Of course, such a condition must be consulted with a family doctor or neurologist to rule out conditions other than spinal problems. A physiotherapist can also be the first contact person, who will suggest what positions can be adopted and, if necessary, inform you of the need to go to a medical appointment. The doctor will prescribe drug treatment, order an imaging study or issue a release. 

Chronic phase - occurs gradually after the acute phase. This phase can last 2 weeks and sometimes several months. The patient can move, but usually in certain positions or after sitting/walking for a long time, he feels discomfort/pain radiating to the leg. Sometimes there is a persistent reduction in superficial sensation, or even a slight weakness in muscle strength. This is the time when you need to visit a physiotherapist to plan therapy that can help you avoid a recurrence of the discomfort and speed up your return to full fitness.

Home remedies for roots

- I would rather avoid strong heating, as it can aggravate inflammation. Gentle heat, on the other hand, can be useful; it can relieve the muscle tension that builds up during such acute pain episodes.

To reduce pain, we can take pain-relieving positions, such as: the embryonic position or lying on the back with the legs placed on a chair (limbs bent at 90 degrees at the hip and knee joints) - the so-called chair position.

As much as possible, movement is advisable. Even simple exercises like lifting the hips up in a lying position, translating the knees from left to right, walking if possible. Immobility in bed plays to our disadvantage. 

When is it absolutely necessary to see a neurologist / neurosurgeon?

- It is imperative that we visit the doctor when we observe in ourselves:

• Significantly reduced strength in the lower limb, e.g. foot drop, inability to climb on the toes while standing on one foot,

• lower limb paresis,
• disturbances in urination, bowel movements (may indicate significant pressure on nerve structures),
• severe pain.

What are the causes of root problems?

There are many causes of root problems, below I will list the most important ones:

• Pressure on the nerve roots, usually at the L5-S1 or L4-L5 level,
• blockage of the inter-articular or sacroiliac joint - these are symptoms that mimic pain complaints of nerve origin - similar symptoms to pressure on a nerve structure,
• Overloading of the spine (physical labor, pregnancy, overweight),
• Sedentary work - contracted muscles, dehydrated intervertebral discs (prone to damage) prolonged nerve compression,
• Intervertebral disc degeneration,
• Spinal canal stenosis, or narrowing of the spinal canal,
• chiropractic,
• tumors in the spinal area,
• obesity.

How to treat sciatica?

- In the acute phase, rest and pharmacotherapy are recommended to reduce severe pain. A good option is to visit a physiotherapist who, after a history and examination, will plan an individual therapeutic process for the patient. Most often it consists of: manual therapy (mobilization), appropriate exercises and supportively physical therapy treatments (such as high-energy laser, currents and others.).

Sciatica is an ailment that is extremely annoying for the patient, which often gets us when we least expect it. It is worthwhile for us to know how to help ourselves before we go to the doctor or physiotherapist.